WorldWideScience

Sample records for auscultation

  1. The paediatrician and cardiac auscultation

    OpenAIRE

    Roy, Douglas L

    2003-01-01

    The cardiac auscultation (CA) skills of paediatric residents and office-based paediatricians have recently been shown to be suboptimal. CA is known to have a high degree of specificity and sensitivity, and is inexpensive. New teaching aids and availability of surrogate patient heart sounds and murmurs now allow most physicians to acquire CA skills. These teaching aids should be available in all medical schools and in all postgraduate paediatric training programs. While the relationship betwee...

  2. Heart murmurs auscultation as professional learning problems.

    Science.gov (United States)

    Naumov, Leonid B

    2009-06-01

    To compare the effectiveness of traditional and innovative methods of training for heart auscultation in medical students, physicians, and medical teachers, to find out the major reasons of the deficient auscultative skills, and to determine a place and significance of alternative methods of auscultation training. By principle of other equal conditions, the comparison of traditional and algorithmic diagnostics by the same auscultative signs in textual tasks, magnetic sound records and heart auscultation of patients. The independent diagnostics has been reflected the results of usual medical education. The same data have been used by the same examinees for diagnostics by original innovative diagnostic algorithm of heart auscultation, and programmed training. Murmurs diagnostics on magnetic recording was erroneous frequently. For reliable diagnostics of acoustic phenomena is needed the constant feedback, and much more time, than is scheduled in standard curriculum. Conventional training for heart auscultation is ineffective. Auscultation skills acquired by medical students do not grow up during their program of study. Even graduated cardiologists and instructors clinicians themselves make frequent errors in diagnostics of heart murmurs. The proposed diagnostic algorithm decreases the number of errors many times. The programmed teaching with constant feedback is the optimal method for flawless recognition of acoustic signs.

  3. The paediatrician and cardiac auscultation.

    Science.gov (United States)

    Roy, Douglas L

    2003-11-01

    The cardiac auscultation (CA) skills of paediatric residents and office-based paediatricians have recently been shown to be suboptimal. CA is known to have a high degree of specificity and sensitivity, and is inexpensive. New teaching aids and availability of surrogate patient heart sounds and murmurs now allow most physicians to acquire CA skills. These teaching aids should be available in all medical schools and in all postgraduate paediatric training programs. While the relationship between musicality and CA skill has not been proven, the author assumes this relationship to be valid. Specific learning objectives in CA should be established. Recognizing that the current trend is away from clinical examinations, students frequently are unaware that a CA learning deficit exists. Therefore, students' CA skills should be evaluated before medical school graduation and at the Royal College of Physicians and Surgeons specialty examination. Students with amusia (inability to distinguish pitch of sound) should be identified and consideration should be given to directing them away from a clinical specialty in which CA is important. Further study is required in the physiology of learning of CA. Appropriate action by medical school and paediatric postgraduate program directors and the Royal College will effect a higher standard of patient care by increasing CA skills, resulting in a more financially efficient system - something everyone is trying to achieve in these times of increasing medical care costs.

  4. Cardiac Auscultation Using Smartphones: Pilot Study.

    Science.gov (United States)

    Kang, Si-Hyuck; Joe, Byunggill; Yoon, Yeonyee; Cho, Goo-Yeong; Shin, Insik; Suh, Jung-Won

    2018-02-28

    Cardiac auscultation is a cost-effective, noninvasive screening tool that can provide information about cardiovascular hemodynamics and disease. However, with advances in imaging and laboratory tests, the importance of cardiac auscultation is less appreciated in clinical practice. The widespread use of smartphones provides opportunities for nonmedical expert users to perform self-examination before hospital visits. The objective of our study was to assess the feasibility of cardiac auscultation using smartphones with no add-on devices for use at the prehospital stage. We performed a pilot study of patients with normal and pathologic heart sounds. Heart sounds were recorded on the skin of the chest wall using 3 smartphones: the Samsung Galaxy S5 and Galaxy S6, and the LG G3. Recorded heart sounds were processed and classified by a diagnostic algorithm using convolutional neural networks. We assessed diagnostic accuracy, as well as sensitivity, specificity, and predictive values. A total of 46 participants underwent heart sound recording. After audio file processing, 30 of 46 (65%) heart sounds were proven interpretable. Atrial fibrillation and diastolic murmur were significantly associated with failure to acquire interpretable heart sounds. The diagnostic algorithm classified the heart sounds into the correct category with high accuracy: Galaxy S5, 90% (95% CI 73%-98%); Galaxy S6, 87% (95% CI 69%-96%); and LG G3, 90% (95% CI 73%-98%). Sensitivity, specificity, positive predictive value, and negative predictive value were also acceptable for the 3 devices. Cardiac auscultation using smartphones was feasible. Discrimination using convolutional neural networks yielded high diagnostic accuracy. However, using the built-in microphones alone, the acquisition of reproducible and interpretable heart sounds was still a major challenge. ClinicalTrials.gov NCT03273803; https://clinicaltrials.gov/ct2/show/NCT03273803 (Archived by WebCite at http://www.webcitation.org/6x6g1fHIu).

  5. Outcomes of Using Heart Sound Simulator in Teaching Cardiac Auscultation

    Directory of Open Access Journals (Sweden)

    Ralitsa Akins

    2010-03-01

    Conclusions - Based on our findings and the review of literature, we recommend that heart sound simulation is introduced at medical student level as the standard for teaching cardiologic auscultation findings and as preparation for auscultation of live patients.  We also suggest that training with digitally simulated heart sounds is similarly beneficial in resident training.

  6. Hybrid High-Fidelity Auscultation Scope, Phase I

    Data.gov (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...

  7. A Study of New Pulse Auscultation System

    Directory of Open Access Journals (Sweden)

    Ying-Yun Chen

    2015-04-01

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

  8. A study of new pulse auscultation system.

    Science.gov (United States)

    Chen, Ying-Yun; Chang, Rong-Seng

    2015-04-14

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

  9. Source Separation of Heartbeat Sounds for Effective E-Auscultation

    Science.gov (United States)

    Geethu, R. S.; Krishnakumar, M.; Pramod, K. V.; George, Sudhish N.

    2016-03-01

    This paper proposes a cost effective solution for improving the effectiveness of e-auscultation. Auscultation is the most difficult skill for a doctor, since it can be acquired only through experience. The heart sound mixtures are captured by placing the four numbers of sensors at appropriate auscultation area in the body. These sound mixtures are separated to its relevant components by a statistical method independent component analysis. The separated heartbeat sounds can be further processed or can be stored for future reference. This idea can be used for making a low cost, easy to use portable instrument which will be beneficial to people living in remote areas and are unable to take the advantage of advanced diagnosis methods.

  10. Report on Auscultation of the Arenal's Dam P. H. Arenal

    International Nuclear Information System (INIS)

    1994-09-01

    The Costa Rican Electricity Institute (Instituto Costarricense de Electricidad), always has been worried to verify the good state of the works and thus to guarantee its operation. For that reason, it has established different sorts of auscultation to the Arenal's Dam. This report analyzes the geo-hydraulic, structural and topographic auscultation. It also includes information about the new techniques used by the ARCAL XVIII RLA/8/018; application of Tracer Techniques for the study of water leakage in dams and damming projects. (author). 18 charts, 2 maps, 4 tabs

  11. Portable system for auscultation and lung sound analysis.

    Science.gov (United States)

    Nabiev, Rustam; Glazova, Anna; Olyinik, Valery; Makarenkova, Anastasiia; Makarenkov, Anatolii; Rakhimov, Abdulvosid; Felländer-Tsai, Li

    2014-01-01

    A portable system for auscultation and lung sound analysis has been developed, including the original electronic stethoscope coupled with mobile devices and special algorithms for the automated analysis of pulmonary sound signals. It's planned that the developed system will be used for monitoring of health status of patients with various pulmonary diseases.

  12. A French national research project to the creation of an auscultation's school: the ASAP project.

    Science.gov (United States)

    Andrès, Emmanuel; Reichert, Sandra; Gass, Raymond; Brandt, Christian

    2009-05-01

    Auscultation of pulmonary sounds provides valuable clinical information but has been regarded as a tool of low diagnostic value due to the inherent subjectivity in the evaluation of these sounds. This paper describes an ambitious study of in the so-called ASAP project or "Analyse de Sons Auscultatoires et Pathologiques". ASAP is a 3-year-long French collaborative project developed in the context of the News Technologies of Information and Communication. ASAP aims at making evolve the auscultation technics: by 1) the development objective tools for the analyse of auscultation sounds: electronic stethoscopes paired with computing device; 2) the creation of an auscultation sounds' database in order to compare and identify the acoustical and visual signatures of the pathologies; and 3) the capitalisation of these new auscultation techniques around the creation of a teaching unit: "Ecole de l'Auscultation". This auscultation's school will be destined to the initial and continuous formation of the medical attendants.

  13. Digital stethoscope system: the feasibility of cardiac auscultation

    Science.gov (United States)

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

    2013-10-01

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

  14. Cardiopulmonary auscultation: duo for strings--Opus 99.

    Science.gov (United States)

    Woywodt, A; Höfer, M; Pilz, B; Schneider, W; Dietz, R; Luft, F C

    1999-11-08

    In spite of increasing mechanization in medicine and reliance on "high-tech" diagnostic tools, bedside clinical skills of the attending physician can still identify findings that are missed by the more sophisticated devices. Using a stethoscope, we relied on our skills in inspection, palpation, percussion, auscultation, as well as echocardiography and phonocardiography to diagnose a patient whose murmur was very reminiscent of the D-sharp pizzicato in the Cello Sonata in F, Opus 99, by Johannes Brahms. Initial echocardiography was not helpful. We suspected an anomalous chorda and confirmed this with phonocardiography and a second echocardiography. Although advances in cardiac imaging are extremely helpful, the use of simple clinical skills, in addition to being fun, is not obsolete. Cardiopulmonary auscultation should receive more emphasis in the medical school curriculum and clinical training.

  15. A comparative study of electronic stethoscopes for cardiac auscultation.

    Science.gov (United States)

    Pinto, C; Pereira, D; Ferreira-Coimbra, J; Portugues, J; Gama, V; Coimbra, M

    2017-07-01

    There are several electronic stethoscopes available on the market today, with a very high potential for healthcare namely telemedicine, assisted decision and education. However, there are no recent comparatives studies published about the recording quality of auscultation sounds. In this study we aim to: a) define a ranking, according to experts opinion of 6 of the most relevant electronic stethoscopes on the market today; b) verify if there are any relations between a stethoscope's performance and the type of pathology present; c) analyze if some pathologies are more easily identified than others when using electronic auscultation. Our methodology consisted in creating two study groups: the first group included 18 cardiologists and cardiology house officers, acting as the gold standard of this work. The second included 30 medical students. Using a database of heart sounds recorded in real hospital environments, we applied questionnaires to observers from each group. The first group listened to 60 cardiac auscultations recorded by the 6 stethoscopes, and each one was asked to identify the pathological sound present: aortic stenosis, mitral regurgitation or normal. The second group was asked to choose, between two auscultation recordings, using as criteria the best sound quality for the identification of pathological sounds. Results include a total of 1080 evaluations, in which 72% of cases were correctly diagnosed. A detailed breakdown of these results is presented in this paper. As conclusions, results showed that the impact of the differences between stethoscopes is very small, given that we did not find statistically significant differences between all pairs of stethoscopes. Normal sounds showed to be easier to identify than pathological sounds, but we did not find differences between stethoscopes in this identification.

  16. Technology for enhancing chest auscultation in clinical simulation.

    Science.gov (United States)

    Ward, Jeffrey J; Wattier, Bryan A

    2011-06-01

    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.

  17. Automated Auscultative Diagnosis System for Evaluation of Phonocardiogram Signals Associated with Heart Murmur Diseases

    OpenAIRE

    YILDIZ, Oktay; Arslan, Ayşe

    2018-01-01

    Cardiac auscultation that is a still widely used technique to diagnose heart murmurs induced by heart disorders. Taking into account that this method is quite subjective and time consuming, the enhancement of diagnosis techniques would contribute significantly to clinical auscultation. Development of computer-aided auscultative diagnosis systems, which provide more objective and reliable results would be beneficial to reduce the classification errors for the cardiac disorder categories. The p...

  18. Manipulation of Cognitive Load Variables and Impact on Auscultation Test Performance

    Science.gov (United States)

    Chen, Ruth; Grierson, Lawrence; Norman, Geoffrey

    2015-01-01

    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…

  19. Heart sound segmentation of pediatric auscultations using wavelet analysis.

    Science.gov (United States)

    Castro, Ana; Vinhoza, Tiago T V; Mattos, Sandra S; Coimbra, Miguel T

    2013-01-01

    Auscultation is widely applied in clinical activity, nonetheless sound interpretation is dependent on clinician training and experience. Heart sound features such as spatial loudness, relative amplitude, murmurs, and localization of each component may be indicative of pathology. In this study we propose a segmentation algorithm to extract heart sound components (S1 and S2) based on it's time and frequency characteristics. This algorithm takes advantage of the knowledge of the heart cycle times (systolic and diastolic periods) and of the spectral characteristics of each component, through wavelet analysis. Data collected in a clinical environment, and annotated by a clinician was used to assess algorithm's performance. Heart sound components were correctly identified in 99.5% of the annotated events. S1 and S2 detection rates were 90.9% and 93.3% respectively. The median difference between annotated and detected events was of 33.9 ms.

  20. A High Performance Approach to Improving Auscultation Capability in Noisy Environments, Phase I

    Data.gov (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...

  1. 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

    2010-01-01

    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....... All groups showed a tendency to interpret healthy heart sounds as cardiac murmurs. CONCLUSIONS: Diagnostic ability was found to correlate positively with clinical experience, whereas the ability to distinguish cardiac murmurs from normal heart sounds seems independent of clinical experience....

  2. Comparison between users of a new methodology for heart sound auscultation.

    Science.gov (United States)

    Castro, Ana; Gomes, Pedro; Mattos, Sandra S; Coimbra, Miguel T

    2016-08-01

    Auscultation is a routine exam and the first line of screening in heart pathologies. The objective of this study was to assess if using a new data collection system, the DigiScope Collector, with a guided and automatic annotation of heart auscultation, different levels of expertise/experience users could collect similar digital auscultations. Data were collected within the Heart Caravan Initiative (Paraíba, Brasil). Patients were divided into two study groups: Group 1 evaluated by a third year medical student (User 1), and an experienced nurse (User 2); Group 2 evaluated by User 2 and an Information Technology professional (User 3). Patients were auscultated sequentially by the two users, according to the randomization. Features extracted from each data set included the length (HR) of the audio files, the number of repetitions per auscultation area, heart rate, first (S1) and second (S2) heart sound amplitudes, S2/S1, and aortic (A2) and pulmonary (P2) components of the second heart sound and relative amplitudes (P2/A2). Features extracted were compared between users using paired-sample test Wilcoxon test, and Spearman correlations (Panalysis showed significant correlations between extracted features from both groups: S2/S1 in Group 1, and S1, S2, A2, P2, P2/A2 amplitudes, and HR in Group 2. Using the DigiScope Collector, we were able to collect similar digital auscultations, according to the features evaluated. This may indicate that in sites with limited access to specialized clinical care, auscultation files may be acquired and used in telemedicine for an expert evaluation.

  3. Cardiac Auscultation in the Modern Era: Premature Requiem or Phoenix Rising?

    Science.gov (United States)

    Barrett, Michael J; Mackie, Andrew S; Finley, John P

    Competent cardiac auscultation remains a most important skill for the detection of heart disease. Currently it is poorly taught and often ignored or poorly performed, resulting in inaccurate and inefficient patient assessments. This review documents that teaching can be over 90% effective with new, proven teaching methods emphasizing repetition and normal-abnormal comparisons of sounds, using computer-aided and online resources. At present, these concepts are not widely adopted by medical schools. Our current knowledge of teaching heart auscultation is critically reviewed, including traditional bedside, clinic and classroom settings, as well as computer, simulator, and multimedia-based learning. The assessment of auscultation skill in the learning process. The adoption of competence-based learning promises to integrate the assessment of auscultation skill in the learning process. Newer teaching methods, such as auditory training and repetitive listening, offer excellent murmur recognition and diagnosis learning, and hand-held ultrasound is proposed as a helpful adjunct to teaching auscultation. Although ongoing research remains important to develop better teaching methods, the adoption of proven existing concepts has great potential to improve teaching and practice of this valuable skill.

  4. 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

    2012-01-01

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

  5. The reliability and validity of cervical auscultation in the diagnosis of dysphagia : A systematic review

    NARCIS (Netherlands)

    Lagarde, Marloes L J; Kamalski, DMA; Van Den Engel-Hoek, Lenie

    2016-01-01

    Objective: To systematically review the available evidence for the reliability and validity of cervical auscultation in diagnosing the several aspects of dysphagia in adults and children suffering from dysphagia. Data sources: Medline (PubMed), Embase and the Cochrane Library databases. Review

  6. DigiScope--unobtrusive collection and annotating of auscultations in real hospital environments.

    Science.gov (United States)

    Pereira, D; Hedayioglu, F; Correia, R; Silva, T; Dutra, I; Almeida, F; Mattos, S S; Coimbra, M

    2011-01-01

    Digital stethoscopes are medical devices that can collect, store and sometimes transmit acoustic auscultation signals in a digital format. These can then be replayed, sent to a colleague for a second opinion, studied in detail after an auscultation, used for training or, as we envision it, can be used as a cheap powerful tool for screening cardiac pathologies. In this work, we present the design, development and deployment of a prototype for collecting and annotating auscultation signals within real hospital environments. Our main objective is not only pave the way for future unobtrusive systems for cardiac pathology screening, but more immediately we aim to create a repository of annotated auscultation signals for biomedical signal processing and machine learning research. The presented prototype revolves around a digital stethoscope that can stream the collected audio signal to a nearby tablet PC. Interaction with this system is based on two models: a data collection model adequate for the uncontrolled hospital environments of both emergency room and primary care, and a data annotation model for offline metadata input. A specific data model was created for the repository. The prototype has been deployed and is currently being tested in two Hospitals, one in Portugal and one in Brazil.

  7. Report on the auscultation of the Arenal's Dam: P.H. Arenal

    International Nuclear Information System (INIS)

    Cordero Calderon, C.F.

    1996-02-01

    To verify the correct functioning of the works that the Instituto Costarricense de Electricidad constructs, they have established different types of auscultation for the Arenal's. Thus they make investigations to know new methodologies that contributes to the improvement and to the elimination of risks in the different works (author)

  8. Innocent Cardiac Murmur in Puppies : Prevalence, Correlation with Hematocrit, and Auscultation Characteristics

    NARCIS (Netherlands)

    Szatmári, V; van Leeuwen, M W; Teske, E

    2015-01-01

    BACKGROUND: The aims of this study were to establish the prevalence of innocent cardiac murmurs in clinically healthy puppies, to investigate a possible correlation between the presence of an innocent murmur and hematocrit, and to describe the auscultation characteristics of innocent murmurs.

  9. Comparison of the measurement of heart rate in adult free-range chickens (Gallus domesticus) by auscultation and electrocardiography.

    Science.gov (United States)

    Smith, C F; Gavaghan, B J; McSweeney, D; Powell, V; Lisle, A

    2014-12-01

    To compare the heart rates of adult free-range chickens (Gallus domesticus) measured by auscultation with a stethoscope with those measured simultaneously using electrocardiography (ECG). With each bird in a standing position, estimation of the heart rate was performed by placing a mark on paper for every 4 beats for roosters and 8 beats for hens as detected by auscultation over 30 s, while simultaneous ECG was performed. Heart rates measured by auscultation showed a high correlation (r = 0.97) with those measured by ECG. There was a high correlation between the heart rates of adult free-range chickens measured by auscultation with a stethoscope and those measured simultaneously using ECG. © 2014 Australian Veterinary Association.

  10. A hybrid particle swarm optimization-SVM classification for automatic cardiac auscultation

    Directory of Open Access Journals (Sweden)

    Prasertsak Charoen

    2017-04-01

    Full Text Available Cardiac auscultation is a method for a doctor to listen to heart sounds, using a stethoscope, for examining the condition of the heart. Automatic cardiac auscultation with machine learning is a promising technique to classify heart conditions without need of doctors or expertise. In this paper, we develop a classification model based on support vector machine (SVM and particle swarm optimization (PSO for an automatic cardiac auscultation system. The model consists of two parts: heart sound signal processing part and a proposed PSO for weighted SVM (WSVM classifier part. In this method, the PSO takes into account the degree of importance for each feature extracted from wavelet packet (WP decomposition. Then, by using principle component analysis (PCA, the features can be selected. The PSO technique is used to assign diverse weights to different features for the WSVM classifier. Experimental results show that both continuous and binary PSO-WSVM models achieve better classification accuracy on the heart sound samples, by reducing system false negatives (FNs, compared to traditional SVM and genetic algorithm (GA based SVM.

  11. A quality assessment of cardiac auscultation material on YouTube.

    Science.gov (United States)

    Camm, Christian F; Sunderland, Nicholas; Camm, A John

    2013-02-01

    YouTube is a highly utilized Web site that contains a large amount of medical educational material. Although some studies have assessed the education material contained on the Web site, little analysis of cardiology content has been made. This study aimed to assess the quality of videos relating to heart sounds and murmurs contained on YouTube. We hypothesized that the quality of video files purporting to provide education on heart auscultation would be highly variable. Videos were searched for using the terms "heart sounds," "heart murmur," and "heart auscultation." A built-in educational filter was employed, and manual rejection of non-English language and nonrelated videos was undertaken. Remaining videos were analyzed for content, and suitable videos were scored using a purpose-built tool. YouTube search located 3350 videos in total, and of these, 22 were considered suitable for scoring. The average score was 4.07 out of 7 (standard deviation, 1.35). Six videos scored 5.5 or greater and 5 videos scoring 2.5 or less. There was no correlation between video score and YouTube indices of preference (hits, likes, dislikes, or search page). The quality of videos found in this study was highly variable. YouTube indications of preference were of no value in determining the value of video content. Therefore, teaching institutions or professional societies should endeavor to identify and highlight good online teaching resources. YouTube contains many videos relating to cardiac auscultation, but very few are valuable education resources. © 2012 Wiley Periodicals, Inc.

  12. Multimedia Respiratory Database (RespiratoryDatabase@TR: Auscultation Sounds and Chest X-rays

    Directory of Open Access Journals (Sweden)

    Gokhan Altan

    2017-10-01

    Full Text Available Auscultation is a method for diagnosis of especially internal medicine diseases such as cardiac, pulmonary and cardio-pulmonary by listening the internal sounds from the body parts. It is the simplest and the most common physical examination in the assessment processes of the clinical skills. In this study, the lung and heart sounds are recorded synchronously from left and right sides of posterior and anterior chest wall and back using two digital stethoscopes in Antakya State Hospital. The chest X-rays and the pulmonary function test variables and spirometric curves, the St. George respiratory questionnaire (SGRQ-C are collected as multimedia and clinical functional analysis variables of the patients. The 4 channels of heart sounds are focused on aortic, pulmonary, tricuspid and mitral areas. The 12 channels of lung sounds are focused on upper lung, middle lung, lower lung and costophrenic angle areas of posterior and anterior sides of the chest. The recordings are validated and labelled by two pulmonologists evaluating the collected chest x-ray, PFT and auscultation sounds of the subjects. The database consists of 30 healthy subjects and 45 subjects with pulmonary diseases such as asthma, chronic obstructive pulmonary disease, bronchitis. The novelties of the database are the combination ability between auscultation sound results, chest X-ray and PFT; synchronously assessment capability of the lungs sounds; image processing based computerized analysis of the respiratory using chest X-ray and providing opportunity for improving analysis of both lung sounds and heart sounds on pulmonary and cardiac diseases.

  13. Computerized Lung Sound Screening for Pediatric Auscultation in Noisy Field Environments.

    Science.gov (United States)

    Emmanouilidou, Dimitra; McCollum, Eric D; Park, Daniel E; Elhilali, Mounya

    2017-06-19

    Chest auscultations offer a non-invasive and low-cost tool for monitoring lung disease. However, they present many shortcomings including inter-listener variability, subjectivity, and vulnerability to noise and distortions. The current work proposes a computer-aided approach to process lung signals acquired in the field under adverse noisy conditions, by improving the signal quality and offering automated iden- tification of abnormal auscultations indicative of respiratory pathologies. The developed noise-suppression scheme eliminates ambient sounds, heart sounds, sensor artifacts and crying contamination. The improved high-quality signal is then mapped onto a rich spectro-temporal feature space before being classified using a trained support-vector machine clas- sifier. Individual signal frame decisions are then combined using an evaluation scheme, providing an overall patient-level decision for unseen patient records. All methods are evaluated on a large data set with > 1,000 children enrolled, 1-59 months old. The noise suppression scheme is shown to significantly improve signal quality; and the classification system achieves an accuracy of 86.7% in distinguishing normal from pathological sounds, far surpassing other state-of-the art methods. Computerized lung sound processing can benefit from the enforcement of advanced noise-suppression. A fairly short processing window size (< 1 s) combined with detailed spectro-temporal features is recommended, in order to capture transient adventitious events without highlighting sharp noise occurrences. Unlike existing methodologies in the literature, the proposed work is not limited in scope or confined to laboratory-settings: this work validates a practical method for fully automated chest sound processing applicable to realistic and noisy auscultation settings.

  14. Dysphagia Screening: Contributions of Cervical Auscultation Signals and Modern Signal-Processing Techniques.

    Science.gov (United States)

    Dudik, Joshua M; Coyle, James L; Sejdić, Ervin

    2015-08-01

    Cervical auscultation is the recording of sounds and vibrations caused by the human body from the throat during swallowing. While traditionally done by a trained clinician with a stethoscope, much work has been put towards developing more sensitive and clinically useful methods to characterize the data obtained with this technique. The eventual goal of the field is to improve the effectiveness of screening algorithms designed to predict the risk that swallowing disorders pose to individual patients' health and safety. This paper provides an overview of these signal processing techniques and summarizes recent advances made with digital transducers in hopes of organizing the highly varied research on cervical auscultation. It investigates where on the body these transducers are placed in order to record a signal as well as the collection of analog and digital filtering techniques used to further improve the signal quality. It also presents the wide array of methods and features used to characterize these signals, ranging from simply counting the number of swallows that occur over a period of time to calculating various descriptive features in the time, frequency, and phase space domains. Finally, this paper presents the algorithms that have been used to classify this data into 'normal' and 'abnormal' categories. Both linear as well as non-linear techniques are presented in this regard.

  15. The Agreement between Auscultation and Lung Ultrasound in Hemodialysis Patients: The LUST Study

    Science.gov (United States)

    Torino, Claudia; Gargani, Luna; Sicari, Rosa; Letachowicz, Krzysztof; Ekart, Robert; Fliser, Danilo; Covic, Adrian; Siamopoulos, Kostas; Stavroulopoulos, Aristeidis; Massy, Ziad A.; Fiaccadori, Enrico; Caiazza, Alberto; Bachelet, Thomas; Slotki, Itzchak; Martinez-Castelao, Alberto; Coudert-Krier, Marie-Jeanne; Rossignol, Patrick; Gueler, Faikah; Hannedouche, Thierry; Panichi, Vincenzo; Wiecek, Andrzej; Pontoriero, Giuseppe; Sarafidis, Pantelis; Klinger, Marian; Hojs, Radovan; Seiler-Mussler, Sarah; Lizzi, Fabio; Siriopol, Dimitrie; Balafa, Olga; Shavit, Linda; Tripepi, Rocco; Mallamaci, Francesca; Tripepi, Giovanni; Picano, Eugenio; London, Gérard Michel

    2016-01-01

    Background and objectives Accumulation of fluid in the lung is the most concerning sequela of volume expansion in patients with ESRD. Lung auscultation is recommended to detect and monitor pulmonary congestion, but its reliability in ESRD is unknown. Design, setting, participants, & measurements In a subproject of the ongoing Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with Cardiomyopathy Trial, we compared a lung ultrasound–guided ultrafiltration prescription policy versus standard care in high-risk patients on hemodialysis. The reliability of peripheral edema was tested as well. This study was on the basis of 1106 pre– and postdialysis lung ultrasound studies (in 79 patients) simultaneous with standardized lung auscultation (crackles at the lung bases) and quantification of peripheral edema. Results Lung congestion by crackles, edema, or a combination thereof poorly reflected the severity of congestion as detected by ultrasound B lines in various analyses, including standard regression analysis weighting for repeated measures in individual patients (shared variance of 12% and 4% for crackles and edema, respectively) and κ-statistics (κ ranging from 0.00 to 0.16). In general, auscultation had very low discriminatory power for the diagnosis of mild (area under the receiver operating curve =0.61), moderate (area under the receiver operating curve =0.65), and severe (area under the receiver operating curve =0.68) lung congestion, and the same was true for peripheral edema (receiver operating curve =0.56 or lower) and the combination of the two physical signs. Conclusions Lung crackles, either alone or combined with peripheral edema, very poorly reflect interstitial lung edema in patients with ESRD. These findings reinforce the rationale underlying the Lung Water by Ultra-Sound Guided Treatment to Prevent Death and Cardiovascular Complications in High Risk ESRD Patients with

  16. Left–Right Asymmetry in Spectral Characteristics of Lung Sounds Detected Using a Dual-Channel Auscultation System in Healthy Young Adults

    Directory of Open Access Journals (Sweden)

    Jang-Zern Tsai

    2017-06-01

    Full Text Available Though lung sounds auscultation is important for the diagnosis and monitoring of lung diseases, the spectral characteristics of lung sounds have not been fully understood. This study compared the spectral characteristics of lung sounds between the right and left lungs and between healthy male and female subjects using a dual-channel auscultation system. Forty-two subjects aged 18–22 years without smoking habits and any known pulmonary diseases participated in this study. The lung sounds were recorded from seven pairs of auscultation sites on the chest wall simultaneously. We found that in four out of seven auscultation pairs, the lung sounds from the left lung had a higher total power (PT than those from the right lung. The PT of male subjects was higher than that of female ones in most auscultation pairs. The ratio of inspiration power to expiration power (RI/E of lung sounds from the right lung was greater than that from the left lung at auscultation pairs on the anterior chest wall, while this phenomenon was reversed at auscultation pairs on the posterior chest wall in combined subjects, and similarly in both male and female subjects. Though the frequency corresponding to maximum power density of lung sounds (FMPD from the left and right lungs was not significantly different, the frequency that equally divided the power spectrum of lung sounds (F50 from the left lung was significantly smaller than that from the right lung at auscultation site on the anterior and lateral chest walls, while it was significantly larger than that of from the right lung at auscultation site on the posterior chest walls. In conclusion, significant differences in the PT, FMPD, F50, and RI/E between the left and right lungs at some auscultation pairs were observed by using a dual-channel auscultation system in this study. Structural differences between the left and the right lungs, between the female and male subjects, and between anterior and posterior lungs might

  17. Left-Right Asymmetry in Spectral Characteristics of Lung Sounds Detected Using a Dual-Channel Auscultation System in Healthy Young Adults.

    Science.gov (United States)

    Tsai, Jang-Zern; Chang, Ming-Lang; Yang, Jiun-Yue; Kuo, Dar; Lin, Ching-Hsiung; Kuo, Cheng-Deng

    2017-06-07

    Though lung sounds auscultation is important for the diagnosis and monitoring of lung diseases, the spectral characteristics of lung sounds have not been fully understood. This study compared the spectral characteristics of lung sounds between the right and left lungs and between healthy male and female subjects using a dual-channel auscultation system. Forty-two subjects aged 18-22 years without smoking habits and any known pulmonary diseases participated in this study. The lung sounds were recorded from seven pairs of auscultation sites on the chest wall simultaneously. We found that in four out of seven auscultation pairs, the lung sounds from the left lung had a higher total power (P T ) than those from the right lung. The P T of male subjects was higher than that of female ones in most auscultation pairs. The ratio of inspiration power to expiration power (R I/E ) of lung sounds from the right lung was greater than that from the left lung at auscultation pairs on the anterior chest wall, while this phenomenon was reversed at auscultation pairs on the posterior chest wall in combined subjects, and similarly in both male and female subjects. Though the frequency corresponding to maximum power density of lung sounds (F MPD ) from the left and right lungs was not significantly different, the frequency that equally divided the power spectrum of lung sounds (F 50 ) from the left lung was significantly smaller than that from the right lung at auscultation site on the anterior and lateral chest walls, while it was significantly larger than that of from the right lung at auscultation site on the posterior chest walls. In conclusion, significant differences in the P T , F MPD , F 50 , and R I/E between the left and right lungs at some auscultation pairs were observed by using a dual-channel auscultation system in this study. Structural differences between the left and the right lungs, between the female and male subjects, and between anterior and posterior lungs might

  18. Auscultation microsismique appliquée à la détection des éboulements des falaises crayeuses

    OpenAIRE

    Senfaute, Gloria; Gourry, Jean-Christophe

    2004-01-01

    National audience; The microseismic monitoring carried out on an experimental site showed that the chalk rock ruptures are recordable by a seismic network composed of geophones and accelerometers. The microseismic method also showed the capacity to detect the precursory signs of a cliff collapse. This study enabled to dimension the essential parameters for the implementation of an operational microseismic system to monitor unstable cliffs zones and predict rock-falls hazard.; L'auscultation m...

  19. Rolling ball sifting algorithm for the augmented visual inspection of carotid bruit auscultation

    Science.gov (United States)

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

    2016-01-01

    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. PMID:27452722

  20. Rolling ball sifting algorithm for the augmented visual inspection of carotid bruit auscultation.

    Science.gov (United States)

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

    2016-07-25

    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.

  1. Prototype electronic stethoscope vs. conventional stethoscope for auscultation of heart sounds.

    Science.gov (United States)

    Kelmenson, Daniel A; Heath, Janae K; Ball, Stephanie A; Kaafarani, Haytham M A; Baker, Elisabeth M; Yeh, Daniel D; Bittner, Edward A; Eikermann, Matthias; Lee, Jarone

    2014-08-01

    In an effort to decrease the spread of hospital-acquired infections, many hospitals currently use disposable plastic stethoscopes in patient rooms. As an alternative, this study examines a prototype electronic stethoscope that does not break the isolation barrier between clinician and patient and may also improve the diagnostic accuracy of the stethoscope exam. This study aimed to investigate whether the new prototype electronic stethoscope improved auscultation of heart sounds compared to the standard conventional isolation stethoscope. In a controlled, non-blinded, cross-over study, clinicians were randomized to identify heart sounds with both the prototype electronic stethoscope and a conventional stethoscope. The primary outcome was the score on a 10-question heart sound identification test. In total, 41 clinicians completed the study. Subjects performed significantly better in the identification of heart sounds when using the prototype electronic stethoscope (median = 9 [7-10] vs. 8 [6-9] points, p value prototype electronic stethoscope. Clinicians using a new prototype electronic stethoscope achieved greater accuracy in identification of heart sounds and also universally favoured the new device, compared to the conventional stethoscope.

  2. Time to Add a Fifth Pillar to Bedside Physical Examination: Inspection, Palpation, Percussion, Auscultation, and Insonation.

    Science.gov (United States)

    Narula, Jagat; Chandrashekhar, Y; Braunwald, Eugene

    2018-02-28

    Inspection, palpation, percussion, and auscultation have been the 4 pillars of clinical bedside medicine. Although these basic methods of physical examination have served us well, traditional bedside examination, for a number of reasons including diminishing interest and expertise, performs well less than what is required of a modern diagnostic strategy. Improving the performance of physical examination is vital given that it is crucial to guide diagnostic possibilities and further testing. Current efforts at improving physical examination skills during medical training have not been very successful, and incorporating appropriate technology at the bedside might improve its performance. Selective use of bedside ultrasound (or insonation) can be one such strategy that could be incorporated as the fifth component of the physical examination. Seeing pathology through imaging might improve interest in physical examination among trainees, and permit appropriate downstream testing and possibly superior decision making. Current ultrasound technology makes this feasible, and further miniaturization of ultrasound devices and reduced cost will allow for routine use at the bedside. It is time to have a wider debate and a possible consensus about updates required to enhance current paradigms of physical examination.

  3. Teaching cardiac auscultation to trainees in internal medicine and family practice: Does it work?

    Science.gov (United States)

    Favrat, B; Pécoud, A; Jaussi, A

    2004-01-01

    Background The general proficiency in physical diagnostic skills seems to be declining in relation to the development of new technologies. The few studies that have examined this question have invariably used recordings of cardiac events obtained from patients. However, this type of evaluation may not correlate particularly well with bedside skills. Our objectives were 1) To compare the cardiac auscultatory skills of physicians in training with those of experienced cardiologists by using real patients to test bedside diagnostic skills. 2) To evaluate the impact of a five-month bedside cardiac auscultation training program. Methods 1) In an academic primary care center, 20 physicians (trainees in internal medicine and family practice) and two skilled academic cardiologists listened to 33 cardiac events in 13 patients directly at bedside and identified the cardiac events by completing an open questionnaire. Heart sounds, murmurs and diagnosis were determined beforehand by an independent skilled cardiologist and were validated by echocardiography. Thirteen primary cardiologic diagnoses were possible. 2) Ten of the physicians agreed to participate in a course of 45-minute sessions once a week for 5 months. After the course they listened again to the same patients (pre/post-interventional study). Results 1) The experts were the most skillful, achieving 69% recognition of heart sounds and murmurs and correct diagnoses in 62% of cases. They also heard all of the diastolic murmurs. The residents heard only 40% of the extra heart sounds and made a correct diagnosis in 24% of cases. 2) After the weekly training sessions, their mean percentage for correct diagnosis was 35% [an increase of 66% (p < 0.05)]. Conclusions The level of bedside diagnostic skills in this relatively small group of physicians in training is indeed low, but can be improved by a course focusing on realistic bedside teaching. PMID:15056393

  4. Variation in effectiveness of a cardiac auscultation training class with a cardiology patient simulator among heart sounds and murmurs.

    Science.gov (United States)

    Kagaya, Yutaka; Tabata, Masao; Arata, Yutaro; Kameoka, Junichi; Ishii, Seiichi

    2017-08-01

    Effectiveness of simulation-based education in cardiac auscultation training is controversial, and may vary among a variety of heart sounds and murmurs. We investigated whether a single auscultation training class using a cardiology patient simulator for medical students provides competence required for clinical clerkship, and whether students' proficiency after the training differs among heart sounds and murmurs. A total of 324 fourth-year medical students (93-117/year for 3 years) were divided into groups of 6-8 students; each group participated in a three-hour training session using a cardiology patient simulator. After a mini-lecture and facilitated training, each student took two different tests. In the first test, they tried to identify three sounds of Category A (non-split, respiratory split, and abnormally wide split S2s) in random order, after being informed that they were from Category A. They then did the same with sounds of Category B (S3, S4, and S3+S4) and Category C (four heart murmurs). In the second test, they tried to identify only one from each of the three categories in random order without any category information. The overall accuracy rate declined from 80.4% in the first test to 62.0% in the second test (p<0.0001). The accuracy rate of all the heart murmurs was similar in the first (81.3%) and second tests (77.5%). That of all the heart sounds (S2/S3/S4) decreased from 79.9% to 54.3% in the second test (p<0.0001). The individual accuracy rate decreased in the second test as compared with the first test in all three S2s, S3, and S3+S4 (p<0.0001). Medical students may be less likely to correctly identify S2/S3/S4 as compared with heart murmurs in a situation close to clinical setting even immediately after training. We may have to consider such a characteristic of students when we provide them with cardiac auscultation training. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  5. Detection of innocent systolic murmurs by auscultation and their relation to hematologic and echocardiographic findings in clinically normal Whippets.

    Science.gov (United States)

    Bavegems, Valérie C; Duchateau, Luc; Polis, Ingeborgh E; Van Ham, Luc M; De Rick, André F; Sys, Stanislas U

    2011-02-15

    To determine murmur prevalence by auscultation of 105 apparently healthy Whippets without signs of cardiac disease, to determine the origin of these murmurs, and to evaluate the influence of sex, type of pedigree (ie, bred for showing or racing), and training on these murmurs. Cross-sectional study. 105 client-owned Whippets. All dogs were auscultated by the first author and underwent a complete physical and cardiological examination, together with a hematologic assessment. Several RBC variables and echocardiographic variables were compared between dogs with or without a murmur at the level of the aortic valve. 44 of 105 (41.9%) dogs had no murmur. A soft systolic murmur was present with point of maximal intensity at the level of the aortic valve in 50 (47.6%) dogs, at the level of the pulmonic valve in 8 (7.6%) dogs, and at the level of the mitral valve in 3 (2.9%) dogs. No significant differences were found in heart rate, rhythm, murmur presence, point of maximal intensity, and murmur grade between males and females, between dogs with race- and show-type pedigrees, or between dogs in training and not in training. Dogs with a murmur at the level of the aortic valve had a significantly higher aortic and pulmonic blood flow velocity and cardiac output, compared with dogs without a murmur. Whippets have a high prevalence of soft systolic murmurs in the absence of any structural abnormalities, which fit the description of innocent murmurs. No influence of sex, pedigree type, or training was found on the occurrence of these murmurs in Whippets.

  6. Intermittent auscultation versus continuous fetal monitoring: exploring factors that influence birthing unit nurses' fetal surveillance practice using theoretical domains framework.

    Science.gov (United States)

    Patey, Andrea M; Curran, Janet A; Sprague, Ann E; Francis, Jill J; Driedger, S Michelle; Légaré, France; Lemyre, Louise; Pomey, Marie-Pascale A; Grimshaw, Jeremy M

    2017-09-25

    Intermittent Auscultation (IA) is the recommended method of fetal surveillance for healthy women in labour. However, the majority of women receive continuous electronic monitoring. We used the Theoretical Domains Framework (TDF) to explore the views of Birthing Unit nurses about using IA as their primary method of fetal surveillance for healthy women in labour. Using a semi-structured interview guide, we interviewed a convenience sample of birthing unit nurses throughout Ontario, Canada to elicit their views about fetal surveillance. Interviews were recorded and transcribed verbatim. Transcripts were content analysed using the TDF and themes were framed as belief statements. Domains potentially key to changing fetal surveillance behaviour and informing intervention design were identified by noting the frequencies of beliefs, content, and their reported influence on the use of IA. We interviewed 12 birthing unit nurses. Seven of the 12 TDF domains were perceived to be key to changing birthing unit nurses' behaviour The nurses reported that competing tasks, time constraints and the necessity to multitask often limit their ability to perform IA (domains Beliefs about capabilities; Environmental context and resources). Some nurses noted the decision to use IA was something that they consciously thought about with every patient while others stated it their default decision as long as there were no risk factors (Memory, attention and decision processes, Nature of behaviour). They identified positive consequences (e.g. avoid unnecessary interventions, mother-centered care) and negative consequences of using IA (e.g. legal concerns) and reported that the negative consequences can often outweigh positive consequences (Beliefs about consequences). Some reported that hospital policies and varying support from care teams inhibited their use of IA (Social influences), and that support from the entire team and hospital management would likely increase their use (Social

  7. Cardiotocography versus intermittent auscultation of fetal heart on admission to labour ward for assessment of fetal wellbeing.

    Science.gov (United States)

    Devane, Declan; Lalor, Joan G; Daly, Sean; McGuire, William; Cuthbert, Anna; Smith, Valerie

    2017-01-26

    The admission cardiotocograph (CTG) is a commonly used screening test consisting of a short (usually 20 minutes) recording of the fetal heart rate (FHR) and uterine activity performed on the mother's admission to the labour ward. This is an update of a review published in 2012. To compare the effects of admission cardiotocography with intermittent auscultation of the FHR on maternal and infant outcomes for pregnant women without risk factors on their admission to the labour ward. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register to 30 November 2016 and we planned to review the reference list of retrieved papers All randomised and quasi-randomised trials comparing admission CTG with intermittent auscultation of the FHR for pregnant women between 37 and 42 completed weeks of pregnancy and considered to be at low risk of intrapartum fetal hypoxia and of developing complications during labour. Two authors independently assessed trial eligibility and quality, and extracted data. Data were checked for accuracy. We included no new trials in this update. We included four trials involving more than 13,000 women which were conducted in the UK and Ireland and included women in labour. Three trials were funded by the hospitals where the trials took place and one trial was funded by the Scottish government. No declarations of interest were made in two trials; the remaining two trials did not mention declarations of interest. Overall, the studies were assessed as low risk of bias. Results reported in the 2012 review remain unchanged.Although not statistically significant using a strict P labour (RR 1.30, 95% CI 1.14 to 1.48, 3 trials, 10,753 women, I² = 79%, low quality evidence) and fetal blood sampling (RR 1.28, 95% CI 1.13 to 1.45, 3 trials, 10,757 women, I² = 0%) than women allocated to intermittent auscultation. There were no differences between groups in other secondary outcome measures including incidence and severity of hypoxic ischaemic

  8. VALIDATION OF THE MECG-DP-NS-01 MONITOR IN OSCILLOMETRY AND AUSCULTATION MODES IN CHILDREN AND ADOLESCENTS, ACCORDING TO ESH-IP2, BHS AND AAMI PROTOCOLS

    Directory of Open Access Journals (Sweden)

    S. I. Fedorova

    2015-01-01

    Full Text Available Background: High blood pressure in childhood and adolescence is associated with a 2 to 3-fold increase of the risk of arterial hypertension. According to the Russian guidelines, only devices that have been tested by international protocols can be used for the main diagnostic method of arterial hypertension in children and adolescents, i.e. ambulatory 24-hour blood pressure monitoring.Aim: To validate the MECG-DP-NS-01 upper arm BP monitor in oscillometry and auscultation modes within the “Soyuz” complex, in children and adolescents aged from 5 to 15 years according to the international protocol of the European Society of Hypertension (ESH from 2010 (ESH-IP2, the protocol of the British Hypertension Society (BHS from 1993 and the standard of the Association for the Advancement of Medical Instrumentation (AAMI.Materials and methods: We recruited 99 children and adolescents (49 male, 50 female aged from 5 to 15 years (33 children, from 5 to 7 years, 33, from 8 to 11 years, 33, from 12 to 15 years. Expert and device blood pressure measurements were performed in each patient according to the protocols.Results: The MECG-DP-NS-01 upper arm blood pressure monitor was validated and its accuracy in blood pressure measurement in children and adolescents according to ESH-IP2, BHS and AAMI protocols confirmed. According to BHS 1993 protocol, its accuracy corresponded to A/A both in the oscillometry and auscultation modes.Conclusion: According to ESH-IP2, BHS and AAMI protocols, MEGC-DP-NS-01 within the “Soyuz” complex could be recommended for 24-hour ambulatory blood pressure monitoring in children and adolescents aged from 5 to 15 years, both in the oscillometry and auscultation modes. According to the Declaration of blood pressure Measuring Device Equivalence signed by the manufacturer for the devices MDP-NS-02s “Voshod” and MEGCDPNS-01, and to the equivalence criteria for blood pressure measuring devices, the results of testing and its

  9. Evolution of geodesical auscultation monitoring in power plants: Foz do Areia, Segredo and Salto Caxias; Evolucao da auscultacao geodesica no monitoramento das usinas: Foz do Areia, Segredo e Salto Caxias

    Energy Technology Data Exchange (ETDEWEB)

    Soares, Marcos Alberto; Ferreira, Elizeu Santos [Companhia Paranaense de Energia (COPEL), Curitiba, PR (Brazil)], Emails: marcos.asoares@copel.com, elizeu.sf@copel.com; Faggion, Pedro Luis; Veiga, Luis Augusto Kuenig; Nadal, Carlos Aurelio; Freitas, Silvio Rogerio Correia de; Nadal, Marco Aurelio Debus; Neves, Ricardo Vilares [Universidade Federal do Parana (UFPR), Curitiba, PR (Brazil)], Emails: faggion@ufpr.br, kngveiga@ufpr.br, cnadal@ufpr.br, sfreitas@ufpr.br, marco_nadal@yahoo.com.br, ricvilar@yahoo.com.br; Boszczowski, Roberta Bomfim [Instituto de Tecnologia para o Desenvolvimento (LACTEC), Curitiba, PR (Brazil)], Email: roberta.bomfim@lactec.org.br

    2009-10-15

    The main objective of the geodetic auscultation is to obtain cartesian coordinates of points by geodetic techniques, such as differential leveling, GPS, triangulation and traverse applied in the monitoring of certain phenomena.This paper presents some results on the integration of Geodetic Auscultation with the security instrumentation; The objective of this is to determine possible points displacements in the Salto Caxias dam. This integration is intended to provide support to the technicians to set absolute displacements of the blocks since the conventional instruments provides only relative changes. Thus, it were established a monitoring network downstream of the reservoir, formed by six concrete piles, equipped with forced centering system. This network serves to perform the external monitoring of the dam and also to support a precision traverse that is conducted within the galleries. It were also performed a differential leveling on the crest of the dam. (author)

  10. Limitations of Routine Verification of Nasogastric Tube Insertion Using X-Ray and Auscultation: Two Case Reports of Life-Threatening Complications.

    Science.gov (United States)

    Nejo, Takahide; Oya, Soichi; Tsukasa, Tsuchiya; Yamaguchi, Naomi; Matsui, Toru

    2016-12-01

    Several bedside approaches used in combination with thoracoabdominal X-ray are widely used to avoid severe complications that have been reported during nasogastric tube management. Although confirmation by X-ray is considered the gold standard, it is not yet perfect. We present 2 cases of rare complications in which the routine verification methods could not detect all the complications related to the nasogastric tube placement. Case 1 was a 17-year-old male who presented with a brain tumor and repeatedly required nasogastric tube placement. Despite normal auscultatory and X-ray findings, the patient's condition deteriorated rapidly after resuming the enteral nutrition (EN). Computed tomography images showed the presence of hepatic portal venous gas (HPVG). Urgent upper gastrointestinal endoscopy showed esophagogastric submucosal tunneling of the tube that required an emergency open total gastrectomy. Case 2 was a 76-year-old man with long-term EN after stroke. While the last auscultatory verification was normal, he suddenly developed extensive HPVG due to gastric mucosal injury following EN, which resulted in progressive intestinal necrosis, general peritonitis, and death. These 2 cases indicated that routine verification methods consisting of auscultation and X-ray may not be completely reliable, and the awareness of the limitations of these methods should be reaffirmed because expeditious examinations and necessary interventions are critical in preventing life-threatening complications.

  11. Contribuição da ausculta cervical para a avaliação clínica das disfagia orofaríngeas Contribution of the cervical auscultation in clinical assessment of the oropharyngeal dysphagia

    Directory of Open Access Journals (Sweden)

    Geovana de Paula Bolzan

    2013-04-01

    Full Text Available Para auxiliar na avaliação funcional da deglutição, a maior parte dos fonoaudiólogos utiliza recursos instrumentais como a ausculta cervical. Em vista disso, o objetivo deste estudo foi verificar na literatura a contribuição da ausculta cervical para a avaliação clínica das disfagias. Para tanto, foram revisados periódicos nacionais e internacionais, indexados nas bases de dados Springer, Lilacs, Bireme, Medline e Scielo, entre os anos de 1992 e 2011. A partir da análise dos estudos foi possível verificar que a ausculta cervical vem se modernizando com a evolução tecnológica, possibilitando a realização de estudos quantitativos dos sons da deglutição; que ainda há evidências pouco claras das correspondências entre os componentes sonoros da deglutição e os eventos fisiológicos da fase faríngea; que não foram evidenciadas diferenças nos sons da deglutição entre crianças e adultos; e que alguns estudos apresentaram concordância entre a ausculta cervical e a avaliação videofluoroscópica da deglutição, e outros ainda apresentaram correlação positiva entre estas duas avaliações. Assim, considerando-se que a videofluoroscopia da deglutição em nosso país ainda é um exame de difícil acesso, com custo relativamente alto, acredita-se que a ausculta cervical constitui um importante recurso para o diagnóstico e acompanhamento clínico em casos de disfagia orofaríngea.In order to assist on the functional assessment of swallowing, most speech therapists make use of instrumental resources such as cervical auscultation. Thus, the objective of this study was to search the literature in order to find the contribution of cervical auscultation for assessing dysphagias. To this end, international and national journals were reviewed. These journals were indexed in Springer, Lilacs, Bireme, Medline and Scielo databases, comprising the period between 1992 and 2011. From the analysis of the studies, it was possible to

  12. 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

    2006-12-01

    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

  13. Terminologia da ausculta pulmonar utilizada em publicações médicas brasileiras, no período de janeiro de 1980 a dezembro de 2003 Pulmonary auscultation terminology employed in Brazilian medical journals between January of 1980 and December of 2003

    Directory of Open Access Journals (Sweden)

    Kamila Fernanda Staszko

    2006-10-01

    Full Text Available OBJETIVO: Avaliar a adequação de uso de termos semiológicos da ausculta pulmonar em publicações médicas brasileiras sobre doenças respiratórias, no período de janeiro de 1980 a dezembro de 2003. MÉTODOS: Realizou-se um estudo descritivo, analisando-se três revistas médicas: Jornal de Pneumologia, Jornal de Pediatria e Revista Médica Brasileira. Foram selecionados os artigos originais e relatos de casos sobre doenças respiratórias, de onde foram extraídos os termos semiológicos da ausculta pulmonar. Foi avaliada a adequação dos termos na descrição dos ruídos adventícios. RESULTADOS: Encontrou-se maior inadequação no uso dos termos de ruídos descontínuos, comparado com o uso dos termos de ruídos contínuos (87,7% versus 44%, p = 0,0000. Não houve diferença significativa entre relatos de pneumologistas e de outros especialistas quanto à inadequação no uso dos termos (56,5% versus 62,0%, p = 0,26. Também não observamos diferença significativa entre as regiões do país e os períodos antes e após a divulgação da nomenclatura internacional. CONCLUSÃO: O uso inadequado dos termos para descrever ruídos adventícios na ausculta pulmonar continua sendo um fenômeno freqüente e geral nas publicações médicas brasileiras.OBJECTIVE: To evaluate the appropriateness of the use of auscultation terminology in Brazilian respiratory disease-related medical journals published between January of 1980 and December of 2003. METHODS: A descriptive study was conducted, evaluating three medical journals: the Jornal de Pneumologia (Journal of Pulmonology, Jornal de Pediatria (Journal of Pediatrics and Revista Brasileira de Medicina (Brazilian Journal of Medicine. Original articles and case reports about respiratory diseases were selected, and auscultation terminology was extracted from these articles. The appropriateness of terms used to describe adventitious sounds was assessed. RESULTS: We found that the inappropriate use of

  14. 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

    1999-01-01

    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

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

    International Nuclear Information System (INIS)

    Kawamura, Takeo; Matsumoto, Tsuneo; Tanaka, Nobuyuki; Matsunaga, Naofumi; Kido, Shoji; Jiang Zhongwei

    2003-01-01

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

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

    Science.gov (United States)

    Branck, Charles E.; And Others

    1987-01-01

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

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

    Science.gov (United States)

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

    2015-07-01

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

  18. Laser Stethoscope for Use in Noisy Spacecraft Environments, Phase I

    Data.gov (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...

  19. [Post exertion bronchospasm--usefulness of different methods for evaluating bronchial constriction after exertional provocation].

    Science.gov (United States)

    Gaszczyk, G

    1997-01-01

    55 children with bronchial asthma were tested using three exercise provocation tests: a treadmill, stairways running and cycloergometer. The results were evaluated on the base of the lung function tests, auscultation and airways resistance measurement with occlusion method. Of these three tests the treadmill test seemed to be the most useful to prove bronchial hyperreactivity towards exercise. Stairways running occurred to be very congenial. The study also proved usefulness of auscultation in evaluating of bronchial constriction after exercise.

  20. Improving auscultatory proficiency using computer simulated heart sounds

    Directory of Open Access Journals (Sweden)

    Hanan Salah EL-Deen Mohamed EL-Halawany

    2016-09-01

    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.

  1. Congenital peritoneopericardial diaphragmatic hernia in a terrier dog

    Directory of Open Access Journals (Sweden)

    Reza Kheirandish

    2014-06-01

    Full Text Available A one-month-old male terrier dog was referred in shock status with a history of anorexia, tachypnea, abdominal distention and progressive weight loss. Auscultation of right side of the lungs found enhanced respiratory noises. The thorough auscultation of the opposite side of the chest revealed the presence of typical intestinal sounds. Cardiac auscultation revealed muffled heart sounds and a diminished palpable precordial cardiac impulse was evident. The radiograph showed the presence of gas within the bowel in abrupt contrast to the adjacent structures of soft tissue opacity. Conservative treatment was failed and the animal died. At necropsy, cranial displacement of abdominal viscera into the pericardial sac was seen. A definitive diagnosis of peritoneopericardial diaphragmatic hernia was made. Although congenital pericardial diseases are rare in dogs, awareness of the clinical manifestation of these kinds of defects combined with early use of available imaging modalities can yield a preoperative diagnosis.

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

    Science.gov (United States)

    2012-01-01

    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. PMID:22691418

  3. Multidimensional Analytical Study of Heart Sounds: A Review

    Directory of Open Access Journals (Sweden)

    Akash Kumar Bhoi

    2015-09-01

    Full Text Available Heart diagnosis by phonocardiography and auscultation is highly dependent on experience and there is a considerable inter-observer variation. The complex structure of the Phonocardiogram (PCG and the variations due to cardiac contractility can generate additional difficulties for auscultation. This review paper focuses on such critical problem solving issues with a variant of analysis. However, different methods and techniques are also described for detection and analysis of PCG signal and it will certainly aid findings in novel computational tools in biosignal processing.

  4. Phonocardiography Signal Processing

    CERN Document Server

    Abbas, Abbas K

    2009-01-01

    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

  5. On the blind recovery of cardiac and respiratory sounds

    DEFF Research Database (Denmark)

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

    2015-01-01

    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...

  6. Trisomy 21, a consequence of advanced maternal age | Osati | Dar ...

    African Journals Online (AJOL)

    ... eyes, low set ears, flat nose-bridge, small chin, short neck, pigeon chest and webbed toes. He was malnourished with delayed developmental milestones. A pansystolic murmur was auscultated at the lower left sternal edge; and he had impaired speech, reduced muscle bulk and muscle tone with muscle power of grade 3.

  7. [Two hundred years from the birth of Professor Josef Skoda].

    Science.gov (United States)

    Kohout, J

    2005-01-01

    The article deals with the life and work of the eminent professor of internal medicine Josef Skoda, a native of Plzen, who especially deserved of the introduction of examination by percussion and auscultation. He supported materially his nephew Emil and so he contributed to the expansion of Skoda's factory in Plzen.

  8. [Feeding tube placement: auscultatory method and x-ray agreement].

    Science.gov (United States)

    Beghetto, Mariur Gomes; Anziliero, Franciele; Leães, Dória Migotto; de Mello, Elza Daniel

    2015-12-01

    to evaluate the correlation between the auscultation test and X-ray when detecting the position of an enteral feeding tube. cross-sectional study in an intensive care unit in southern Brazil, in 2011. Clinical nurse and nurse researcher performed auscultation test recording the impressions regarding the placement of an enteral feeding tube in 80 patients. A doctor evaluated the X-ray. Kappa coefficient and PABAK reviewed the agreements. The X-ray showed that 70% of the enteral tubes were in the stomach, 27.4% in the duodenum, 1.3% in the esophagus, and 1.3% in the right lung. There was a weak correlation between clinical nurses and nurse researchers (PABAK=0.054; P=0.103), clinical nurses and X-rays (PABAK=0.188; P=0.111) and nurse researchers and X-rays (PABAK=0.128; P=0.107) . The auscultation test did not detect two risk conditions, enteral feeding tube in the esophagus and the bronchus. the auscultation test showed little agreement with the X-ray on the enteral feeding tube location.

  9. Endotracheal tube verification in adult mechanically ventilated patients

    African Journals Online (AJOL)

    To explore the methods that can be used to verify endotracheal tube (ETT) placement in adult mechanically ventilated patients. ... bilateral auscultation of chest and palpation of symmetrical chest movements, oesophageal detector devices, visualisation of the ETT, use of chest X-ray, pulse oximetry and capnography.

  10. neonatal asphyxia and its manager

    African Journals Online (AJOL)

    others, so as to increase blood flow to 'priority' organs such as the brain, and the heart. ... disseminated intravascular, necrotizing enterocolitis and brain damage. When the brain is deprived of oxygen a series of biochemical and mechanical events occur. .... breath sounds are audible on auscultation and the skin is pink.

  11. Pericardial effusion complicated by tamponade: a case report

    African Journals Online (AJOL)

    thready. Respiratory rate 40/minute. Blood pressure. 80/40. Pale but no jaundice. Pitting lower limb oedema up to the knees. Chest auscultation revealed crackles at both bases. The heart sounds were muffled but there were no added sounds, murmurs or friction rubs. The jugular venous pressure could not be determined.

  12. Case report

    African Journals Online (AJOL)

    abp

    2013-11-04

    Nov 4, 2013 ... Key words: Hepatitis B virus, post-infectious glomerulonephritis, antiviral treatment, corticosteroids. Received: 24/12/2012 ... We present a case of acute glomerulonephritis revealing a chronic viral hepatitis B. A 45 year-old ... He was oliguric with lower limbs edema and crackles on pulmonary auscultation.

  13. End-tidal CO2 Detection of an Audible Heart Rate During Neonatal Cardiopulmonary Resuscitation Following Asystole in Asphyxiated Piglets

    Science.gov (United States)

    Chalak, Lina F.; Barber, Chad A.; Hynan, Linda; Garcia, Damian; Christie, Lucy; Wyckoff, Myra H.

    2011-01-01

    Even brief interruption of cardiac compressions significantly reduces critical coronary perfusion pressure during cardiopulmonary resuscitation (CPR). End-tidal CO2 (ETCO2) monitoring may provide a continuous non-invasive method of assessing return of spontaneous circulation (ROSC) without stopping to auscultate for heart rate (HR). However, the ETCO2 value that correlates with an audible HR is unknown. Our objective was to determine the threshold ETCO2 that is associated with ROSC following asphyxia-induced asystole. Neonatal swine (n=46) were progressively asphyxiated until asystole occurred. Resuscitation followed current neonatal guidelines with initial ventilation with 100% O2 followed by cardiac compressions followed by epinephrine for continued asystole. HR was auscultated every 30 sec and ETCO2 was continuously recorded. A receiver operator curve was generated using the calculated sensitivity and specificity for various ETCO2 values where a positive test was defined as the presence of HR >60 bpm by auscultation. An ETCO2 cut off value of 14 mmHg is the most sensitive ETCO2 value with the least false positives. When using ETCO2 to guide uninterrupted CPR in this model of asphyxia-induced asystole, auscultative confirmation of return of an adequate HR should be performed when ETCO2 ≥14 mmHg is achieved. Correlation during human neonatal CPR needs further investigation. PMID:21283051

  14. End-tidal CO₂ detection of an audible heart rate during neonatal cardiopulmonary resuscitation after asystole in asphyxiated piglets.

    Science.gov (United States)

    Chalak, Lina F; Barber, Chad A; Hynan, Linda; Garcia, Damian; Christie, Lucy; Wyckoff, Myra H

    2011-05-01

    Even brief interruption of cardiac compressions significantly reduces critical coronary perfusion pressure during cardiopulmonary resuscitation (CPR). End-tidal CO₂ (ETCO₂) monitoring may provide a continuous noninvasive method of assessing return of spontaneous circulation (ROSC) without stopping to auscultate for heart rate (HR). However, the ETCO₂ value that correlates with an audible HR is unknown. Our objective was to determine the threshold ETCO₂ that is associated with ROSC after asphyxia-induced asystole. Neonatal swine (n = 46) were progressively asphyxiated until asystole occurred. Resuscitation followed current neonatal guidelines with initial ventilation with 100% O₂ followed by cardiac compressions followed by epinephrine for continued asystole. HR was auscultated every 30 s, and ETCO₂ was continuously recorded. A receiver operator curve was generated using the calculated sensitivity and specificity for various ETCO₂ values, where a positive test was defined as the presence of HR >60 bpm by auscultation. An ETCO₂ cut-off value of 14 mm Hg is the most sensitive ETCO₂ value with the least false positives. When using ETCO₂ to guide uninterrupted CPR in this model of asphyxia-induced asystole, auscultative confirmation of return of an adequate HR should be performed when ETCO₂ ≥ 14 mm Hg is achieved. Correlation during human neonatal CPR needs further investigation.

  15. Oculocardiac reflex in a dog caused by a choroidal melanoma with orbital extension.

    Science.gov (United States)

    Steinmetz, Andrea; Ellenberger, Kristin; März, Imke; Ludewig, Eberhard; Oechtering, Gerhard

    2012-01-01

    A 7 yr old mixed-breed dog was presented with a choroidal melanoma of the left eye that had penetrated the sclera, producing an orbital mass. Bradycardia was detected on auscultation. The bradycardia resolved after exenteration of the orbit and was therefore presumed to be associated with the oculocardiac reflex.

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

    Science.gov (United States)

    Salim, Mubadda A.; Alpert, Bruce S.

    2001-01-01

    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…

  17. The electronic stethoscope.

    Science.gov (United States)

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

    2015-07-10

    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.

  18. A System Approach to Navy Medical Education and Training. Appendix 29. Competency Curriculum for Advanced General Duty Corpsman.

    Science.gov (United States)

    1974-08-31

    Elicit information/symptoms pertaining to the cardiac system g. Elicit information/symptoms pertaining to the gastrointestinal system h. Elicit...Percussion, auscultation and palpation techniques Inspection for: contour, engorged veins, S retractions, protrusions, visible peristalsis Percussion of...problems to physician and report results KNOWLEDGES AND SKILLS Anatomy and physiology of hepatic-biliary, pancreatic and gastrointestinal tracts

  19. Case report

    African Journals Online (AJOL)

    ebutamanya

    2015-06-05

    Jun 5, 2015 ... because of progressive dyspnea and asthenia. No past medical history of cardiovascular risk factors. Clinical examination showed awell-looking woman with a facial pigmentation. No signs of congestion was noticed. Cardiac auscultation revealed normal heart sounds and a systolic murmurin Tricuspid ...

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

    Directory of Open Access Journals (Sweden)

    Lucia Helena Eduardo Pinto

    2016-04-01

    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.

  1. The Occupational Health Nurse (OHN) and the Implications for Nursing Education

    Science.gov (United States)

    1992-01-01

    movement, size, markings , etc 2. Auscultate for bowel sounds 3. Percuss for air and organ location 4. Palpate to elicit tenderness, masses B...1.5(2), 96-102. OHN 72 Tarnopolsky , R. (1990). When the patient’s world goes round. Journal of the American Academy of Physician Aistnts. 2(2), 117

  2. association of hypertelorism in children with congenital acyanotic ...

    African Journals Online (AJOL)

    Thorough clinical examination of cardiovascular system by inspection, palpation, percussion and auscultation was done. Echocardiography was performed to .... ocular abnormalities and there is less number of studies in India regarding this association. But still we suggest that any child whose eyes look apart on clinical.

  3. Fitness to Drive among Commercial Intercity Drivers in Benin-City ...

    African Journals Online (AJOL)

    UNIBEN

    Background: Unfit drivers are prone to road traffic accident, therefore their health is paramount in .... road safer. METHODOLOGY. One hundred and ninety-four commercial intercity bus drivers in Benin City, Edo State were interviewed in a descriptive cross sectional ... brachial artery was auscultated while the cuff was slowly ...

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

    Directory of Open Access Journals (Sweden)

    Jovan Lovrenski

    2016-05-01

    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.

  5. Remote auscultatory patient monitoring during magnetic resonance imaging

    DEFF Research Database (Denmark)

    Henneberg, S; Hök, B; Wiklund, L

    1992-01-01

    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......A system for patient monitoring during magnetic resonance imaging (MRI) is described. The system is based on remote auscultation of heart sounds and respiratory sounds using specially developed pickup heads that are positioned on the precordium or at the nostrils and connected to microphones via...... polymer tubing. The microphones operate in a differential mode outside the strong magnetic field to reduce various sources of interference from the MRI equipment. After amplification, the signal is transmitted as infrared light to a small, battery-operated receiver and a headphone set. Thus, the patient...

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

    Science.gov (United States)

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

    2006-01-01

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

  7. Looking Is Not Seeing and Listening Is Not Hearing: A Replication Study With Accelerated BSN Students.

    Science.gov (United States)

    Honan, Linda; Shealy, Sarah; Fennie, Kristopher; Duffy, Thomas C; Friedlaender, Linda; Del Vecchio, Megan

    2016-01-01

    Development of perceptual aptitude is a critical yet complex skill that requires the effective organization and interpretation of data using visual and auditory clinical observation. Educators face challenges in creating pedagogy that consistently demonstrates reliability and validity in fostering clinical skills. We have dependably used the arts as a means to improve students' auditory and visual skills, and this article will describe replication of our work with accelerated nursing students in a bachelor's program in their last semester of nursing school (n=23). Our results reveal that auscultative and observational abilities of soon-to-be registered nurses are in need of improvement. The use of art in a museum improves observational and assessment abilities, and music training increases auscultative interpretive skills significantly. Copyright © 2016 Elsevier Inc. All rights reserved.

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

    Science.gov (United States)

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

    2012-01-01

    Inspection/observation and listening/auscultation are essential skills for health care providers. Given that observational and auditory skills take time to perfect, there is concern about accelerated students' ability to attain proficiency in a timely manner. This article describes the impact of music auditory training (MAT) for nursing students in an accelerated master's entry program on their competence in detecting heart, lung, and bowel sounds. During the first semester, a two-hour MAT session with focused attention on pitch, timbre, rhythm, and masking was held for the intervention group; a control group received traditional instruction only. Students in the music intervention group demonstrated significant improvement in hearing bowel, heart, and lung sounds (p < .0001). The ability to label normal and abnormal heart sounds doubled; interpretation of normal and abnormal lung sounds improved by 50 percent; and bowel sounds interpretation improved threefold, demonstrating the effect of an adult-oriented, creative, yet practical method for teaching auscultation.

  9. Music, Mechanism, and the "Sonic Turn" in Physical Diagnosis.

    Science.gov (United States)

    Pesic, Peter

    2016-04-01

    The sonic diagnostic techniques of percussion and mediate auscultation advocated by Leopold von Auenbrugger and R. T. H. Laennec developed within larger musical contexts of practice, notation, and epistemology. Earlier, François-Nicolas Marquet proposed a musical notation of pulse that connected felt pulsation with heard music. Though contemporary vitalists rejected Marquet's work, mechanists such as Albrecht von Haller included it into the larger discourse about the physiological manifestations of bodily fluids and fibers. Educated in that mechanistic physiology, Auenbrugger used musical vocabulary to present his work on thoracic percussion; Laennec's musical experience shaped his exploration of the new timbres involved in mediate auscultation. © The Author 2015. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Heart sounds: are you listening? Part 1.

    Science.gov (United States)

    Reimer-Kent, Jocelyn

    2013-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Julio González Z

    2016-04-01

    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?

  12. Myxoid liposarcoma of the mediastinum: a case report and review of the literature

    International Nuclear Information System (INIS)

    Escuissato, Dante L.; Adam, Guilherme P.; Gasparetto, Emerson L.; Urban, Linei A.B.D.; Benites Filho, Paulo R.; Sakamoto, Daniele; Marchiori, Edson

    2005-01-01

    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)

  13. Respiratory status of adult patients in the postoperative period of thoracic or upper abdominal surgeries

    OpenAIRE

    Almeida, Alana Gomes de Araujo; Pascoal, Lívia Maia; Santos, Francisco Dimitre Rodrigo Pereira; Lima Neto, Pedro Martins; Nunes, Simony Fabíola Lopes; Sousa, Vanessa Emille Carvalho de

    2017-01-01

    ABSTRACT Objective: to evaluate the respiratory status of postoperative adult patients by assessing the nursing outcome Respiratory Status. Method: descriptive, cross-sectional study developed with 312 patients. Eighteen NOC indicators were assessed and rated using a Likert-scale questionnaire and definitions. Descriptive and correlative analysis were conducted. Results: the most compromised clinical indicators were coughing (65.5%), auscultated breath sounds (55%), and respiratory rate (5...

  14. End-tidal CO2 Detection of an Audible Heart Rate During Neonatal Cardiopulmonary Resuscitation Following Asystole in Asphyxiated Piglets

    OpenAIRE

    Chalak, Lina F.; Barber, Chad A.; Hynan, Linda; Garcia, Damian; Christie, Lucy; Wyckoff, Myra H.

    2011-01-01

    Even brief interruption of cardiac compressions significantly reduces critical coronary perfusion pressure during cardiopulmonary resuscitation (CPR). End-tidal CO2 (ETCO2) monitoring may provide a continuous non-invasive method of assessing return of spontaneous circulation (ROSC) without stopping to auscultate for heart rate (HR). However, the ETCO2 value that correlates with an audible HR is unknown. Our objective was to determine the threshold ETCO2 that is associated with ROSC following ...

  15. In-Clinic Blood Pressure Prediction of Normal Ambulatory Blood Pressure Monitoring in Pediatric Hypertension Referrals.

    Science.gov (United States)

    Johnson, Philip K; Ferguson, Michael A; Zachariah, Justin P

    2016-07-01

    Since younger patients have low pretest probability of hypertension and are susceptible to reactive and masked hypertension, ambulatory blood pressure monitoring (ABPM) can be useful. To better target use in referred patients, we sought to define in-clinic systolic blood pressure (SBP) measures that predicted normal ABPM and target end organ damage. Data were collected on consecutive patients referred for high BP undergoing an ambulatory BP monitor from 2010 to 2013 (n = 248, 33.9% female, mean age 15.5 ± 3.6 years). Candidate in-clinic predictors were systolic maximum, minimum, or average BPs obtained by auscultative, oscillometric, or both. Multivariable logistic regression models were used to determine the prediction of normal ABPM by in-clinic BP predictors. Separate models considered predicting left ventricular hypertrophy (LVH) by in-clinic SBP vs. ABPM-defined hypertension. Identified predictor utility was tested with receiver operator characteristic curves. Maximum (OR 0.97 [95% CI 0.94-0.99]; P = .047), minimum (0.96 [0.94-0.99]; P = .002), and average (0.97 [0.95-1.00]; P = .04) in-clinic auscultative SBP predicted normal ABPM. Each had a c-statistic of 0.58. LVH was associated with in-clinic auscultative minimum SBP treated continuously (1.05, [1.01-1.10], P = .01) or dichotomized at the 90th percentile (8.23, [1.48-45.80], P = .02), as well as ABPM-defined hypertension (3.31, [1.23-8.91], P = .02). Both predictors had poor sensitivity and specificity. In youth, normal auscultative in-clinic systolic blood pressure indices weakly predicted normal ambulatory blood pressure and target end organ damage. © 2016 Wiley Periodicals, Inc.

  16. Motion Sickness: A Study of Its Effects on Human Physiology.

    Science.gov (United States)

    1987-12-01

    that it can result from motion sickness (21). Tachygastria can affect intestinal peristalsis similar to the way cardiac arrhythmias affect normal...a record of audible gastrointestinal mechanical activity. 11. A wireless FM microphone to allow the subject’s symptom reports to be recorded along... Gastrointestinal auscultation. 10. Balance tests. A. Eyes open, heels together. B. Eyes closed, heels together. C. Eyes open, standing on single foot

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

    International Nuclear Information System (INIS)

    Bohn, F.K.

    1994-01-01

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

  18. Deep Neural Networks for the Recognition and Classification of Heart Murmurs Using Neuromorphic Auditory Sensors.

    Science.gov (United States)

    Dominguez-Morales, Juan P; Jimenez-Fernandez, Angel F; Dominguez-Morales, Manuel J; Jimenez-Moreno, Gabriel

    2018-02-01

    Auscultation is one of the most used techniques for detecting cardiovascular diseases, which is one of the main causes of death in the world. Heart murmurs are the most common abnormal finding when a patient visits the physician for auscultation. These heart sounds can either be innocent, which are harmless, or abnormal, which may be a sign of a more serious heart condition. However, the accuracy rate of primary care physicians and expert cardiologists when auscultating is not good enough to avoid most of both type-I (healthy patients are sent for echocardiogram) and type-II (pathological patients are sent home without medication or treatment) errors made. In this paper, the authors present a novel convolutional neural network based tool for classifying between healthy people and pathological patients using a neuromorphic auditory sensor for FPGA that is able to decompose the audio into frequency bands in real time. For this purpose, different networks have been trained with the heart murmur information contained in heart sound recordings obtained from nine different heart sound databases sourced from multiple research groups. These samples are segmented and preprocessed using the neuromorphic auditory sensor to decompose their audio information into frequency bands and, after that, sonogram images with the same size are generated. These images have been used to train and test different convolutional neural network architectures. The best results have been obtained with a modified version of the AlexNet model, achieving 97% accuracy (specificity: 95.12%, sensitivity: 93.20%, PhysioNet/CinC Challenge 2016 score: 0.9416). This tool could aid cardiologists and primary care physicians in the auscultation process, improving the decision making task and reducing type-I and type-II errors.

  19. Visualization of Heart Sounds and Motion Using Multichannel Sensor

    Science.gov (United States)

    Nogata, Fumio; Yokota, Yasunari; Kawamura, Yoko

    2010-06-01

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

  20. Oscillometric and auscultatory blood pressure measurement methods in children: a systematic review and meta-analysis.

    Science.gov (United States)

    Duncombe, Stephanie L; Voss, Christine; Harris, Kevin C

    2017-02-01

    The phase-out of mercury from clinical settings calls for valid alternatives to assess blood pressure (BP) in children. Aneroid devices provide a mercury-free alternative to BP measurements by auscultation, whereas oscillometric (automated) devices are increasingly becoming the norm in clinical practice due to their ease of use. The aim of this systematic review and meta-analysis was to investigate the accuracy of oscillometric and aneroid BP devices compared with the mercury sphygmomanometer for the measurement of BP in children. We systematically searched four electronic databases (MEDLINE, Embase, CINAHL, and Web of Science) and relevant journals for eligible articles published before 30 July 2015. We screened 1415 articles, and two authors independently reviewed 92 full-text articles. We included 29 articles (38 studies) with 26 879 children. Random-effects model meta-analyses revealed that oscillometric devices yield higher measurements of SBP than auscultation with a mercury sphygmomanometer (pooled effect estimate 2.53 mmHg; 95% CI 0.57-4.50; P devices and found comparable results. Oscillometric devices may serve as a suitable alternative to auscultation for initial BP screening in the pediatric population.

  1. An open real-time tele-stethoscopy system

    Directory of Open Access Journals (Sweden)

    Foche-Perez Ignacio

    2012-08-01

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

  2. A comparative analysis of DBSCAN, K-means, and quadratic variation algorithms for automatic identification of swallows from swallowing accelerometry signals.

    Science.gov (United States)

    Dudik, Joshua M; Kurosu, Atsuko; Coyle, James L; Sejdić, Ervin

    2015-04-01

    Cervical auscultation with high resolution sensors is currently under consideration as a method of automatically screening for specific swallowing abnormalities. To be clinically useful without human involvement, any devices based on cervical auscultation should be able to detect specified swallowing events in an automatic manner. In this paper, we comparatively analyze the density-based spatial clustering of applications with noise algorithm (DBSCAN), a k-means based algorithm, and an algorithm based on quadratic variation as methods of differentiating periods of swallowing activity from periods of time without swallows. These algorithms utilized swallowing vibration data exclusively and compared the results to a gold standard measure of swallowing duration. Data was collected from 23 subjects that were actively suffering from swallowing difficulties. Comparing the performance of the DBSCAN algorithm with a proven segmentation algorithm that utilizes k-means clustering demonstrated that the DBSCAN algorithm had a higher sensitivity and correctly segmented more swallows. Comparing its performance with a threshold-based algorithm that utilized the quadratic variation of the signal showed that the DBSCAN algorithm offered no direct increase in performance. However, it offered several other benefits including a faster run time and more consistent performance between patients. All algorithms showed noticeable differentiation from the endpoints provided by a videofluoroscopy examination as well as reduced sensitivity. In summary, we showed that the DBSCAN algorithm is a viable method for detecting the occurrence of a swallowing event using cervical auscultation signals, but significant work must be done to improve its performance before it can be implemented in an unsupervised manner. Copyright © 2015 Elsevier Ltd. All rights reserved.

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

    Science.gov (United States)

    Shivaram, Pushpa; Ahmed, Molla Imaduddin; Kariyanna, Pramod Theetha; Sabbineni, Harika; Avula, Uma Mahesh R

    2013-01-01

    Doppler echocardiography has been demonstrated to be accurate in diagnosing valvular lesions in rheumatic heart disease (RHD) when compared to clinical evaluation alone. 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. 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. 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 demonstrate the advantages of Doppler echocardiography, paving the way

  4. 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

  5. Everything that wheezes… Late presentation of an aspirated foreign body as a cause of near fatal respiratory distress

    OpenAIRE

    L. Hindle*

    2013-01-01

    Aspirated foreign bodies are a common cause of mortality in children. They can be difficult to diagnose if the aspiration is not witnessed or if the object is not radiopaque, as this case illustrates. Case report: A 4 year old boy with a history of previous TB presented with respiratory distress after a week of fever and cough. No history of choking or foreign body was elicited. On examination the child was distressed, hypoxic and febrile. On auscultation bilateral coarse crackles and an e...

  6. Giant Coronary Arterial Aneurysm of the Proximal Left Anterior Descending Artery as the Cause of Wide Splitting of the Second Heart Sound.

    Science.gov (United States)

    Nagasawa, Akira; Mori, Shumpei; Akita, Tomomi; Yamada, Haruhi; Oki, Tsumugi; Nishii, Tatsuya; Yamashita, Tomoya; Okita, Yutaka; Hirata, Ken-Ichi

    2017-12-21

    Even in modern clinical cardiology, basic auscultation skill is not obsolete and is still important because it can always provide a clue to an underlying pathophysiology. We demonstrate an unusual mechanism of pathological wide splitting of the second heart sound due to external compression of the pulmonary trunk in a patient with a giant coronary arterial aneurysm of the proximal left anterior descending artery. Echocardiography, when combined with a three-dimensional anatomical analysis with cardiac computed tomography, was useful for elucidating the mechanism of the abnormal heart sounds.

  7. Valvular dysplasia and congestive heart failure in a juvenile African penguin (Spheniscus demersus).

    Science.gov (United States)

    McNaughton, Allyson; Frasca, Salvatore; Mishra, Neha; Tuttle, Allison D

    2014-12-01

    Abstract: An aquarium-housed, 6-mo-old African penguin (Spheniscus demersus) presented with acute respiratory distress. Auscultation revealed a grade II-III systolic murmur in the absence of adventitial sounds, and an enlarged heart without pulmonary edema was seen radiographically. Echocardiographic evaluation revealed atrioventricular (AV) valvular dysplasia and ventricular enlargement. The penguin was treated with enalapril, furosemide, and pimobendan but died within 3 wk of detection of the murmur. Congenital dysplasia of the right AV valve with right atrial and ventricular dilation and ventricular hypertrophy were diagnosed on postmortem examination.

  8. Gastric outlet obstruction from a caecal volvulus, herniated through epiploic foramen: a case report

    Science.gov (United States)

    Ray, Kausik; Snowden, Claire; Khatri, Kamran; Mcfall, Malcolm

    2009-01-01

    A 55-year-old woman presented with sudden onset upper abdominal pain and vomiting. On examination she had tender epigastric mass with “succusion splash” on auscultation. Straight abdominal x ray showed a distended and displaced stomach with another gas filled viscus around it. Subsequent computed tomography suggested caecal volvulus herniated through the epiploic foramen obstructing the gastric outlet. The patient underwent reduction of the internal hernia and right hemicolectomy. Postoperative recovery was uneventful. Herniation of caecal volvulus through the epiploic foramen is a very rare condition and its presentation as a gastric outlet obstruction has not been reported before. PMID:21747900

  9. [The bicentenary of Josef Skoda's birth (1805-1881). An innovator in the field of the physical examination].

    Science.gov (United States)

    Sedivy, Roland

    2006-03-01

    The bicentenary of Josef Skoda's birth (December 10(th) 2005) was seen as an excellent opportunity to review his accomplishments for internal medicine. He extended the physical examination, namely percussion and auscultation, and established the scientific basis for these techniques. While Skoda's predecessors interpreted sounds and murmurs by natural philosophy and phenomenologically, Skoda established diagnoses based on empirical and experimental investigations. He compared diagnostic findings with post mortem results at Rokitansky's morgue. Thus, Skoda's work led to the modern capabilities of the physical examination.

  10. Rupture of an aneurysm of the coronary sinus of Valsalva: diagnosis by helical CT angiography

    Energy Technology Data Exchange (ETDEWEB)

    Azarine, A.; Lions, C.; Beregi, J.P. [Dept. of Vascular Surgery, Hopital Cardiologique, CHRU de Lille (France); Koussa, M. [Dept. of Vascular Radiology, Hopital Cardiologique, CHRU de Lille (France)

    2001-08-01

    A 75-year-old man presented with a 5-day history of upper chest discomfort. On auscultation, there was a systolic murmur in the left parasternal area that radiated to the apex. Electrocardiography showed flat T waves in the anterior precordial leads. Chest X ray revealed mediastinal enlargement. Transthoracic echocardiography showed a dilated proximal ascending aorta with moderate aortic regurgitation. A contrast-enhanced helical CT scan, performed to eliminate an aortic dissection, showed a ruptured left coronary sinus of Valsalva aneurysm, confirmed at surgery. This case highlights the fact that helical CT, in patients with suspected aortic dissection, may reveal other pathology that accounts for the clinical presentation. (orig.)

  11. Acute Pulmonary Edema Caused by a Giant Atrial Myxoma

    Directory of Open Access Journals (Sweden)

    Andrea Fisicaro

    2013-01-01

    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.

  12. Value of noninvasive diagnostic procedures in cardiology: typical findings in hypertrophic obstructive cardiomyopathy

    Energy Technology Data Exchange (ETDEWEB)

    Riebeling, V.; Bubenheimer, P.

    1984-06-01

    Routine chest X-ray often yields poor information for diagnosis of heart disease. The diagnostic value of invasive procedures in cardiology is generally accepted. The patient's as well as the physician's risk of the examination, however, has to be considered. A high number of heart diseases, e.g. hypertrophic obstructive cardiomyopathy (HOCM) is mainly detected by noninvasive procedures such as auscultation, electrocardiography, phonomechanocardiography, echocardiography, physical manoeuvres, and pharmacological provocation tests. Typical findings in hypertrophic obstructive cardiomyopathy are demonstrated.

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

    Directory of Open Access Journals (Sweden)

    Stibane, Tina

    2016-08-01

    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.

  14. A case of acute respiratory failure in a young man

    Directory of Open Access Journals (Sweden)

    Fabio Di Stefano

    2007-06-01

    Full Text Available A 40 years old man presents with a few hours history of progressive dyspnea. He was suffering from almost a week of low grade fever. The night before the onset of dyspnea he had high fever (39,5°C, polyuria and dysuria. His blood pressure is 115/65 mmHg and his oxygen saturation while breathing ambient air is 81%. Chest auscultation reveals rales bilaterally. A chest radiography shows bilateral pulmonary infiltrates consistent with pulmonary edema. How should this patient be evaluated to establish the cause of the acute pulmonary edema and to determine appropriate therapy?

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

    Directory of Open Access Journals (Sweden)

    Shima Sheybani

    2014-10-01

    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.

  16. La Hongrie et les minorités magyares. Une relation complexe à l'heure de l'intégration européenne

    OpenAIRE

    Capelle-Pogacean, Antonela

    2003-01-01

    Relancées au début des années 1990, suivies d'un œil inquiet dans quelques capitales de la région craignant des manifestations d'irrédentisme, auscultées à l'Ouest dans la perspective de la stabilité régionale, les relations de la Hongrie avec les quelque 2,6 millions de Magyars, citoyens des Etats voisins se développent depuis plusieurs années dans un climat désormais plus apaisé (...).

  17. CT pulmonay angiography features of a hepatopulmonary syndrome

    Energy Technology Data Exchange (ETDEWEB)

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

    2015-08-15

    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.

  18. CT pulmonay angiography features of a hepatopulmonary syndrome

    International Nuclear Information System (INIS)

    Chawla, Ashish; Gaikwad, Vishai; Dubey, Niraj; Bosco, Jerome

    2015-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    Gudrun Björkhem

    2006-09-01

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

  20. Chronic hypersensitivity pneumonitis.

    Science.gov (United States)

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

    2016-01-01

    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.

  1. [Synchronous playing and acquiring of heart sounds and electrocardiogram based on labVIEW].

    Science.gov (United States)

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

    2008-12-01

    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.

  2. Mixoma recidivante: Diagnóstico ecocardiográfico bi y tridimensional

    OpenAIRE

    Vázquez-Antona,Clara A; Roldan,Francisco Javier; Erdmenger Orellana,Julio; Romero-Cárdenas,Ángel; Buendía,Alfonso; Vargas-Barrón,Jesús

    2005-01-01

    Se presenta el caso clínico y ecocardiográfico de una paciente en edad pediátrica con mixomas recidivantes, que se manifiesta a los 16 años con embolismo cerebral. Se detecta mixoma auricular izquierdo y se realiza resección quirúrgica y electrocoagulación. A los 40 meses de seguimiento inicia con disnea de grandes esfuerzos, auscultándose soplo expulsivo aórtico. El ecocardiograma bidimensional muestra la presencia de 3 masas tumorales: en aurícula y ventrículo izquierdo y en ventrículo dere...

  3. Collecting, archiving, and sharing of digitized medical information.

    Science.gov (United States)

    Campbell, W E

    1996-05-01

    Telemedicine is the practice of medicine via telephony. Telemedicine has developed into an affordable, indispensable tool for use by frontline veterinary clinicians, hospitals, and clinics. Board certified specialists are available via telemedicine with little more difficulty than making a long distance telephone call. Current technology allows clinicians to refer cases via the Internet, radio waves, satellite, or land lines. Cases may include typed data, audio clips such as cardiac auscultation, high resolution imagery for radiographs, ultrasound, and microscopy. This article is a primer on digitization and transmission of images.

  4. Chest health surveillance utility in the early detection of bronchiolitis obliterans syndrome in children after allo-SCT.

    Science.gov (United States)

    Gassas, A; Craig-Barnes, H; Dell, S; Doyle, J; Schechter, T; Sung, L; Egeler, M; Palaniyar, N

    2013-06-01

    To prospectively assess whether periodic chest health surveillance is beneficial for the early detection of bronchiolitis obliterans syndrome (BOS) in children after allo-SCT. Children up to 18 years of age receiving allo-SCT from September 2009 to September 2011 were included. Surveillance consisted of the following: a 7-item respiratory system questionnaire of cough, wheeze and shortness of breath; focused physical examination; and pulmonary function test (PFT) conducted before SCT and at 1, 3, 6, 9, 12, 18 and 24 months after SCT. Thirty-nine patients were enrolled. Five children developed BOS at a median time of 192 days (range 94-282). Positive response comparisons between the BOS group vs the non-BOS group were NS for history questionnaire (P=0.2), heart rate (P=0.3), respiratory rate (P=0.3) and oxygen saturation monitoring (P=0.8). Differences between the two groups for chest auscultation and PFT were statistically significant (P=0.03 and P=0.01, respectively). However, chest auscultation in the BOS group was only positive after BOS diagnosis. PFT reduction was evident in the asymptomatic phase (BOS group 33%; non-BOS group 4.5%, P=0.01). Changes in PFT, but not history/physical examination, allow the early detection of BOS in children after SCT. Our study is limited by the small sample size.

  5. Efficient method for events detection in phonocardiographic signals

    Science.gov (United States)

    Martinez-Alajarin, Juan; Ruiz-Merino, Ramon

    2005-06-01

    The auscultation of the heart is still the first basic analysis tool used to evaluate the functional state of the heart, as well as the first indicator used to submit the patient to a cardiologist. In order to improve the diagnosis capabilities of auscultation, signal processing algorithms are currently being developed to assist the physician at primary care centers for adult and pediatric population. A basic task for the diagnosis from the phonocardiogram is to detect the events (main and additional sounds, murmurs and clicks) present in the cardiac cycle. This is usually made by applying a threshold and detecting the events that are bigger than the threshold. However, this method usually does not allow the detection of the main sounds when additional sounds and murmurs exist, or it may join several events into a unique one. In this paper we present a reliable method to detect the events present in the phonocardiogram, even in the presence of heart murmurs or additional sounds. The method detects relative maxima peaks in the amplitude envelope of the phonocardiogram, and computes a set of parameters associated with each event. Finally, a set of characteristics is extracted from each event to aid in the identification of the events. Besides, the morphology of the murmurs is also detected, which aids in the differentiation of different diseases that can occur in the same temporal localization. The algorithms have been applied to real normal heart sounds and murmurs, achieving satisfactory results.

  6. Applying cybernetic technology to diagnose human pulmonary sounds.

    Science.gov (United States)

    Chen, Mei-Yung; Chou, Cheng-Han

    2014-06-01

    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.

  7. Investigation of the efficacy of colorimetric capnometry method used to verify the correct placement of the nasogastric tube.

    Science.gov (United States)

    Erzincanli, Saadet; Zaybak, Ayten; Güler, Ayşe

    2017-02-01

    This present study was designed to determine the efficacy of the colorimetric capnometry method used to verify the correct placement of the nasogastric tube. The present study comprised forty patients who had a nasogastric tube inserted and were being monitored in the adult intensive care unit. After the insertion of the nasogastric tube, 40 colorimetric capnometry and 40 auscultation measurements were performed. Auscultation and colorimetric capnometry results were compared with tube placement results confirmed radiologically. In the confirmation of the placement of the nasogastric tube, the consistency was 97.5% (p0.05) between the auscultatory method and the radiological method. The oesophageal placement of the nasogastric tube was detected with the colorimetric capnometry method, but the gastric and duodenal insertions were not determined. While the sensitivity and specificity of the colorimetric capnometry method in determining the correct placement of the nasogastric tube were 1.00 and 0.667 respectively, those of the auscultatory method were 0.89 and 0.0 respectively. As a result, for the confirmation of the NGT placement, the colorimetric capnometry method is considered more reliable than the auscultatory method and is compatible with the radiological method. However, the colorimetric capnometry method is inadequate to distinguish between the gastric or duodenal insertion. Copyright © 2016 Elsevier Ltd. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    Melody Ni

    2014-12-01

    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.

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

    Science.gov (United States)

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

    2013-01-01

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

  10. Digital stethoscope as an innovative tool on the teaching of auscultatory skills.

    Science.gov (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

    2013-02-01

    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.

  11. Instructional Multiple Binaural Stethoscope

    Directory of Open Access Journals (Sweden)

    Catalina C. Platon

    2015-12-01

    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.

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

    Science.gov (United States)

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

    2016-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    M Amiri-Siavoshani

    2016-10-01

    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.  

  14. Development of a Smartphone App for Visualizing Heart Sounds and Murmurs.

    Science.gov (United States)

    Mamorita, Noritaka; Arisaka, Naoya; Isonaka, Risa; Kawakami, Tadashi; Takeuchi, Akihiro

    Auscultation is one of the basic techniques for the diagnosis of heart disease. However, the interpretation of heart sounds and murmurs is a highly subjective and difficult skill. To assist the auscultation skill at the bedside, a handy phonocardiogram was developed using a smartphone (Samsung Galaxy J, Android OS 4.4.2) and an external microphone attached to a stethoscope. The Android app used Java classes, "AudioRecord," "AudioTrack," and "View," that recorded sounds, replayed sounds, and plotted sound waves, respectively. Sound waves were visualized in real-time, simultaneously replayed on the smartphone, and saved to WAV files. To confirm the availability of the app, 26 kinds of heart sounds and murmurs sounded on a human patient simulator were recorded using three different methods: a bell-type stethoscope, a diaphragm-type stethoscope, and a direct external microphone without a stethoscope. The recorded waveforms were subjectively confirmed and were found to be similar to the reference waveforms. The real-time visualization of the sound waves on the smartphone may help novices to readily recognize and learn to distinguish the various heart sounds and murmurs in real-time. © 2017 S. Karger AG, Basel.

  15. Clinical assessment compared with chest X-Ray after removal of chest tube to diagnose pneumothorax

    International Nuclear Information System (INIS)

    Majeed, F. A.; Noor, Q. U. H.; Mehmood, U.; Imtiaz, T.; Zafar, U.

    2017-01-01

    Objective: To evaluate clinical judgment in ruling out pneumothorax during the removal of the chest tube by auscultating the chest before removal and after the extubation of the chest tube in comparison to x ray radiological results. Study Design: Descriptive cross sectional study. Place and Duration of Study: Combined Military Hospital (CMH) Lahore Pakistan, from August 2015 to March 2016. Material and Methods: A sample size of 100 was calculated. Patients were selected via non probability purposive sampling. Children under 14 years were not included. The patients with mal-positioned chest tube, surgical site infection, air leak and the patients with more than one chest tube on one side were excluded. A proforma was made and filled by one person. Chest tubes were removed by two trained senior registrars according to a protocol devised. It was ensured that there was no air leak present before removal clinically and radiologically. Another chest x-ray was done within 24 hours of extubation to detect any pathology that might have occurred during the process. Any complication in the patient clinically was observed till the x-ray film became available. Two sets of readings were obtained. Set A included auscultation findings and set B included x ray results. Results: Out of 100 patients, 60 (60 percent) were males and 40 (40 percent) females. The ages of the patients ranged between 17-77 years. Mean age of the patient was 43.27 ± 17.05 years. In set A out of 100 (100 percent) no pneumothorax developed clinically. In set B out of 100 patients 99 (99 percent) showed no pneumothorax on chest x ray, only 1 (1 percent) showed pneumothorax which was not significant (less than 15 percent on X ray). However, the patient remained asymptomatic clinically and there was no need of reinsertion of the chest tube. Conclusion: Auscultatory findings in diagnosing a significant pneumothorax are justified. Hence, if the chest tube is removed according to the protocol, clinically by

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

    Directory of Open Access Journals (Sweden)

    Salleh SH

    2012-06-01

    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

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

    Directory of Open Access Journals (Sweden)

    Marchamalo, M.

    2011-06-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Ali Dabbagh

    2011-09-01

    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.

  19. The effectiveness of the wavelet transforms method in the heart sounds analysis.

    Science.gov (United States)

    Debbal, S M; Bereksi-Reguig, F

    2009-01-01

    Heart sounds can be used more efficiently by medical doctors when they are displayed visually, rather through a conventional stethoscope. Heart sounds provide clinicians with valuable diagnostic and prognostic information. Although heart sound analysis by auscultation is convenient as a clinical tool, heart sound signals are so complex and non-stationary that they are very difficult to analyse in time or frequency domains. We have studied the extraction of features from heart sounds in the time-frequency domain for recognition of heart sounds through time-frequency analysis. The application of wavelet transform for the heart sounds is thus described. The performance of continuous wavelet transform, discrete wavelet transform and packet wavelet transform is discussed in this paper. After these transformations, we can compare normal and abnormal heart sounds to verify clinical usefulness of our extraction methods for recognition of heart sounds.

  20. Frequency shifting approach towards textual transcription of heartbeat sounds

    Directory of Open Access Journals (Sweden)

    Safar Khorasani Ehsan

    2011-10-01

    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.

  1. Detecting fetal heart sounds by means of Fractal Dimension analysis in the Wavelet domain.

    Science.gov (United States)

    Koutsiana, E; Hadjileontiadis, L J; Chouvarda, I; Khandoker, A H

    2017-07-01

    Phonocardiography is a low-cost technique for the detection of fetal heart sounds (FHS) that can extend clinical auscultation in mobile and home care setups. The work presented here examines the transferability of a Wavelet Transform (WT)-based method that combines also Fractal Dimension (FD) analysis, previously proposed as WT-FD for the cases of lung and bowel sound analysis [4], to the extraction of FHSs. The WT-FD method has been evaluated with 12 simulated FHS signals and has shown promising results in terms of accuracy and performance (89%) in identifying the location of heartbeat, even in cases of signals with additive noise up to (6dB). This robustness paves the way for WT-FD testing in real FHSs, recorded under clinical setting, clearly contributing to better evaluation of the fetal heart functionality.

  2. Why should you model time when you use Markov models for heart sound analysis.

    Science.gov (United States)

    Oliveira, Jorge; Mantadelis, Theofrastos; Coimbra, Miguel

    2016-08-01

    Auscultation is a widely used technique in clinical activity to diagnose heart diseases. However, heart sounds are difficult to interpret because a) of events with very short temporal onset between them (tens of milliseconds) and b) dominant frequencies that are out of the human audible spectrum. In this paper, we propose a model to segment heart sounds using a semi-hidden Markov model instead of a hidden Markov model. Our model in difference from the state-of-the-art hidden Markov models takes in account the temporal constraints that exist in heart cycles. We experimentally confirm that semi-hidden Markov models are able to recreate the "true" continuous state sequence more accurately than hidden Markov models. We achieved a mean error rate per sample of 0.23.

  3. [Spectral analysis and LDB based classification of heart sounds with mechanical prosthetic heart valves].

    Science.gov (United States)

    Zhang, Di; Wu, Yuequan; Yao, Jianping; Yang, Song; Du, Minghui

    2011-12-01

    Auscultation, the act of listening for heart sounds to aid in the diagnosis of various heart diseases, is a widely used efficient technique by cardiologists. 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. The study on five different mechanical valves showed that only the case of perivalvular leakage could be detected by spectral estimation. Though it is possible to classify different mechanical valves by using time-frequency components of the signal directly, the recognition rate is merely 84%. However, with the improved local discriminant bases (LDB) algorithm to extract features from heart sounds, the recognition rate is 97.3%. Experimental results demonstrated that the improved LDB algorithm could improve classification rate and reduce computational complexity in comparison with original LDB algorithm.

  4. Frequency shifting approach towards textual transcription of heartbeat sounds

    Science.gov (United States)

    2011-01-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  6. Extravascular Lung Water and Acute Lung Injury

    Directory of Open Access Journals (Sweden)

    Ritesh Maharaj

    2012-01-01

    Full Text Available Acute lung injury carries a high burden of morbidity and mortality and is characterised by nonhydrostatic pulmonary oedema. The aim of this paper is to highlight the role of accurate quantification of extravascular lung water in diagnosis, management, and prognosis in “acute lung injury” and “acute respiratory distress syndrome”. Several studies have verified the accuracy of both the single and the double transpulmonary thermal indicator techniques. Both experimental and clinical studies were searched in PUBMED using the term “extravascular lung water” and “acute lung injury”. Extravascular lung water measurement offers information not otherwise available by other methods such as chest radiography, arterial blood gas, and chest auscultation at the bedside. Recent data have highlighted the role of extravascular lung water in response to treatment to guide fluid therapy and ventilator strategies. The quantification of extravascular lung water may predict mortality and multiorgan dysfunction. The limitations of the dilution method are also discussed.

  7. VII CORENDE. Abstracts book

    International Nuclear Information System (INIS)

    2009-01-01

    This book contains the papers presented at the Regional Congress of Nondestructive Testing and Structural organized by the Argentine Association of Non-Destructive Testing and Structural, with the support of institutions, companies and academic institutions. The papers present an overview of the state-of-the-art of the latest developments and applications in the various nondestructive testing and structural. The articles are presented in ten sessions, each of which integrates work transcending disciplinary boundaries of nondestructive testing and structural disciplines such as auscultation of equipment, structures, welding, life management and quality control in the areas of electricity generation (hydraulic, thermal and nuclear), steel, automotive, food processing, aerospace, civil structures, artwork, services and insurance companies, industrial maintenance and inspection. [es

  8. 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.

    2013-06-01

    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.

  9. Frequent left ventricular hypertrophy independent of blood pressure in 1851 pre-western Inuit

    DEFF Research Database (Denmark)

    Andersen, Stig; Kjærgaard, Marie; Jørgensen, Marit Eika

    2011-01-01

    only after the age of 40 years in pre-western Inuit. Left ventricular hypertrophy peaked among 30-year olds and was independent of elevated blood pressure. It may be speculated that the common left ventricular hypertrophy was due to marked physical activity that contributed to the low occurrence......BACKGROUND: Elevated blood pressure is a risk factor for cardiovascular disease and may be detected by left ventricular hypertrophy (LVH) in electrocardiogram (ECG). Pre-western Inuit had frequent signs of LVH in ECG predominantly in the 3rd decade while a low occurrence of ischemic heart disease....... METHODS: We evaluated the association between blood pressures and ECG signs of LVH, cardiac auscultation, and symptoms related to heart disease in the recently recovered data from the survey of 1851 Inuit conducted in 1962-1964 in East Greenland. RESULTS: The participation rate was 97%. Among the 812...

  10. Techniques for Non-Invasive Monitoring of Arterial Blood Pressure

    Directory of Open Access Journals (Sweden)

    Agnes S. Meidert

    2018-01-01

    Full Text Available Since both, hypotension and hypertension, can potentially impair the function of vital organs such as heart, brain, or kidneys, monitoring of arterial blood pressure (BP is a mainstay of hemodynamic monitoring in acutely or critically ill patients. Arterial BP can either be obtained invasively via an arterial catheter or non-invasively. Non-invasive BP measurement provides either intermittent or continuous readings. Most commonly, an occluding upper arm cuff is used for intermittent non-invasive monitoring. BP values are then obtained either manually (by auscultation of Korotkoff sounds or palpation or automatically (e.g., by oscillometry. For continuous non-invasive BP monitoring, the volume clamp method or arterial applanation tonometry can be used. Both techniques enable the arterial waveform and BP values to be obtained continuously. This article describes the different techniques for non-invasive BP measurement, their advantages and limitations, and their clinical applicability.

  11. Emergence of co-trimoxazole resistant Nocardia brasiliensis causing fatal pneumonia.

    Science.gov (United States)

    Khare, Vineeta; Gupta, Prashant; Himanshu, D; Kumar, Deepak

    2013-04-17

    An 85-year-old man was admitted to the medical intensive care unit with a 10-day history of severe breathlessness, fever and cough. The patient was known to have chronic obstructive pulmonary disease and had been receiving corticosteroids in the preceding 18 months. He had been treated for tuberculosis 2.5 years previously. On examination he was febrile, tachycardic with a respiratory rate of 46/min. Auscultation revealed bilateral crepitation's and wheeze. Chest radiograph revealed patchy infiltrates on right lung. The patient developed respiratory depression and was mechanically ventilated. His sputum and endotracheal aspirates revealed Nocardia brasiliensis on culture which was found to be co-trimoxazole resistant. Once this became known imipenem was substituted for co-trimoxazole but unfortunately condition of the patient did not improve and he died following a cardiac arrest.

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

    Directory of Open Access Journals (Sweden)

    Catherine Miller

    2013-07-01

    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.hypothèses.org. Un des grands mérites de cet ouvrage est de dépasser l’actualité immédiate pour fournir un panorama syn...

  13. Remote auscultatory patient monitoring during magnetic resonance imaging

    DEFF Research Database (Denmark)

    Henneberg, S; Hök, B; Wiklund, L

    1992-01-01

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

  14. Aller, revenir, tisser un abri : Route One/USA, de Robert Kramer (1989)

    OpenAIRE

    Chamerois, Gilles

    2013-01-01

    Route One/USA marque le temporaire retour d’exil du cinéaste américain Robert Kramer. Dans un mélange de documentaire et de fiction typique du cinéaste, celui-ci ausculte le pouls du pays à la veille des élections de 1988, sous la double figure de Doc, qui va de rencontre en rencontre le long de la route éponyme, et de Robert qui le filme. Le film établit le diagnostic d’une société malade de ne plus pouvoir raccrocher ses mots à sa réalité et à son histoire, mais il se veut aussi remède, et ...

  15. A floating right heart thrombus in transit across tricuspid valve causing an endocardial friction rub

    Directory of Open Access Journals (Sweden)

    Babu Kanjirakadavath

    2013-07-01

    Full Text Available We report a 42-year-old lady on combined oral contraceptive pills with deep venous thrombosis and mild pulmonary embolism, who developed shock, while being treated with heparin. On auscultation, there was an unexpected loud, superficial, squeaky, triphasic friction rub over the left lower parasternal area. Simultaneous echocardiogram revealed a large serpiginous, freely floating mass in right atrium, prolapsing freely to right ventricular inlet across the tricuspid valve. The endocardial friction rub persisted for about 24 h as long as the thrombus was intracardiac and disappeared when the thrombus disappeared from right heart, occluding the proximal left pulmonary artery. She died due to shock awaiting surgery. We highlight that such a rub in a patient with deep venous thrombosis, though rare, may be an important clue to impending pulmonary embolism.

  16. Pneumothorax occurring after nasogastric tube removal

    Science.gov (United States)

    Paul, Vishesh; Shenoy, Amith; Kupfer, Yizhak; Tessler, Sidney

    2013-01-01

    An 85-year-old woman with failure to thrive due to poor oral intake was admitted owing to dehydration. A nasogastric (NG) tube was inserted for the initiation of enteral feedings. The tube position was confirmed by gastric auscultation after insufflating air through the tube. A chest X-ray revealed that the NG tube traversed the right main stem bronchus with its tip ending in the right costophrenic angle adjacent to the pleura. No pneumothorax was identified. The tube was removed and a short while later the patient developed mild chest discomfort. A repeat chest X-ray revealed significant pneumothorax on the right side. She was treated conservatively with 100% oxygen with successful resolution of the pneumothorax. PMID:24296770

  17. Using urea dilution to standardise cellular and non-cellular components of pleural and bronchoalveolar lavage (BAL) fluids in the cat.

    Science.gov (United States)

    Mills, Paul C; Litster, Annette

    2006-04-01

    A technique to standardise the analysis of cellular and non-cellular components in epithelial lining fluid (ELF) collected during saline lavage of pulmonary and pleural cavities was developed using the urea dilution method. Bronchoalveolar lavage (BAL) and pleural lavage (PL) fluids were collected from 12 clinically healthy cats. Total and differential cell counts in BAL fluid were within normal ranges for the cat, while cell counts in PL fluid were assumed to be normal based on clinical health during examination, auscultation and lactate dehydrogenase (LDH) activities being comparable with other species. The major clinical implication of this study was that nucleated cell counts within feline ELF could not be predicted from analysis of lavage fluid which suggests that calculation of the proportion of ELF in lavage fluid by the urea dilution method may be necessary to avoid misdiagnosis of health or disease in pulmonary or pleural cavities.

  18. Pain in the chest in a user of cocaine

    International Nuclear Information System (INIS)

    Wiener, M.D.; Putnam, C.E.

    1987-01-01

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

  19. Analysis of Respiratory Sounds: State of the Art

    Directory of Open Access Journals (Sweden)

    Sandra Reichert

    2008-01-01

    Full Text Available Objective This paper describes state of the art, scientific publications and ongoing research related to the methods of analysis of respiratory sounds. Methods and material Review of the current medical and technological literature using Pubmed and personal experience. Results The study includes a description of the various techniques that are being used to collect auscultation sounds, a physical description of known pathologic sounds for which automatic detection tools were developed. Modern tools are based on artificial intelligence and on technics such as artificial neural networks, fuzzy systems, and genetic algorithms… Conclusion The next step will consist in finding new markers so as to increase the efficiency of decision aid algorithms and tools.

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

    Science.gov (United States)

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

    2015-03-01

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

  1. Lymphoma and broncho-pneumonia in a calf

    International Nuclear Information System (INIS)

    Lallemand, M.; Francoz, D.; Latouche, J.S.

    2005-01-01

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

  2. 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

    2012-01-01

    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......-TNF-alpha agents. Screening should take place for both active tuberculosis and latent tuberculosis. Screening must evaluate the risk of hepatitis B exposure/infection and that of other viral infections such as human immunodeficiency virus (HIV) and varicella zoster virus (VZV). The assessment should include...... should be administered in accordance with the guidelines of the National Board of Health of Denmark. In patients without a prior VZV infection, VZV vaccination may be considered. Information for patients: Anti-TNF-alpha treatment results in a generally increased risk of infection and latent tuberculosis...

  3. Nuclear technology for peace and progress

    International Nuclear Information System (INIS)

    Cordero Calderon, C.F.

    1997-01-01

    It is important, to become aware of the new worries arisen to the light of the last events happened in Costa Rica, as in other countries, which have had a particular impact within the activities of the Costa Rican Institute of Electricity. In the field of the topography, particularly, it has developed the so call auscultation of works, in order to carry out better and to expand the registration of the behavior of the main projects of engineering, diagnostic its operation and to offer efficient and opportune solutions to delicate situations by means of new or improved technology. It also contemplates the alternative of carrying out investigations that permit to adopt new measured of control before any eventuality. (S. Grainger) [es

  4. Social Networks as Enablers of Enterprise Creativity: Evidence from Portuguese Firms and Users

    Directory of Open Access Journals (Sweden)

    Silvia Fernandes

    2016-06-01

    Full Text Available The present work analyzes the profiles of social networks’ users, individuals and enterprises in Algarve (Portugal, having accomplished online questionnaires. Samples of 230 users and 70 firms were collected. According to data obtained there are different behaviors. Users’ results highlight the need of harnessing the potential of recruitment and business projects through social networks, as searching for knowledge, communication and professional relations are expressive. Firms’ results reveal two types of social networks’ use: 1 knowledge search, interact with customers, launch new products; and 2 potential for marketing. Users’ desire of expressing own ideas and being creative had low importance. In social networks they auscultate more about what others are doing than revealing own aspirations. Here firms can act in order to shape users’ attitudes and preferences to their creativity. Thus, enterprises can use the first level of social networks (knowledge and product-customer interaction in order to enhance the second level (marketing and innovation.

  5. Sensitivity of bronchial responsiveness measurements in young infants

    DEFF Research Database (Denmark)

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

    2006-01-01

    OBJECTIVES: There is limited evidence on the preferred methods for evaluating lung function in infancy. The objective of this study was to compare sensitivity and repeatability of indexes of lung function in young infants during induced airway obstruction. METHODS: The study population consisted...... of variations for Ptco(2) and FEV(0.5) were 4% and 7%, respectively. CONCLUSIONS: Ptco(2) and FEV(0.5) are the most sensitive parameters for measurement of bronchial responsiveness in young infants. Measurements of baseline lung function should preferably be made using FEV(0.5.) Measurements of bronchial...... 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...

  6. 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

    2016-02-01

    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.

  7. Respiratory status of adult patients in the postoperative period of thoracic or upper abdominal surgeries 1

    Science.gov (United States)

    Almeida, Alana Gomes de Araujo; Pascoal, Lívia Maia; Santos, Francisco Dimitre Rodrigo Pereira; Lima, Pedro Martins; Nunes, Simony Fabíola Lopes; de Sousa, Vanessa Emille Carvalho

    2017-01-01

    ABSTRACT Objective: to evaluate the respiratory status of postoperative adult patients by assessing the nursing outcome Respiratory Status. Method: descriptive, cross-sectional study developed with 312 patients. Eighteen NOC indicators were assessed and rated using a Likert-scale questionnaire and definitions. Descriptive and correlative analysis were conducted. Results: the most compromised clinical indicators were coughing (65.5%), auscultated breath sounds (55%), and respiratory rate (51.3%). Factors associated with worse NOC ratings in specific clinical indicators were sex, age, pain, and general anesthesia. Conclusions: certain clinical indicators of respiratory status were more compromised than others in postoperative patients. Patient and context-related variables can affect the level of respiratory compromise. PMID:29211198

  8. TRANSPOSICION DIDACTICA DEL MODELO CIENTIFICO DE LEWIS-LANGMUIR

    Directory of Open Access Journals (Sweden)

    Janneth Isabel Herreño Chaves

    2010-04-01

    Full Text Available Este artículo presenta las conclusiones obtenidas en un proyecto de investigación, en el que se auscultó la transposición didáctica que hacen del modelo de Lewis-Langmuir, diez de los textos para la enseñanza de la química más empleados por algunos profesores universitarios y de educación secundaria. Para el análisis se tuvo en cuenta lo histórico, lo epistemológico y lo didáctico. Los resultados muestran que en estos textos no hay referencia a la historia de la construcción del modelo y solo se reducen a la utilización didáctica de las fórmulas de Lewis. Tampoco aluden al papel cumplido por I. Langmuir en la divulgación de dicho modelo.

  9. 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.

    2016-01-01

    : In the Danish Kennel Club mandatory breeding scheme, 997 purebred CKCS were examined during the period 2002-2011. Each dog was evaluated 1-4 times with a total of 1,380 examinations. Methods: Auscultation and echocardiography were performed to evaluate mitral regurgitation murmur severity and degree of mitral...... valve prolapse (MVP). The odds of having mitral regurgitation murmur or MVP > grade 1 in 2010-2011 compared to 2002-2003 were estimated using logistic regression analysis including age and sex as covariates. Odds were estimated for dogs that were products of the breeding scheme (defined as dogs...... with both parents approved by the breeding scheme before breeding) and non-products of the breeding scheme (defined as dogs with at least 1 parent with unknown cardiac status). Results: In 2010-2011, the odds of having mitral regurgitation murmur were 0.27 if dogs were a product of the breeding scheme...

  10. [Foreign body aspiration in children].

    Science.gov (United States)

    Ibarz, J A Esteban; Samitier, A Sáinz; Alvira, R Delgado; Prades, P Burgués; Martínez-Pardo, N González; Pollina, J Elías

    2007-01-01

    The aim to this study is evaluate the history, symptoms, radiographic and endoscopic findings in 420 children who were admitted for suspected foreign body aspiration in our hospital between 1972 and 2005. In 13 children we didn't find foreign body and in 16 children the foreign bodies were lodged in larynx. The mean age was 33 months. The medical history, phisical exploration, auscultation and radiological findings were positive in 91,4%, 78,3%, 91,6% and 81%. The frecuency or foreign body aspiration is undervaluate and sometimes is excluded as diagnosis. Only 218 (51,9%) patients went to the hospital in the first 24 hours, although 87,8% of patients presented symptoms and 75,4% presented severe symptoms. Moreover the removed foreign bodies and suspected foreign bodies are the same in 82,95%. We think that bronchoscopy should by performed in all children who have had a choking episode.

  11. The value of the physical examination in clinical practice: an international survey.

    Science.gov (United States)

    Elder, Andrew T; McManus, I Chris; Patrick, Alan; Nair, Kichu; Vaughan, Louella; Dacre, Jane

    2017-12-01

    A structured online survey was used to establish the views of 2,684 practising clinicians of all ages in multiple countries about the value of the physical examination in the contemporary practice of internal medicine. 70% felt that physical examination was 'almost always valuable' in acute general medical referrals. 66% of trainees felt that they were never observed by a consultant when undertaking physical examination and 31% that consultants never demonstrated their use of the physical examination to them. Auscultation for pulmonary wheezes and crackles were the two signs most likely to be rated as frequently used and useful, with the character of the jugular venous waveform most likely to be rated as -infrequently used and not useful. Physicians in contemporary hospital general medical practice continue to value the contribution of the physical examination to assessment of outpatients and inpatients, but, in the opinion of trainees, teaching and demonstration could be improved. © Royal College of Physicians 2017. All rights reserved.

  12. A successful treatment for concomitant injury of the coronary artery and tricuspid valve after blunt chest trauma.

    Science.gov (United States)

    Kikuchi, Chizuo; Motohashi, Shinya; Takahashi, Yoshiki; Nakazawa, Satoshi; Kanazawa, Hiroshi

    2015-11-01

    A 63-year-old woman involved in an automobile accident was brought to our hospital with thoracic injury sustained by the impact of her vehicle's steering wheel. Cardiac auscultation revealed a grade III/VI systolic murmur and the electrocardiogram showed ST elevation in leads 2, 3 and aVF. A 2D echocardiogram revealed severe tricuspid regurgitation and a hypokinetic right ventricle. Coronary angiography revealed dissection of the proximal right coronary artery (RCA) with 90 % stenosis. Urgent CABG for the RCA and tricuspid valvuloplasty were performed, as the anterior leaflet of the tricuspid valve had prolapsed as a result of chordal rupture. Blunt thoracic trauma causing both tricuspid insufficiency and coronary artery dissection is a very rare and life-threatening situation. Prompt diagnosis and timely surgery enabled us to save this patient's life.

  13. Chronic hypersensitivity pneumonitis

    Directory of Open Access Journals (Sweden)

    Pereira CA

    2016-09-01

    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

  14. Swyer-James-Macleod's syndrome. A case report

    International Nuclear Information System (INIS)

    Pacheco C, Dario; Ojeda Leon, Paulina; Varo Acosta, Humberto; Salcedo Veles, Patricia; Salazar Juan Carlos

    1998-01-01

    This is a case report about a 67 years-old female patient with respiratory syndrome of 8 years with cough and dyspnoea. End-inspiration crackles in the pulmonary auscultation were found in left hemi thorax. Chest x-ray in expiration and inspiration showed hyperluscency and air trapping in the same hemi-thorax. Chest high-resolution CT revealed a low sized, oligohemic left lung with cylindrical bronchiectasis. Perfusion scintigraphy 99Tc labeled showed markedly left lung hypo-perfusion. Mild obstructive process was found in pulmonary function test. Lung biopsy of lingula reported bronchiolitis obliterans. Considered all the results that were obtained from clinical, x-ray and histopathology, a diagnosis of Swyer-James-Macleods syndrome was made

  15. [Lung ultrasound as a tool to guide the administration of surfactant in premature neonates].

    Science.gov (United States)

    Rodríguez-Fanjul, J; Balcells Esponera, C; Moreno Hernando, J; Sarquella-Brugada, G

    2016-05-01

    The aim of this study is to assess the usefulness of lung ultrasound (LUS) to estimate the endotracheal tube (ETT) depth position during the Intubation-Surfactant-Extubation (INSURE) procedure. The ETT insertion depth was estimated using the weight (insertion depth (cm)=weight (kg)+5.5). After intubation two independent neonatologists using bilateral auscultation or LUS checked the ETT depth. Twelve newborns with respiratory distress syndrome were included. In two cases LUS helped to correctly replace the ETT. All the patients progressed well, with normal x-ray and LUS before discharge. LUS appears to be a safe and non-invasive technique and is useful in clinical situations were x-ray is not routinely performed, as it is fast and radiation free. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  16. 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

    2013-10-01

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

  17. Development of digital stethoscope for telemedicine.

    Science.gov (United States)

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

    2016-01-01

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

  18. Double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle in a calf.

    Science.gov (United States)

    Newhard, D K; Jung, S W; Winter, R L; Kuca, T; Bayne, J; Passler, T

    2017-04-01

    A 3-day-old Hereford heifer calf presented for evaluation of lethargy and dyspnea, with persistent hypoxia despite supplemental oxygen therapy. A grade III/VI right apical systolic murmur was noted during cardiac auscultation. Echocardiography revealed a double-outlet right ventricle with an intact interventricular septum and concurrent hypoplastic left ventricle and tricuspid valve dysplasia. Post-mortem examination revealed additional congenital anomalies of ductus arteriosus, patent foramen ovale, and persistent left cranial vena cava. This report illustrates the use of echocardiographic images to diagnose a double-outlet right ventricle with an intact interventricular septum and a hypoplastic left ventricle in a calf. Copyright © 2016 Elsevier B.V. All rights reserved.

  19. An interesting case of cor pulmonale

    Directory of Open Access Journals (Sweden)

    Bagrecha Manish V, Kunkulol Rahul R

    2013-01-01

    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.

  20. Acute Pericarditis Following Acute Pulmonary Thromboembolism.

    Science.gov (United States)

    Nakata, Akio; Aburadani, Isao; Kontani, Koichirou; Hirota, Satoshi

    2017-12-12

    We describe the case of a 45-year-old Japanese man who developed acute pericarditis following an acute pulmonary thromboembolism. He had developed shortness of breath 7 days prior to hospitalization and was admitted with severe dyspnea. Echocardiography and laboratory results were compatible with acute pulmonary thromboembolism, which was confirmed by contrast-enhanced chest computed tomography. On the third hospital day, he experienced chest pain exacerbated by inspiration. On the fourth hospital day, his body temperature increased to 39°C and echocardiography revealed circumferential pericardial effusion. A diagnosis of acute pericarditis was made and the patient was treated with colchicine and aspirin. On the fifth hospital day, his symptoms largely subsided. Auscultation revealed pericardial friction rub. Electrocardiography demonstrated diffuse ST-segment elevations. Twenty-four days later, computed tomography revealed the disappearance of both the pericardial effusion and pulmonary arterial emboli. This case was thought to be one of acute pericarditis following acute pulmonary thromboembolism.

  1. Combined pulmonary fibrosis and emphysema in hypersensitivity pneumonitis.

    Science.gov (United States)

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

    2015-12-21

    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. 2015 BMJ Publishing Group Ltd.

  2. Dynamic monitoring equipment for earthworks and sub grades

    International Nuclear Information System (INIS)

    Alvarez de Sotomayor, R.

    2013-01-01

    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.

  3. [Incidental findings in cardiology. Diagnosing today what can cause illness tomorrow].

    Science.gov (United States)

    Castrucci, M; Seifert, T; Breithardt, G

    2000-10-26

    Among the anatomical and functional findings in cardiology, congenitally corrected transposition of the major vessels (ventricular inversion), bicuspid aortic valve and prolapse of the mitral valve with simultaneous mitral insufficiency have at least a potential for causing future problems. In such cases, regular cardiological checks or a further diagnostic work-up is to be recommended. The assessment of cardiac sounds can usually be correctly interpreted on the basis of the history, physical examination and auscultation. Among the electrocardiological findings, complete left bundle-branch block and prolongation of the QT segment, mandate clarification of a structural heart condition. Furthermore, in the event of ventricular extrasystoles, right-ventricular cardiomyopathy needs to be excluded. Such isolated conduction disorders as left-anterior fascicular block or right bundle-branch block are of no prognostic significance.

  4. Detection of the third heart sound using a tailored wavelet approach.

    Science.gov (United States)

    Hult, P; Fjällbrant, T; Wranne, B; Ask, P

    2004-03-01

    The third heart sound is normally heard during auscultation of younger individuals but disappears with increasing age. However, this sound can appear in patients with heart failure and is thus of potential diagnostic use in these patients. Auscultation of the heart involves a high degree of subjectivity. Furthermore, the third heart sound has low amplitude and a low-frequency content compared with the first and second heart sounds, which makes it difficult for the human ear to detect this sound. It is our belief that it would be of great help to the physician to receive computer-based support through an intelligent stethoscope, to determine whether a third heart sound is present or not. A precise, accurate and low-cost instrument of this kind would potentially provide objective means for the detection of early heart failure, and could even be used in primary health care. In the first step, phonocardiograms from ten children, all known to have a third heart sound, were analysed, to provide knowledge about the sound features without interference from pathological sounds. Using this knowledge, a tailored wavelet analysis procedure was developed to identify the third heart sound automatically, a technique that was shown to be superior to Fourier transform techniques. In the second step, the method was applied to phonocardiograms from heart patients known to have heart failure. The features of the third heart sound in children and of that in patients were shown to be similar. This resulted in a method for the automatic detection of third heart sounds. The method was able to detect third heart sounds effectively (90%), with a low false detection rate (3.7%), which supports its clinical use. The detection rate was almost equal in both the children and patient groups. The method is therefore capable of detecting, not only distinct and clearly visible/audible third heart sounds found in children, but also third heart sounds in phonocardiograms from patients suffering from

  5. Physiological effects of a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates.

    Science.gov (United States)

    Mehta, Y; Shetye, J; Nanavati, R; Mehta, A

    2016-01-01

    To assess the changes on various physiological cardio-respiratory parameters with a single chest physiotherapy session in mechanically ventilated and extubated preterm neonates with respiratory distress syndrome. This is a prospective observational study in a neonatal intensive care unit setting. Sixty preterm neonates with respiratory distress syndrome, thirty mechanically ventilated and thirty extubated preterm neonates requiring chest physiotherapy were enrolled in the study. Parameters like heart rate (HR), respiratory rate (RR), Silverman Anderson score (SA score in extubated), oxygen saturation (SpO2) and auscultation findings were noted just before, immediately after chest physiotherapy but before suctioning, immediately after suctioning and after 5 minutes of the session. The mean age of neonates was 9.55±5.86 days and mean birth weight was 1550±511.5 g. As there was no significant difference in the change in parameters on intergroup comparison, further analysis was done considering two groups together (n = 60) except for SA score. As SA score was measured only in extubated neonates. HR did not change significantly during chest physiotherapy compared to the baseline but significantly decreased after 15 minutes (p = 0.01). RR and SA score significantly increased after suctioning (p = 0.014) but reduced after 15 minutes (p = physiotherapy (p = physiotherapy may help facilitate the overall well-being of a fragile preterm neonate. Lung auscultation finding suggests that after suctioning, there was a significant reduction in crepitation (p = 0.0000) but significant increase in crepitation after 15 minutes (p = physiotherapy. Chest physiotherapy is safe in preterm neonates. Suctioning causes significant cardio-respiratory parameter changes, but within normal physiological range. Thus, chest physiotherapy should be performed with continuous monitoring only when indicated and not as a routine procedure. More research is needed

  6. Automated graphic assessment of respiratory activity is superior to pulse oximetry and visual assessment for the detection of early respiratory depression during therapeutic upper endoscopy.

    Science.gov (United States)

    Vargo, John J; Zuccaro, Gregory; Dumot, John A; Conwell, Darwin L; Morrow, J Brad; Shay, Steven S

    2002-06-01

    Recommendations from the American Society of Anesthesiologists suggest that monitoring for apnea using the detection of exhaled carbon dioxide (capnography) is a useful adjunct in the assessment of ventilatory status of patients undergoing sedation and analgesia. There are no data on the utility of capnography in GI endoscopy, nor is the frequency of abnormal ventilatory activity during endoscopy known. The aims of this study were to determine the following: (1) the frequency of abnormal ventilatory activity during therapeutic upper endoscopy, (2) the sensitivity of observation and pulse oximetry in the detection of apnea or disordered respiration, and (3) whether capnography provides an improvement over accepted monitoring techniques. Forty-nine patients undergoing therapeutic upper endoscopy were monitored with standard methods including pulse oximetry, automated blood pressure measurement, and visual assessment. In addition, graphic assessment of respiratory activity with sidestream capnography was performed in all patients. Endoscopy personnel were blinded to capnography data. Episodes of apnea or disordered respiration detected by capnography were documented and compared with the occurrence of hypoxemia, hypercapnea, hypotension, and the recognition of abnormal respiratory activity by endoscopy personnel. Comparison of simultaneous respiratory rate measurements obtained by capnography and by auscultation with a pretracheal stethoscope verified that capnography was an excellent indicator of respiratory rate when compared with the reference standard (auscultation) (r = 0.967, p < 0.001). Fifty-four episodes of apnea or disordered respiration occurred in 28 patients (mean duration 70.8 seconds). Only 50% of apnea or disordered respiration episodes were eventually detected by pulse oximetry. None were detected by visual assessment (p < 0.0010). Apnea/disordered respiration occurs commonly during therapeutic upper endoscopy and frequently precedes the development

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

    Science.gov (United States)

    de Figueiredo Locks, Giovani; Simões de Almeida, Maria Cristina; Sperotto Ceccon, Maurício; Campos Pastório, Karen Adriana

    2015-01-01

    To examine whether there are changes in the distance between the orotracheal tubeand carina induced by orthostatic retractor placement or by pneumoperitoneum insufflation in obese patients undergoing gastroplasty. 60 patients undergoing bariatric surgery by two techniques: open (G1) or videola-paroscopic (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. G1 was composed of 22 and G2 of 38 patients. No cases of endobronchial intubationwere 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 gastroplastyand 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 under-going open surgery and 0.1 cm to -2.2 cm in patients undergoing videolaparoscopic surgery. There was no significant change in orotracheal tube-CA distance after placementof orthostatic retractors in patients undergoing open gastroplasty. There was a reduction inorotracheal 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. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Publicado por Elsevier Editora Ltda. All rights reserved.

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

    Science.gov (United States)

    de Figueiredo Locks, Giovani; Simões de Almeida, Maria Cristina; Sperotto Ceccon, Maurício; Campos Pastório, Karen Adriana

    2015-01-01

    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. 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. 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 -0.03cm (95% CI 0.06 to -0.13) in the group of patients undergoing open gastroplasty and in -0.42cm (95% CI -0.56 to -1.4) in the group of patients undergoing videolaparoscopic gastroplasty. The extremes of variation in each group were: 0.5cm to -1.6cm in patients undergoing open surgery and 0.1cm to -2.2cm in patients undergoing videolaparoscopic surgery. 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. Copyright © 2014 Sociedade Brasileira de Anestesiologia. Published by Elsevier Editora Ltda. All rights reserved.

  9. Auscultatory and electrocardiographic characteristics of Crioulo horses

    Directory of Open Access Journals (Sweden)

    Jackson Schade

    2014-03-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Giovani de Figueiredo Locks

    2015-10-01

    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.

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

    Science.gov (United States)

    Pinto, Lucia Helena Eduardo; Aun, Marcelo Vivolo; Cukier-Blaj, Sabrina; Stelmach, Rafael; Cukier, Alberto; Kalil, Jorge; Agondi, Rosana Câmara; Giavina-Bianchi, Pedro

    2016-04-01

    Many patients with vocal cord dysfunction (VCD), with or without asthma, receive inappropriate treatment because they are misdiagnosed as having difficult-to-control asthma alone. We developed a clinical screening check list designed to aid the diagnosis of VCD. A prospective observational study involving 80 patients aged ≥18 years, diagnosed with severe asthma. After anamnesis and physical examination, physicians completed a check list with 6 questions to identify VCD, for which the answer "yes" counted one point. Then patients underwent spirometry and laryngoscopy. On the basis of the laryngoscopic findings, we created three patient groups: VCD (vocal cord adduction during inspiration, n = 14); unconfirmed VCD (inconclusive findings, n = 29); and control (normal findings, n = 37). We attempted to determine whether any of those groups were associated with the responses to individual questions or sets of questions on the check list. The proportion of affirmative answers to the question "Does pulmonary auscultation reveal wheezing, predominantly in the cervical region, and/or stridor?" was significantly higher for the VCD group than for the other two groups (P = 0.006), notably in elderly patients. The variable "4 or more affirmative answers" was more common in VCD and unconfirmed VCD groups in comparison to controls (P = 0.022). 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. Copyright © 2015 Japanese Society of Allergology. Production and hosting by Elsevier B.V. All rights reserved.

  12. A Wireless Electronic Esophageal Stethoscope for Continuous Monitoring of Cardiovascular and Respiratory Systems during Anaesthesia

    Directory of Open Access Journals (Sweden)

    Parsaei H.

    2017-03-01

    Full Text Available Background: The basic requirements for monitoring anesthetized patients during surgery are assessing cardiac and respiratory function. Esophageal stethoscopes have been developed for this purpose, but these devices may not provide clear heart and lung sound due to existence of various noises in operating rooms. In addition, the stethoscope is not applicable for continues monitoring, and it is unsuitable for observing inaccessible patients in some conditions such as during CT scan. Objective: A wireless electronic esophageal stethoscope is designed for continues auscultation of heart and lung sounds in anesthetized patients. The system consists of a transmitter and a receiver. The former acquires, amplifies and transmits the acquired sound signals to the latter via a frequency modulation transmitter. The receiver demodulates, amplifies, and delivers the received signal to a headphone to be heard by anesthesiologist. Results: The usability and effectiveness of the designed system was qualitatively evaluated by 5 anesthesiologists in Namazi Hospital and Shahid Chamran Hospital, Shiraz, Iran on 30 patients in several operating rooms in different conditions; e.g., when electro surgery instruments are working. Fortunately, the experts on average ranked good quality for the heard heart and lung sounds and very good on the user friendly being of the instrument. Conclusion: Evaluation results demonstrate that the developed system is capable of capturing and transmitting heart and lung sounds successfully. Therefore, it can be used to continuously monitor anesthetized patients’ cardiac and respiratory function. Since via the instrument wireless auscultation is possible, it could be suitable for observing inaccessible patients in several conditions such as during CT scan.

  13. [Comparison of laryngeal mask airway (LMA)- Proseal and the LMA-Classic in ventilated children receiving neuromuscular blockade].

    Science.gov (United States)

    Lardner, David R R; Cox, Robin G; Ewen, Alastair; Dickinson, Darren

    2008-01-01

    To determine whether a functional difference exists between the size 2 laryngeal mask airway (LMA)-Classic (CLMA) and LMA-Proseal (PLMA) in anesthetized children who have received neuromuscular blockade. Airway leak during intermittent positive pressure ventilation (IPPV) and adequacy of fibreoptic laryngeal view were the primary study outcomes. A randomized, controlled, single-blinded study of 51 ASA I or II children weighing 10-20 kg was undertaken. The anesthetic technique was standardized. Following insertion of the LMA and cuff inflation to 60 cm H(2)O, we measured oropharyngeal leak pressure and gastric insufflation and leak fraction during IPPV, and evaluated the adequacy of fibreoptic view. Oropharyngeal leak pressure measured by neck auscultation was higher for the PLMA compared to the CLMA (23.7 vs 16.5 cm H(2)O, P = 0.009) but, when measured by the inspiratory hold maneuver was not significantly different (24.8 vs 20.3 cm H(2)O, respectively, P = 0.217). Leak fraction values were similar for the CLMA and the PLMA (21.2%. vs 13.3%, respectively, P = 0.473). A satisfactory view of the larynx was obtained more frequently in the PLMA group (21/25 vs 10/25, P = 0.003). Gastric insufflation during leak determination was more common with the CLMA (12/26 vs 2/25 CLMA vs PLMA, respectively, P = 0.006). In children undergoing IPPV with neuromuscular blockade, the size 2 PLMA is associated with a higher leak pressure by auscultation and less gastric insufflation compared to the CLMA. Leak pressures assessed by manometric stability are similar with these two devices. The improved fibreoptic view of the larynx through the PLMA may be advantageous for bronchoscopy.

  14. To characterize the incidence of airway misplacement of nasogastric tubes in anesthetized intubated patients by using a manometer technique.

    Science.gov (United States)

    Hsieh, Shao-Wei; Chen, Hung-Shu; Chen, Yi-Ting; Hung, Kuo-Chuan

    2017-04-01

    This study characterized the incidence of airway misplacement of nasogastric (NG) tubes in surgical patients, and the benefit of using a manometer to discriminate gastric placement from airway placement of NG tubes. Subjects included adult patients scheduled for abdominal surgery. After tracheal intubation, a 16 Fr. NG tube was inserted blindly through the nostril, and its position was assessed using the auscultation (10-ml air insufflation) or manometer (attached to NG tubes) techniques. Briefly, a biphasic pressure change synchronous with airway pressure during mechanical ventilation indicated airway misplacement. The presence of a notable pressure change while compressing the epigastric area indicated a gastric placement. A surgeon made the final confirmation of NG tube placement within the stomach using manual palpation of the tube immediately after laparotomy. The first-attempt success rate was 82.7 % in 104 patients. There were 29 misplacements of 130 attempted insertions (oral cavity, n = 23; trachea, n = 3; distal esophagus, n = 3). The incidence of airway misplacement was 2.9 % (3 of 104 cases). For confirmation of gastric placement, the auscultation technique had a sensitivity of 100.0 % and a specificity of 79.3 %. In contrast, the manometer technique had a sensitivity of 100.0 % and a specificity of 100.0 % in the discrimination of gastric placement from airway placement of NG tubes. Airway misplacement of NG tubes is not uncommon in surgical patients, and the manometer technique may be a reliable and safe method to discriminate gastric placement from airway placement of NG tubes.

  15. Automated signal quality assessment of mobile phone-recorded heart sound signals.

    Science.gov (United States)

    Springer, David B; Brennan, Thomas; Ntusi, Ntobeko; Abdelrahman, Hassan Y; Zühlke, Liesl J; Mayosi, Bongani M; Tarassenko, Lionel; Clifford, Gari D

    Mobile phones, due to their audio processing capabilities, have the potential to facilitate the diagnosis of heart disease through automated auscultation. However, such a platform is likely to be used by non-experts, and hence, it is essential that such a device is able to automatically differentiate poor quality from diagnostically useful recordings since non-experts are more likely to make poor-quality recordings. This paper investigates the automated signal quality assessment of heart sound recordings performed using both mobile phone-based and commercial medical-grade electronic stethoscopes. The recordings, each 60 s long, were taken from 151 random adult individuals with varying diagnoses referred to a cardiac clinic and were professionally annotated by five experts. A mean voting procedure was used to compute a final quality label for each recording. Nine signal quality indices were defined and calculated for each recording. A logistic regression model for classifying binary quality was then trained and tested. The inter-rater agreement level for the stethoscope and mobile phone recordings was measured using Conger's kappa for multiclass sets and found to be 0.24 and 0.54, respectively. One-third of all the mobile phone-recorded phonocardiogram (PCG) signals were found to be of sufficient quality for analysis. The classifier was able to distinguish good- and poor-quality mobile phone recordings with 82.2% accuracy, and those made with the electronic stethoscope with an accuracy of 86.5%. We conclude that our classification approach provides a mechanism for substantially improving auscultation recordings by non-experts. This work is the first systematic evaluation of a PCG signal quality classification algorithm (using a separate test dataset) and assessment of the quality of PCG recordings captured by non-experts, using both a medical-grade digital stethoscope and a mobile phone.

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

    Directory of Open Access Journals (Sweden)

    Daryaei P.

    2008-06-01

    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

  17. Defining characteristics and risk indicators for diagnosing nursing home-acquired pneumonia and aspiration pneumonia in nursing home residents, using the electronically-modified Delphi Method.

    Science.gov (United States)

    Hollaar, Vanessa; van der Maarel-Wierink, Claar; van der Putten, Gert-Jan; van der Sanden, Wil; de Swart, Bert; de Baat, Cees

    2016-03-07

    In nursing home residents, it is not possible to distinguish pneumonia and aspiration pneumonia clinically. International literature reveals no consensus on which and how many characteristics and risk indicators must be present to diagnose (nursing home-acquired) pneumonia and aspiration pneumonia. The aim of this survey was to reach consensus among a panel of clinical medical experts in geriatrics and pulmonology about the characteristics required for diagnosing pneumonia, and about the risk indicators needed to consider the diagnosis aspiration pneumonia in nursing home residents with pneumonia. Literature review and three expert-rating iterations using the electronically-modified Delphi Method were carried out. After each expert rating iteration, data analysis was performed. Qualitative responses and additional (nursing home-acquired) pneumonia characteristics which were mentioned in reply to structured open-ended questions were summarised, whilst similar responses were combined and these combinations were ordered by frequency in order to use them in the next iteration. Characteristics which failed to reach consensus were considered as inconclusive and eliminated. Consensus was reached when at least 70 % of the participants agreed. Literature review revealed 16 currently used common characteristics for diagnosing (nursing home-acquired) pneumonia. No consensus was reached about characteristics and the number of characteristics required for diagnosing (nursing home-acquired) pneumonia. However, 57 % agreed that dyspnea, fever, deterioration of general functioning, tachypnea and crepitation with auscultation are the most important characteristics and the responses by the participants suggested that two or three characteristics should be present. Subsequently, 80 % of the participants agreed on the risk indicators dysphagia, choking incident, (history of) tube feeding, neurological disease and cognitive impairment for considering the diagnosis aspiration pneumonia

  18. Wireless laptop-based phonocardiograph and diagnosis

    Directory of Open Access Journals (Sweden)

    Amy T. Dao

    2015-08-01

    Full Text Available Auscultation is used to evaluate heart health, and can indicate when it’s needed to refer a patient to a cardiologist. Advanced phonocardiograph (PCG signal processing algorithms are developed to assist the physician in the initial diagnosis but they are primarily designed and demonstrated with research quality equipment. Therefore, there is a need to demonstrate the applicability of those techniques with consumer grade instrument. Furthermore, routine monitoring would benefit from a wireless PCG sensor that allows continuous monitoring of cardiac signals of patients in physical activity, e.g., treadmill or weight exercise. In this work, a low-cost portable and wireless healthcare monitoring system based on PCG signal is implemented to validate and evaluate the most advanced algorithms. Off-the-shelf electronics and a notebook PC are used with MATLAB codes to record and analyze PCG signals which are collected with a notebook computer in tethered and wireless mode. Physiological parameters based on the S1 and S2 signals and MATLAB codes are demonstrated. While the prototype is based on MATLAB, the later is not an absolute requirement.

  19. A comprehensive newborn exam: part I. General, head and neck, cardiopulmonary.

    Science.gov (United States)

    Lewis, Mary L

    2014-09-01

    A comprehensive newborn examination involves a systematic inspection. A Ballard score uses physical and neurologic characteristics to assess gestational age. Craniosynostosis is caused by premature fusion of the sutures, and 20% of children with this condition have a genetic mutation or syndrome. The red reflex assessment is normal if there is symmetry in both eyes, without opacities, white spots, or dark spots. If the red reflex findings are abnormal or the patient has a family history of pertinent eye disorders, consultation with an ophthalmologist is warranted. Newborns with low-set ears should be evaluated for a genetic condition. Renal ultrasonography should be performed only in patients with isolated ear anomalies, such as preauricular pits or cup ears, if they are accompanied by other malformations or significant family history. If ankyloglossia is detected, a frenotomy may be considered if it impacts breastfeeding. The neck should be examined for full range of motion because uncorrected torticollis can lead to plagiocephaly and ear misalignment. Proper auscultation is crucial for evaluation of the bronchopulmonary circulation with close observation for signs of respiratory distress, including tachypnea, nasal flaring, grunting, retractions, and cyanosis. Benign murmurs are often present in the first hours of life. Pulse oximetry should be performed in a systematic fashion before discharge.

  20. The use of ultrasonic pulse velocity to estimate the water permeability of concretes

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    Abdelhalim Benouis

    2018-01-01

    Full Text Available In this work we investigated the possibility of estimating the water permeability of concrete from the ultrasonic surface wave velocity (Rayleigh's waves. This is a method for the non-destructive permeability diagnosis of the in situ auscultation of a structure. Four ordinary concrete compositions with different W/C ratios and two self compacting concretes SCC were used. This study showed a decrease in of ultrasonic pulse velocity with the increase in the W/C ratio, this is due to the increase in porosity. Curing in air of the concrete specimens produces greater permeability than curing in water. The increase in the permeability with the increase of W/C ratio is more important for curing in water than for the curing in air. SCC1 has a lower permeability than that of SCC2, this difference is respectively 20% and 10 % for curing in air and in water. The study show that permeability estimation with ultrasonic surface waves is more reliable for curing in water mode than tin curing in air. The correlations obtained between the permeability and the indirect ultrasonic velocity are linear, with an inversely proportional relation.

  1. Cardiac evaluation of anesthetized Grevy's zebras (Equus grevyi).

    Science.gov (United States)

    Adin, Darcy B; Maisenbacher, Herbert W; Ojeda, Nyurka; Fiorello, Christine V; Estrada, Amara H; Prosek, Robert; Citino, Scott B

    2007-02-01

    To determine ECG and echocardiographic measurements in healthy anesthetized Grevy's zebras (Equus grevyi). 20 healthy zebras. Auscultation, base-apex ECG, and echocardiography were performed on anesthetized zebras. Low-grade systolic murmurs were detected in the left basilar region in 4 of 20 zebras. Evaluation of ECGs from 19 zebras revealed sinus rhythm with a predominantly negative QRS complex and a mean +/- SD heart rate of 67 +/- 10 beats/min. Echocardiograms of sufficient image quality were obtained for 16 zebras. Interventricular septal thickness in diastole, left ventricular chamber in diastole and systole, left atrial diameter, and left ventricular mass were significantly and moderately correlated with estimated body weight (r values ranged from 0.650 to 0.884). Detectable swirling of blood in the right and sometimes the left ventricles was detected in 9 of 16 zebras, whereas physiologic regurgitation of blood was detected for the aortic valve in 3 zebras, pulmonary valve in 2 zebras, mitral valve in 2 zebras, and tricuspid valve in 1 zebra. Results of this study provide reference information for use in the cardiac evaluation of anesthetized Grevy's zebras.

  2. [Electronic fetal monitoring and management of adverse outcomes: how to perform and improve a training program for clinicians?].

    Science.gov (United States)

    Secourgeon, J-F

    2012-10-01

    Electronic fetal monitoring during labor is the most commonly used method to evaluate the fetal status, but it remains exposed to some criticism. By comparison with intermittent auscultation and in the light of the results of the great studies in the last 30 years, it may be accused its failure to improve the neonatal outcome and its responsibility in the increase on operative deliveries. Actually, the electronic fetal monitoring is a tool whose effectiveness is linked to the accuracy of the analysis developed by the clinician. Studies on assessment of the tracing interpretation indicate that there is always a lack of quality, which may be improved through training programs. It also reveals the benefit of the fetal blood sampling to reduce operative deliveries and the generalization of this method, in addition to electronic fetal monitoring, is recommended by referral agencies. More generally, the continuous monitoring is only a part of the patient safety strategy in the labour ward and we are currently observing, in some European countries and in the United States, the development of training programs concerning the management of the adverse outcomes in obstetrics. The good performances related to the quality of care are demonstrated by the findings of the studies performed in the centers that have implemented an active training policy. In France, the professionals directly involved in the field of the perinatology should benefit from such educational programs that could be organized within the care networks under the authority of referral agencies. Copyright © 2012 Elsevier Masson SAS. All rights reserved.

  3. Development of an Acoustic Signal Analysis Tool “Auto-F” Based on the Temperament Scale

    Science.gov (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.

  4. Novel algorithm to identify and differentiate specific digital signature of breath sound in patients with diffuse parenchymal lung disease.

    Science.gov (United States)

    Bhattacharyya, Parthasarathi; Mondal, Ashok; Dey, Rana; Saha, Dipanjan; Saha, Goutam

    2015-05-01

    Auscultation is an important part of the clinical examination of different lung diseases. Objective analysis of lung sounds based on underlying characteristics and its subsequent automatic interpretations may help a clinical practice. We collected the breath sounds from 8 normal subjects and 20 diffuse parenchymal lung disease (DPLD) patients using a newly developed instrument and then filtered off the heart sounds using a novel technology. The collected sounds were thereafter analysed digitally on several characteristics as dynamical complexity, texture information and regularity index to find and define their unique digital signatures for differentiating normality and abnormality. For convenience of testing, these characteristic signatures of normal and DPLD lung sounds were transformed into coloured visual representations. The predictive power of these images has been validated by six independent observers that include three physicians. The proposed method gives a classification accuracy of 100% for composite features for both the normal as well as lung sound signals from DPLD patients. When tested by independent observers on the visually transformed images, the positive predictive value to diagnose the normality and DPLD remained 100%. The lung sounds from the normal and DPLD subjects could be differentiated and expressed according to their digital signatures. On visual transformation to coloured images, they retain 100% predictive power. This technique may assist physicians to diagnose DPLD from visual images bearing the digital signature of the condition. © 2015 Asian Pacific Society of Respirology.

  5. Wavelet-based segmentation and feature extraction of heart sounds for intelligent PDA-based phonocardiography.

    Science.gov (United States)

    Nazeran, H

    2007-01-01

    Many pathological conditions of the cardiovascular system cause murmurs and aberrations in heart sounds. Phonocardiography provides the clinician with a complementary tool to record the heart sounds heard during auscultation. The advancement of intracardiac phonocardiography combined with modern digital signal processing techniques has strongly renewed researchers' interest in studying heart sounds and murmurs. The aim of this work is to investigate the applicability of different spectral analysis methods to heart sound signals and explore their suitability for PDA-based implementation. Fourier transform (FT), short-time Fourier transform (STFT) and wavelet transform (WT) are used to perform spectral analysis on heart sounds. A segmentation algorithm based on Shannon energy is used to differentiate between first and second heart sounds. Then wavelet transform is deployed again to extract 64 features of heart sounds. The FT provides valuable frequency information but the timing information is lost during the transformation process. The STFT or spectrogram provides valuable time-frequency information but there is a trade-off between time and frequency resolution. Wavelet analysis, however, does not suffer from limitations of the STFT and provides adequate time and frequency resolution to accurately characterize the normal and pathological heart sounds. The results show that the wavelet-based segmentation algorithm is quite effective in localizing the important components of both normal and abnormal heart sounds. They also demonstrate that wavelet-based feature extraction provides suitable feature vectors which are clearly differentiable and useful for automatic classification of heart sounds.

  6. Noninvasive blood pressure and the second heart sound analysis.

    Science.gov (United States)

    Castro, Ana; Mattos, Sandra S; Coimbra, Miguel T

    2014-01-01

    Heart sound characteristics are linked to blood pressure, and its interpretation is important for detection of cardiovascular disease. In this study, heart sounds' auscultation, acquired from children patients (27 patients, 10.2±3.9 years, 35.7±20.8 kg, 132.3±25.5 cm), were automatically segmented to extract the two main components: the first sound (S1) and the second sound (S2). Following, a set of time, frequency, and wavelet based features, were extracted from the S2, and analyzed in relation to the noninvasive cuff-based measures of blood pressure (mean blood pressure of 78±8.8 mmHg). A multivariate regression analysis was performed for each S2 feature set to determine which features better related to the blood pressure measurements. The best results, in the leave-one-out evaluation, were obtained using the frequency features set, with a MAE of 6.08 mmHg, a MAPE of 7.85%, and a ME of 0.31 mmHg, in the estimation of the mean blood pressure.

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

    Science.gov (United States)

    De Panfilis, S; Moroni, C; Peccianti, M; Chiru, O M; Vashkevich, V; Parisi, G; Cassone, R

    2013-03-01

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

  8. Spectral analysis of the heart sounds in children with and without pulmonary artery hypertension.

    Science.gov (United States)

    Elgendi, Mohamed; Bobhate, Prashant; Jain, Shreepal; Guo, Long; Rutledge, Jennifer; Coe, Yashu; Zemp, Roger; Schuurmans, Dale; Adatia, Ian

    2014-04-15

    Pulmonary artery hypertension (PAH) is difficult to recognize clinically. Digital stethoscopes offer an opportunity to re-evaluate the diagnosis of PAH. We hypothesized that spectral analysis of heart sound frequencies using recordings from a digital stethoscope would differ between children with and without PAH. We recorded heart sounds using a digital stethoscope from 27 subjects (12 males) with a median age of 7 years (3 months to 19 years) undergoing simultaneous cardiac catheterization. 13 subjects had a mean pulmonary artery pressure (mPAp)analysis, separability testing, and linear discriminant analysis with leave-one-out cross-validation to the heart sounds recorded from the cardiac apex and 2nd left intercostal space (LICS) to examine the frequency domain. The significance of the results was determined using a t-test and rank-sum test. The relative power of the frequencies 21-22 Hz of the heart sounds recorded at the 2nd LICS was decreased significantly in subjects mPAp≥25 mm Hg versusHeart sound signals of patients with PAH contain significantly less relative power in the band 21-22 Hz compared to subjects with normal PAp. Information contained in the frequency domain may be useful in diagnosing PAH and aid the development of auscultation based techniques for diagnosing PAH. In the future, utilizing the diagnostic information contained in heart sounds recordings may require analysis of both the time and frequency domains. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. 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

    2005-06-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Petrovic Dejan

    2016-09-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Nicola Scichilone

    2009-01-01

    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.

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

    Directory of Open Access Journals (Sweden)

    A. Voigt

    2009-05-01

    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.

  13. Knowledge based system with embedded intelligent heart sound analyser for diagnosing cardiovascular disorders.

    Science.gov (United States)

    Javed, F; Venkatachalam, P A; Hani, A F M

    2007-01-01

    Cardiovascular disease (CVD) is the leading cause of death worldwide, and due to the lack of early detection techniques, the incidence of CVD is increasing day by day. In order to address this limitation, a knowledge based system with embedded intelligent heart sound analyser (KBHSA) has been developed to diagnose cardiovascular disorders at early stages. The system analyses digitized heart sounds that are recorded from an electronic stethoscope using advanced digital signal processing and artificial intelligence techniques. KBHSA takes into account data including the patient's personal and past medical history, clinical examination, auscultation findings, chest x-ray and echocardiogram, and provides a list of diseases that it has diagnosed. The system can assist the general physician in making more accurate and reliable diagnosis under emergency conditions where expert cardiologists and advanced equipment are not readily available. To test the validity of the system, abnormal heart sound samples and medical data from 40 patients were recorded and analysed. The diagnoses made by the system were counter checked by four senior cardiologists in Malaysia. The results show that the findings of KBHSA coincide with those of cardiologists.

  14. 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

    Energy Technology Data Exchange (ETDEWEB)

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

    2007-08-15

    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)

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

    Directory of Open Access Journals (Sweden)

    Flora Maria Barbosa da Silva

    2013-10-01

    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.

  16. Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective

    Science.gov (United States)

    Zhao, Changbo; Li, Guo-Zheng; Wang, Chengjun; Niu, Jinling

    2015-01-01

    As a complementary and alternative medicine in medical field, traditional Chinese medicine (TCM) has drawn great attention in the domestic field and overseas. In practice, TCM provides a quite distinct methodology to patient diagnosis and treatment compared to western medicine (WM). Syndrome (ZHENG or pattern) is differentiated by a set of symptoms and signs examined from an individual by four main diagnostic methods: inspection, auscultation and olfaction, interrogation, and palpation which reflects the pathological and physiological changes of disease occurrence and development. Patient classification is to divide patients into several classes based on different criteria. In this paper, from the machine learning perspective, a survey on patient classification issue will be summarized on three major aspects of TCM: sign classification, syndrome differentiation, and disease classification. With the consideration of different diagnostic data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification. PMID:26246834

  17. Advances in Patient Classification for Traditional Chinese Medicine: A Machine Learning Perspective.

    Science.gov (United States)

    Zhao, Changbo; Li, Guo-Zheng; Wang, Chengjun; Niu, Jinling

    2015-01-01

    As a complementary and alternative medicine in medical field, traditional Chinese medicine (TCM) has drawn great attention in the domestic field and overseas. In practice, TCM provides a quite distinct methodology to patient diagnosis and treatment compared to western medicine (WM). Syndrome (ZHENG or pattern) is differentiated by a set of symptoms and signs examined from an individual by four main diagnostic methods: inspection, auscultation and olfaction, interrogation, and palpation which reflects the pathological and physiological changes of disease occurrence and development. Patient classification is to divide patients into several classes based on different criteria. In this paper, from the machine learning perspective, a survey on patient classification issue will be summarized on three major aspects of TCM: sign classification, syndrome differentiation, and disease classification. With the consideration of different diagnostic data analyzed by different computational methods, we present the overview for four subfields of TCM diagnosis, respectively. For each subfield, we design a rectangular reference list with applications in the horizontal direction and machine learning algorithms in the longitudinal direction. According to the current development of objective TCM diagnosis for patient classification, a discussion of the research issues around machine learning techniques with applications to TCM diagnosis is given to facilitate the further research for TCM patient classification.

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

    International Nuclear Information System (INIS)

    Jovic-Stosic, J.; Todorovic, V.; Segrt, Z.

    2007-01-01

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

  19. Thoracic ultrasound: Potential new tool for physiotherapists in respiratory management. A narrative review.

    Science.gov (United States)

    Le Neindre, Aymeric; Mongodi, Silvia; Philippart, François; Bouhemad, Bélaïd

    2016-02-01

    The use of diagnostic ultrasound by physiotherapists is not a new concept; it is frequently performed in musculoskeletal physiotherapy. Physiotherapists currently lack accurate, reliable, sensitive, and valid measurements for the assessment of the indications and effectiveness of chest physiotherapy. Thoracic ultrasound may be a promising tool for the physiotherapist and could be routinely performed at patients' bedsides to provide real-time and accurate information on the status of pleura, lungs, and diaphragm; this would allow for assessment of lung aeration from interstitial syndrome to lung consolidation with much better accuracy than chest x-rays or auscultation. Diaphragm excursion and contractility may also be assessed by ultrasound. This narrative review refers to lung and diaphragm ultrasound semiology and describes how physiotherapists could use this tool in their clinical decision-making processes in various cases of respiratory disorders. The use of thoracic ultrasound semiology alongside typical examinations may allow for the guiding, monitoring, and evaluating of chest physiotherapy treatments. Thoracic ultrasound is a potential new tool for physiotherapists. Copyright © 2015 Elsevier Inc. All rights reserved.

  20. [Concomitant discovery of lung cancer and tuberculosis in a cannabis smoker].

    Science.gov (United States)

    Cadelis, G; Ehret, N

    2015-10-01

    The coexistence of lung cancer and active tuberculosis is relatively rare. We report a case of concomitant discovery of lung cancer and tuberculosis in the context of addiction to tobacco and cannabis. A 50-year-old man, smoking tobacco and cannabis since the age of 18, was hospitalized for hemoptysis. Physical examination revealed cachexia, hyperthermia and decreased breath sounds on auscultation of the left lung field. The chest X-ray objectified atelectasis of the left upper lobe. The CT scan revealed a left upper lobe atelectasis and a cavity surrounded opacities taking a tree in bud appearance located at the apex of the left lower lobe. Endoscopy showed an obstruction by a bud located at the upper left lobe. Histology of bronchial biopsy revealed squamous cell carcinoma. Direct examination of bacteriological samples found BAAR and culture confirmed tuberculosis. The contamination could occur via a close relative, smoking cannabis and being treated for tuberculosis. After a 6-month treatment for tuberculosis, the patient underwent a course of chemotherapy, but refused further treatment. Death occurred 3months later. This observation relates the concomitant discovery of lung cancer and tuberculosis. It also highlights the possible role of cannabis addiction in the transmission of tuberculosis and the occurrence of lung cancer in combination with tobacco. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  1. Automatic data-processing equipment of moon mark of nail for verifying some experiential theory of Traditional Chinese Medicine.

    Science.gov (United States)

    Niu, Renjie; Fu, Chenyu; Xu, Zhiyong; Huang, Jianyuan

    2016-04-29

    Doctors who practice Traditional Chinese Medicine (TCM) diagnose using four methods - inspection, auscultation and olfaction, interrogation, and pulse feeling/palpation. The shape and shape changes of the moon marks on the nails are an important indication when judging the patient's health. There are a series of classical and experimental theories about moon marks in TCM, which does not have support from statistical data. To verify some experiential theories on moon mark in TCM by automatic data-processing equipment. This paper proposes the equipment that utilizes image processing technology to collect moon mark data of different target groups conveniently and quickly, building a database that combines this information with that gathered from the health and mental status questionnaire in each test. This equipment has a simple design, a low cost, and an optimized algorithm. The practice has been proven to quickly complete automatic acquisition and preservation of key data about moon marks. In the future, some conclusions will likely be obtained from these data; some changes of moon marks related to a special pathological change will be established with statistical methods.

  2. Ultrasonic Doppler vibrometry: novel method for detection of left ventricular wall vibrations caused by poststenotic coronary flow.

    Science.gov (United States)

    Sikdar, Siddhartha; Lee, Justin C; Remington, Jared; Zhao, Xue-Qiao; Goldberg, Steven L; Beach, Kirk W; Kim, Yongmin

    2007-12-01

    A diastolic coronary flow murmur has been reported for patients with coronary stenoses, yet is rarely appreciated during routine auscultation. We hypothesized that an ultrasonic Doppler method can detect the epicardial vibrations associated with this murmur. Ultrasonic Doppler vibrometry is a pulsed wave echocardiography phase demodulation technique designed for detecting vibrations. We correlated the vibration characteristics measured using vibrometry with the angiographic severity of coronary artery stenosis. In a prospective pilot study, 49 patients were recruited for an ultrasound examination before coronary arteriography. An ultrasound instrument was customized to acquire the raw pulsed wave Doppler echocardiographic data from a range gate placed on the left ventricular myocardium near the path of the epicardial coronary arteries. Patients with angiographically minor stenosis (tightest stenosis vibration energy (computed as the median spectral energy of myocardial wall velocity in the 100 approximately 1000-Hz frequency band normalized by a baseline diastolic value) compared with patients with moderate or severe stenosis (any stenosis > 50%, N = 24) (P vibration energy increased with increasing stenosis severity for less severe narrowing (70%) (R(2) = 0.21, P vibrations measured using ultrasonic Doppler vibrometry are related to the severity of coronary artery stenoses. With further refinement and validation, this noninvasive and low-cost method could lead to an early screening and monitoring test for coronary artery stenosis.

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

    International Nuclear Information System (INIS)

    Marques, Alda; Bruton, Anne; Barney, Anna

    2009-01-01

    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

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

    Directory of Open Access Journals (Sweden)

    F. Z. Benaich

    2015-12-01

    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.

  5. A passive quantitative measurement of airway resistance using depth data.

    Science.gov (United States)

    Ostadabbas, Sarah; Bulach, Christoph; Ku, David N; Anderson, Larry J; Ghovanloo, Maysam

    2014-01-01

    The Respiratory Syncytial Virus (RSV) is the most common cause of serious lower respiratory tract infections in infants and young children. RSV often causes increased airway resistance, clinically detected as wheezing by chest auscultation. In this disease, expiratory flows are significantly reduced due to the high resistance in patient's airway passages. A quantitative method for measuring resistance can have a great benefit to diagnosis and management of children with RSV infections as well as with other lung diseases. Airway resistance is defined as the lung pressure divided by the airflow. In this paper, we propose a method to quantify resistance through a simple, non-contact measurement of chest volume that can act as a surrogate measure of the lung pressure and volumetric airflow. We used depth data collected by a Microsoft Kinect camera for the measurement of the lung volume over time. In our experimentation, breathing through a number of plastic straws induced different airway resistances. For a standard spirometry test, our volume/flow estimation using Kinect showed strong correlation with the flow data collected by a commercially-available spirometer (five subjects, each performing 20 breathing trials, correlation coefficient = 0.88, with 95% confidence interval). As the number of straws decreased, emulating a higher airway obstruction, our algorithm was sufficient to distinguish between several levels of airway resistance.

  6. Clinical management of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat: A case report

    Directory of Open Access Journals (Sweden)

    Faez Firdaus Abdullah Jesse

    2017-12-01

    Full Text Available Objective: This clinical case reports the occurrence of stage I pinkeye with concurrent pneumonic pasteurellosis in a goat. Materials and methods: A 2-year-old Jamnapari goat weighing 25 Kg was presented to the Universiti Veterinary Hospital, Universiti Putra Malaysia with primary complain of eye problem and inappetence. Results: Upon clinical examination, the most prominent abnormality observed was corneal opacity of the right eye with presence of ulceration on the corneal surface and chemosis of the right conjunctiva with excessive lacrimation. On auscultation, there was the presence of crackle lung sounds with bilateral mucopurulent nasal discharges. Samples from the ocular swab yielded a positive growth for Mycoplasma spp., while the nasal swab yielded a positive growth for Mannheimia haemolytica. The goat was diagnosed with stage I pinkeye with concurrent pneumonic pasteurellosis infection. Treatment was instituted with 400 mL of 0.9% NaCl administered intravenously once for rehydration. Flunixin meglumine 2.2 mg/kg bwt was given intramuscularly twice daily for three days as anti-inflammatory and analgesic. Oxytetracycline 20 mg/kg bwt was injected once intramuscularly as long acting broad spectrum antibiotic for treatment of pinkeye and pasteurellosis infections. Furthermore, terramycin eye ointment containing oxytetracycline HCl was also administered intraocularly twice daily for seven days as treatment for the Mycoplasma spp. Conclusion: The prognosis for this case was good as the goat were treated promptly and effectively. [J Adv Vet Anim Res 2017; 4(4.000: 390-393

  7. Computed Tomography Following Body Stuffing Heroin

    Directory of Open Access Journals (Sweden)

    Sean P. Nordt

    2015-12-01

    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.

  8. Community-Acquired Pneumonia Caused by Mycoplasma pneumoniae: How Physical and Radiological Examination Contribute to Successful Diagnosis

    Science.gov (United States)

    Kishaba, Tomoo

    2016-01-01

    Mycoplasma pneumoniae is one of the most common causes of community-acquired pneumonia (CAP), particularly in young adults. Vital signs are usually normal except for temperature. On physical examination, general appearance is normal compared with that of typical pneumonia such as pneumococcal pneumonia patients. Mycoplasma sometimes causes ear infections such as otitis media. It is important to distinguish between typical pneumonia and atypical pneumonia such as mycoplasma pneumonia because having the right diagnosis allows for the use of the correct antibiotic to treat CAP while preventing development of drug-resistant bacteria and also decreasing medical cost. The symptoms and diagnosis of mycoplasma pneumonia is multi-fold. Auscultation of patients can demonstrate trace late inspiratory crackles or normal alveolar sounds; however, bilateral polyphonic wheezes can sometimes be heard because of bronchiolitis. With regard to radiological findings, a chest radiogragh often shows bilateral reticulonodular or patchy consolidation in both lower lobes. Pleural effusion is rarely observed in adult cases. Immunocompetent patients tend to reveal more extensive shadowing compared with immunocompromised patients. As serological diagnostic methods are not able to offer 100% reliable diagnosis, integration of physical and radiological examination is crucial to accurately diagnose mycoplasma pneumonia. Herein, I review the typical findings from physical examination and imaging patterns of patients with mycoplasma pneumonia. PMID:27379238

  9. Increasing awareness with recognition of pulsatile tinnitus for nurse practitioners in the primary care setting: A case study.

    Science.gov (United States)

    Vecchiarelli, Kelly; Amar, Arun Paul; Emanuele, Donna

    2017-09-01

    Pulsatile tinnitus is a whooshing sound heard synchronous with the heartbeat. It is an uncommon symptom affecting fewer than 10% of patients with tinnitus. It often goes unrecognized in the primary care setting. Failure to recognize this symptom can result in a missed or delayed diagnosis of a potentially life-threatening condition known as a dural arteriovenous fistula. The purpose of this case study is to provide a structured approach to the identification of pulsatile tinnitus and provide management recommendations. A case study and review of pertinent literature. Pulsatile tinnitus usually has a vascular treatable cause. A comprehensive history and physical examination will alert the nurse practitioner (NP) when pulsatile tinnitus is present. Auscultation in specific areas of the head can detect audible or objective pulsatile tinnitus. Pulsatile tinnitus that is audible to the examiner is an urgent medical condition requiring immediate consultation and referral. Knowledge of pulsatile tinnitus and awareness of this often treatable condition directs the NP to perform a detailed assessment when patients present with tinnitus, directs appropriate referral for care and treatment, and can reduce the risk of delayed or missed diagnosis. ©2017 American Association of Nurse Practitioners.

  10. Timely diagnosis of dairy calf respiratory disease using a standardized scoring system.

    Science.gov (United States)

    McGuirk, Sheila M; Peek, Simon F

    2014-12-01

    Respiratory disease of young dairy calves is a significant cause of morbidity, mortality, economic loss, and animal welfare concern but there is no gold standard diagnostic test for antemortem diagnosis. Clinical signs typically used to make a diagnosis of respiratory disease of calves are fever, cough, ocular or nasal discharge, abnormal breathing, and auscultation of abnormal lung sounds. Unfortunately, routine screening of calves for respiratory disease on the farm is rarely performed and until more comprehensive, practical and affordable respiratory disease-screening tools such as accelerometers, pedometers, appetite monitors, feed consumption detection systems, remote temperature recording devices, radiant heat detectors, electronic stethoscopes, and thoracic ultrasound are validated, timely diagnosis of respiratory disease can be facilitated using a standardized scoring system. We have developed a scoring system that attributes severity scores to each of four clinical parameters; rectal temperature, cough, nasal discharge, ocular discharge or ear position. A total respiratory score of five points or higher (provided that at least two abnormal parameters are observed) can be used to distinguish affected from unaffected calves. This can be applied as a screening tool twice-weekly to identify pre-weaned calves with respiratory disease thereby facilitating early detection. Coupled with effective treatment protocols, this scoring system will reduce post-weaning pneumonia, chronic pneumonia, and otitis media.

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

    Directory of Open Access Journals (Sweden)

    Ghori U

    2015-01-01

    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 ...

  12. Evaluation of the six-minute walk test in dogs.

    Science.gov (United States)

    Boddy, Kirstin N; Roche, Brian M; Schwartz, Denise S; Nakayama, Tomohiro; Hamlin, Robert L

    2004-03-01

    To determine the feasibility for use of a 6-minute walk test (6-MWT) in dogs with congestive heart failure (CHF) and document that the distance walked in 6 minutes decreases when a dog has CHF. 16 young mature male hound-crossbred dogs weighing between 25 and 37 kg. An unobstructed path (22.73 m) was measured in a hallway. Each dog was walked on a leash for 6 minutes; each dog was allowed to set its own pace. At the end of 6 minutes (as measured by use of a stopwatch), the total distance walked was measured. Heart rate (HR) obtained by auscultation and mean systemic arterial pressure (MAP) obtained by oscillometry were recorded before and after the 6-MWT. Heart failure was induced by use of rapid ventricular pacing. Mean of the distance walked, HR, and MAP before and after the 6-MWT were compared between the control period and after dogs developed induced CHF. Dogs with CHF had a significant increase in resting HR, significant decrease in MAP, and a significant decrease in the distance walked in 6 minutes. The MAP increased slightly after exercise during the control period but decreased slightly after exercise during the CHF period. Fractional shortening decreased significantly when dogs had CHF. Analysis of these results indicated that the distance walked in 6 minutes decreased significantly when a dog had CHF. The 6-MWT requires little time, space, or equipment and may replace the treadmill exercise test.

  13. Long-term survival of quiescent left atrial myxoma in an elderly patient.

    Science.gov (United States)

    Kay, Jay F L; Chow, Wing Hing

    2002-01-01

    Left atrial myxoma, if left untreated, is inexorably progressive and usually fatal. The classical management of this disease is prompt surgical removal. However, there may be exceptions to this traditional dogma. The authors report an 85-year-old man who presented with features of chronic obstructive airway disease and congestive heart failure 15 years previously. Auscultation of the heart showed a pansystolic murmur. Two-dimensional echocardiography revealed a nonobstructive, calcified, and well circumscribed mass in the left atrium, with a pedicle attached to the interatrial septum. Because the patient refused high-risk cardiac surgery related to his comorbidity, he was managed medically with a bronchodilator, diuretics, and digoxin. There have been no features of embolism or intracardiac obstruction, and serial echocardiography demonstrates no disease progression over this long period of time. This case illustrates that calcified left atrial myxoma may exhibit a quiescent phase. Tumor calcification, slow growth potential, and the absence of intracardiac obstruction may correlate with a better outcome in the elderly patient. (c)2002 CVRR, Inc.

  14. Traditional Indian medicine (TIM) and traditional Korean medicine (TKM): aconstitutional-based concept and comparison.

    Science.gov (United States)

    Kang, Young Min; Komakech, Richard; Karigar, Chandrakant Shivappa; Saqib, Asma

    2017-06-01

    Traditional and complementary medicine (T&CM) plays an integral role in providing health care worldwide. It is based on sound fundamental principles and centuries of practices. This study compared traditional Indian medicine (TIM) and traditional Korean medicine (TKM) basing on data obtained from peer reviewed articles, respective government institutional reports and World Health Organization reports. Despite the fact that TIM and TKM have individual qualities that are unique from each other including different histories of origin, they share a lot in common. Apart from Homeopathy in TIM, both systems are hinged on similar principle of body constitutional-based concept and similar disease diagnosis methods of mainly auscultation, palpation, visual inspection, and interrogation. Similarly, the treatment methods of TIM and TKM follow similar patterns involving use of medicinal herbs, moxibustion, acupuncture, cupping, and manual therapy. Both T&CM are majorly practiced in well-established hospitals by T&CM doctors who have undergone an average of 6-7 years of specialized trainings. However, unlike TIM which has less insurance coverage, the popularity of TKM is majorly due to its wide national insurance coverage. These two medical traditions occupy increasingly greater portion of the global market. However, TIM especially Ayurveda has gained more global recognition than TKM although the emergence of Sasang Constitutional Medicine in TKM is beginning to become more popular. This comparative analysis between TIM and TKM may provide vital and insightful contribution towards constitutional-based concept for further development and future studies in T&CM.

  15. Ultrasound data for laboratory calibration of an analytical model to calculate crack depth on asphalt pavements.

    Science.gov (United States)

    Franesqui, Miguel A; Yepes, Jorge; García-González, Cándida

    2017-08-01

    This article outlines the ultrasound data employed to calibrate in the laboratory an analytical model that permits the calculation of the depth of partial-depth surface-initiated cracks on bituminous pavements using this non-destructive technique. This initial calibration is required so that the model provides sufficient precision during practical application. The ultrasonic pulse transit times were measured on beam samples of different asphalt mixtures (semi-dense asphalt concrete AC-S; asphalt concrete for very thin layers BBTM; and porous asphalt PA). The cracks on the laboratory samples were simulated by means of notches of variable depths. With the data of ultrasound transmission time ratios, curve-fittings were carried out on the analytical model, thus determining the regression parameters and their statistical dispersion. The calibrated models obtained from laboratory datasets were subsequently applied to auscultate the evolution of the crack depth after microwaves exposure in the research article entitled "Top-down cracking self-healing of asphalt pavements with steel filler from industrial waste applying microwaves" (Franesqui et al., 2017) [1].

  16. Ultrasound data for laboratory calibration of an analytical model to calculate crack depth on asphalt pavements

    Directory of Open Access Journals (Sweden)

    Miguel A. Franesqui

    2017-08-01

    Full Text Available This article outlines the ultrasound data employed to calibrate in the laboratory an analytical model that permits the calculation of the depth of partial-depth surface-initiated cracks on bituminous pavements using this non-destructive technique. This initial calibration is required so that the model provides sufficient precision during practical application. The ultrasonic pulse transit times were measured on beam samples of different asphalt mixtures (semi-dense asphalt concrete AC-S; asphalt concrete for very thin layers BBTM; and porous asphalt PA. The cracks on the laboratory samples were simulated by means of notches of variable depths. With the data of ultrasound transmission time ratios, curve-fittings were carried out on the analytical model, thus determining the regression parameters and their statistical dispersion. The calibrated models obtained from laboratory datasets were subsequently applied to auscultate the evolution of the crack depth after microwaves exposure in the research article entitled “Top-down cracking self-healing of asphalt pavements with steel filler from industrial waste applying microwaves” (Franesqui et al., 2017 [1].

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

    Directory of Open Access Journals (Sweden)

    Jisa George

    2015-06-01

    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.

  18. Successful management using airway pressure release ventilation for severe postoperative pulmonary edema.

    Science.gov (United States)

    Morimoto, Yoshihisa; Sugimoto, Takaki; Arase, Hiroki; Haba, Fumiya

    2016-01-01

    Postoperative pulmonary edema is a fatal adverse event after a cardiac surgery. We here report successful management using airway pressure release ventilation (APRV) for severe hypoxia with pulmonary edema after a cardiac surgery. A 58-year-old man underwent an uneventful mitral valve repair. Immediately afterwards, the patient became agitated and made vigorous inspiratory efforts. His oxygen saturation dropped to 90%. Coarse inspiratory rhonchi were heard on auscultation, and copious, pink, frothy sputum was obtained with suctioning. Initial chest radiograph showed right-sided patchy opacities and interstitial infiltrates. A transthoracic echocardiogram demonstrated normal cardiac function. With worsening respiratory failure on mechanical ventilation, APRV was attempted. His condition and blood gas was subsequently improved. Over the following 3days, the patient experienced an uneventful postoperative course and was discharged to home on postoperative day 14. Extracorponeal membrane oxygenation (ECMO) is the most effective for severe hypoxia with pulmonary edema; however, ECMO is associated with hemorrhage and infectious complications. Alteratively, APRV was required for the successful management for severe hypoxia with pulmonary edema. APRV could be effective for severe hypoxia with pulmonary edema after a cardiac surgery. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

  19. Acute Respiratory Distress Syndrome after the Use of Gadolinium Contrast Media.

    Science.gov (United States)

    Park, Jihye; Byun, Il Hwan; Park, Kyung Hee; Lee, Jae-Hyun; Nam, Eun Ji; Park, Jung-Won

    2015-07-01

    Acute respiratory distress syndrome (ARDS) is a medical emergency that threatens life. To this day, ARDS is very rarely reported by iodine contrast media, and there is no reported case of ARDS induced by gadolinium contrast media. Here, we present a case with ARDS after the use of gadobutrol (Gadovist) as a magnetic resonance imaging (MRI) contrast medium. A 26 years old female without any medical history, including allergic diseases and without current use of drugs, visited the emergency room for abdominal pain. Her abdominopelvic computed tomography with iodine contrast media showed a right ovarian cyst and possible infective colitis. Eighty-three hours later, she underwent pelvis MRI after injection of 7.5 mL (0.1 mL/kg body weight) of gadobutrol (Gadovist) to evaluate the ovarian cyst. She soon presented respiratory difficulty, edema of the lips, nausea, and vomiting, and we could hear wheezing upon auscultation. She was treated with dexamethasone, epinephrine, and norepinephrine. Her chest X-ray showed bilateral central bat-wing consolidative appearance. Managed with mechanical ventilation, she was extubated 3 days later and discharged without complications.

  20. Early detection of myocardial dysfunction using two-dimensional speckle tracking echocardiography in a young cat with hypertrophic cardiomyopathy

    Directory of Open Access Journals (Sweden)

    Ryohei Suzuki

    2018-02-01

    Full Text Available Case summary A 5-month-old intact female Scottish Fold cat was presented for cardiac evaluation. Careful auscultation detected a slight systolic murmur (Levine I/VI. The findings of electrocardiography, thoracic radiography, non-invasive blood pressure measurements and conventional echocardiographic studies were unremarkable. However, two-dimensional speckle tracking echocardiography revealed abnormalities in myocardial deformations, including decreased early-to-late diastolic strain rate ratios in longitudinal, radial and circumferential directions, and deteriorated segmental systolic longitudinal strain. At the follow-up examinations, the cat exhibited echocardiographic left ventricular hypertrophy and was diagnosed with hypertrophic cardiomyopathy using conventional echocardiography. Relevance and novel information This is the first report on the use of two-dimensional speckle tracking echocardiography for the early detection of myocardial dysfunction in a cat with hypertrophic cardiomyopathy; the myocardial dysfunction was detected before the development of hypertrophy. The findings from this case suggest that two-dimensional speckle tracking echocardiography can be useful for myocardial assessment when conventional echocardiographic and Doppler findings are ambiguous.

  1. Stress Cardiomyopathy in the Setting of COPD Exacerbation

    Directory of Open Access Journals (Sweden)

    Kevin Landefeld

    2015-10-01

    Full Text Available Introduction. Stress cardiomyopathy, or takotsubo cardiomyopathy, is an acute, reversible left ventricular dysfunction usually initiated by a psychological or physical stress. We report this case of stress cardiomyopathy following a chronic obstructive pulmonary disease exacerbation and the subsequent treatment. Case Description. A 49-year-old white female with a history of chronic obstructive pulmonary disease presented to the emergency room via emergency medical services with worsening severe shortness of breath and productive cough for 2 weeks but denied any chest pain on arrival. On presentation, she was noted to be tachypneic, using her accessory muscles and with bilateral coarse expiratory wheezing on lung auscultation. Initial electrocardiogram demonstrated sinus tachycardia. She was treated with multiple albuterol treatments. Soon afterwards, the course was complicated by hypoxic respiratory failure eventually requiring intubation. Her repeat electrocardiogram showed acute changes consistent with myocardial infarction, and an echocardiograph demonstrated apical akinesia with an ejection fraction of 25% to 30%. The patient was urgently taken for cardiac catheterization, which showed no angiographic evidence of coronary artery disease. Three days after initial presentation, a repeat transthoracic echocardiogram showed overall left ventricular systolic function improvement. Discussion. This case provided a unique look at the difficulty of balancing catecholamines in a patient with bronchospasm and stress cardiomyopathy.

  2. November 2015 critical care case of the month

    Directory of Open Access Journals (Sweden)

    Sultan S

    2015-11-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: A 39-year-old Caucasian female was admitted to the ICU with worsening dyspnea and increasing oxygen requirements. Her lips turned blue with minimal activity. She was admitted to another hospital 5 months earlier with pneumonia. At discharge she was placed on oxygen. At follow-up with her pulmonologist, she was diagnosed with sleep apnea. Past Medical History, Family History, Social History: She has a history of an optic glioma at age 7 with resection followed by radiation therapy and development of panhypopituitarism; Liver cirrhosis diagnosed in 2014 with presentation of hematemesis; Type 2 diabetes mellitus; Denies tobacco, ethanol, or illicit drug use; There is a family history of diabetes and liver cirrhosis. Physical Examination: Vital signs:110 / 86, HR 97, RR 16, 88% on 6 liter O2; General: obese female (BMI 35 in no apparent distress; Chest: Clear to auscultation bilaterally; Cardiovascular: regular rate without murmur or rub ...

  3. July 2017 critical care case of the month

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    Raschke RA

    2017-07-01

    Full Text Available No abstract available. Article truncated at 150 words. History of Present Illness: A 62-year-old man was brought to the Emergency Department with an altered mental status after a neighbor found him unresponsive. Medications the paramedics found in his home were cyclobenzaprine, duloxetine, gabapentin, levothyroxine, ibuprofen, and tramadol. Past Medical History, Social History and Family History: He had a past medical history of neck and back pain and hypothyroidism. He lived alone. There was a history of a C3-4 anterior cervical discectomy in 2010. Other history including family history was unobtainable. Physical Examination: • Vital Signs: HR 61 beats/min, BP 86/50 mm Hg, RR 8 breaths/min, T 32.2º C. • General: arousable but did not answer questions. He had multiple tattoos. No needle track marks are identified. • HEENT: pupils were small but reacted to light.•\tLungs: clear to auscultation. • Heart: regular rhythm without murmur. • Abdomen: soft without organomegaly or masses. • Neurology: he moved all 4 extremities but minimally. Plantar reflexes were …

  4. Transposición corregida de grandes vasos

    Directory of Open Access Journals (Sweden)

    José Rafael Escalona Aguilera

    2012-09-01

    Full Text Available Se presenta una paciente de sexo femenino, de 9 años de edad, que acude a su médico de familia y se le auscultó un soplo al examen físico y sintomatología que se comportaba como una comunicación interventricular. Luego de los estudios correspondientes, se permitió hacer el diagnóstico de transposición corregida de grandes vasos. La paciente tenía asociada una anomalía de Ebstein, comunicación interauricular, una comunicación interventricular, y una persistencia del conducto arterioso, todo lo cual agravaba su cuadro clínico. Primero es intervenida quirúrgicamente, y se cierra el ducto; de manera espontánea, cierra la comunicación interauricular, y la anomalía de Ebstein parchea la comunicación interventricular. La niña desarrolla una insuficiencia cardiaca e hipertensión pulmonar, a consecuencia de las anomalías asociadas. El caso es de interés, ya que son pocos los publicados en la literatura internacional con esta cardiopatía congénita asociada a otras anomalías estructurales del corazón, que modifican su historia natural.

  5. Maternal attitudes to fetal monitoring.

    Science.gov (United States)

    Hansen, P K; Smith, S F; Nim, J; Neldam, S; Osler, M

    1985-07-01

    During a randomized clinical trial concerning alternative methods of intrapartum fetal surveillance (electronic fetal monitoring (EFM) and auscultation (AUS)) an investigatory interview was carried out. Out of 655 expecting mothers the antepartum preference of EFM was 39.5%, of AUS 32.3% and 28.1% were undecided (UD). EFM was especially preferred by obstetrical high-risk patients. Reasons for preference of AUS were a natural childbirth, a non-technological milieu, and the lack of supposed discomfort from sensors and belts. The pregnant women found as major advantages of EFM continuous observation and the possibility of quick intervention. Postpartum 385 patients were again interviewed. The majority upheld the original preference if that method was used. If the non-preferred method had been applied many would stick to the primary preference although a tendency to prefer the experienced method was seen. The patients who antepartum preferred AUS, but had EFM, became more positive toward the method, and a significantly increased number were positively influenced by the EFM signal/trace and found the method promoting their partner's involvement in labor. Enforced immobility, however, was a major disadvantage as well as the technical milieu. If EFM is to be accepted by a majority of women giving birth it is necessary to increase the pregnant women's knowledge of the method and to take milieu factors into consideration in order to reduce the intrinsic depersonalization of EFM.

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

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    Heriberto Atanacio Núñez Mendieta

    2015-12-01

    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.

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

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    A.B. Zambelli

    2006-06-01

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

  8. Assessment of Pulmonary Edema: Principles and Practice.

    Science.gov (United States)

    Assaad, Sherif; Kratzert, Wolf B; Shelley, Benjamin; Friedman, Malcolm B; Perrino, Albert

    2018-04-01

    Pulmonary edema increasingly is recognized as a perioperative complication affecting outcome. Several risk factors have been identified, including those of cardiogenic origin, such as heart failure or excessive fluid administration, and those related to increased pulmonary capillary permeability secondary to inflammatory mediators. Effective treatment requires prompt diagnosis and early intervention. Consequently, over the past 2 centuries a concentrated effort to develop clinical tools to rapidly diagnose pulmonary edema and track response to treatment has occurred. The ideal properties of such a tool would include high sensitivity and specificity, easy availability, and the ability to diagnose early accumulation of lung water before the development of the full clinical presentation. In addition, clinicians highly value the ability to precisely quantify extravascular lung water accumulation and differentiate hydrostatic from high permeability etiologies of pulmonary edema. In this review, advances in understanding the physiology of extravascular lung water accumulation in health and in disease and the various mechanisms that protect against the development of pulmonary edema under physiologic conditions are discussed. In addition, the various bedside modalities available to diagnose early accumulation of extravascular lung water and pulmonary edema, including chest auscultation, chest roentgenography, lung ultrasonography, and transpulmonary thermodilution, are examined. Furthermore, advantages and limitations of these methods for the operating room and intensive care unit that are critical for proper modality selection in each individual case are explored. Published by Elsevier Inc.

  9. Preliminary Development and Validation of a Paediatric Cardiopulmonary Physiotherapy Discharge Tool

    Science.gov (United States)

    Davis, Aileen; Brooks, Dina

    2011-01-01

    ABSTRACT Purpose: The purpose of this study was to develop a paediatric cardiopulmonary physiotherapy (CPT) discharge tool. We report on the initial stages of its development and the tool's sensibility (face/content validity, feasibility, and ease of usage). Methods: Using a modified Delphi technique, a panel of paediatric physiotherapy clinicians and academic leaders in the area of CPT (n=25) was recruited. Four rounds of discussion among the members of the Delphi panel focused on (1) generation of discharge items, (2) reduction of items, (3) discussion of contentious items and refinement of criterion definitions, and (4) determination of scoring options for the test instrument. The sensibility of a draft of the tool was assessed using a sample of convenience (n=15). Results: Six items (auscultation, discharge planning, mobility, oxygen saturation, secretion clearance, and signs of respiratory distress) were identified for inclusion in the tool. The global mean of all sensibility domains was 6.4 (median=6.6) of a possible 7.0. Conclusion: Using a modified Delphi process, we developed a six-item paediatric CPT discharge planning tool with good face and content validity. Future work will determine the scoring method for using this tool, interrater reliability, and predictive validity to facilitate optimal timing of hospital discharge for paediatric CPT patients. PMID:22210977

  10. The Ventriloscope: 'am I hearing things?'.

    Science.gov (United States)

    Castilano, Amy; Haller, Nairmeen; Goliath, Cheryl; Lecat, Paul

    2009-03-01

    Knowledge of the benefits of incorporating medical simulation into healthcare curricula is rapidly increasing. Though impeded by the high cost of complicated technology, medical simulation devices offer the ability to provide safe and controlled training environments, exposure to rare clinical scenarios, as well as unlimited training opportunities. This report describes a novel, inexpensive method of broadcasting normal and abnormal auscultatory findings to a relatively normal appearing stethoscope for use in training of healthcare professionals. Using wireless transmitter broadcasting to a stethoscope fitted with a receiver apparatus, the student is able to perform a typical medical exam with auscultation of an unlimited variety of clinical sounds from anatomically appropriate sources while being observed from another room. Implications of this low-cost device include limitless training possibilities worldwide and across disciplines. The simplicity and portability of this device increases potential for use in rapid training of recognition of clinical signs associated with chemical/biological warfare agents, mass casualty incidents and field military applications. This is the first device to simulate clinically relevant sounds in a realistic manner on standardized patients and mannequins. The benefits of such simulation in medical education ultimately serve to increase trainee confidence and consequently, improve patient care and safety.

  11. Preliminary development and validation of a paediatric cardiopulmonary physiotherapy discharge tool.

    Science.gov (United States)

    Ellerton, Cindy; Davis, Aileen; Brooks, Dina

    2011-01-01

    The purpose of this study was to develop a paediatric cardiopulmonary physiotherapy (CPT) discharge tool. We report on the initial stages of its development and the tool's sensibility (face/content validity, feasibility, and ease of usage). Using a modified Delphi technique, a panel of paediatric physiotherapy clinicians and academic leaders in the area of CPT (n=25) was recruited. Four rounds of discussion among the members of the Delphi panel focused on (1) generation of discharge items, (2) reduction of items, (3) discussion of contentious items and refinement of criterion definitions, and (4) determination of scoring options for the test instrument. The sensibility of a draft of the tool was assessed using a sample of convenience (n=15). Six items (auscultation, discharge planning, mobility, oxygen saturation, secretion clearance, and signs of respiratory distress) were identified for inclusion in the tool. The global mean of all sensibility domains was 6.4 (median=6.6) of a possible 7.0. Using a modified Delphi process, we developed a six-item paediatric CPT discharge planning tool with good face and content validity. Future work will determine the scoring method for using this tool, interrater reliability, and predictive validity to facilitate optimal timing of hospital discharge for paediatric CPT patients.

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

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    Hassani Kamran

    2011-05-01

    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 http://www.goldwave.com 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. Focal intramural pericardial effusion and cardiac tamponade associated with necrotic adipose tissue in a dog.

    Science.gov (United States)

    Krentz, Terence A; Schutrumpf, Robert J; Zitz, Julie C

    2017-07-15

    CASE DESCRIPTION A 1-year-old castrated male German Shepherd Dog was examined because of an acute onset of lethargy, tachypnea, and inappetence. CLINICAL FINDINGS On initial physical examination, the dog was tachypneic with muffled heart sounds on thoracic auscultation and a palpable abdominal fluid wave. Transthoracic echocardiography revealed focal intramural pericardial effusion and cardiac tamponade. TREATMENT AND OUTCOME The patient underwent emergency therapeutic pericardiocentesis, followed by right lateral intercostal thoracotomy and subtotal pericardiectomy. A 3 × 5-cm mass located between the parietal and visceral layers of the pericardium was resected. The histologic diagnosis was necrotic adipose tissue with granulomatous inflammation and fibroplasia. The patient also underwent exploratory laparotomy and umbilical herniorrhaphy during the same anesthetic episode and recovered from surgery without apparent complications. There were no further clinical signs of cardiac disease. CLINICAL RELEVANCE The patient described in the present report underwent successful subtotal pericardiectomy for treatment of a benign focal lesion causing recurrent pericardial effusion and cardiac tamponade. Prompt diagnosis and intervention may have contributed to the positive outcome in this case.

  14. Misdiagnosis and undiagnosis due to pattern similarity in Chinese medicine: a stochastic simulation study using pattern differentiation algorithm

    Science.gov (United States)

    2011-01-01

    Background Whether pattern similarity causes misdiagnosis and undiagnosis in Chinese medicine is unknown. This study aims to test the effect of pattern similarity and examination methods on diagnostic outcomes of pattern differentiation algorithm (PDA). Methods A dataset with 73 Zangfu single patterns was used with manifestations according to the Four Examinations, namely inspection (Ip), auscultation and olfaction (AO), inquiry (Iq) and palpation (P). PDA was applied to 100 true positive and 100 true negative manifestation profiles per pattern in simulation. Four runs of simulations were used according to the Four Examinations: Ip, Ip+AO, Ip+AO+Iq and Ip+AO+Iq+P. Three pattern differentiation outcomes were separated, namely correct diagnosis, misdiagnosis and undiagnosis. Outcomes frequencies, dual pattern similarity and pattern-dataset similarity were calculated. Results Dual pattern similarity was associated with Four Examinations (gamma = -0.646, P pattern differentiation errors, being less influenced by pattern-dataset similarity (Ip: gamma = 0.684; Ip+AO: gamma = 0.660; Ip+AO+Iq: gamma = 0.398; Ip+AO+Iq+P: gamma = 0.286, P pattern similarity and pattern differentiation outcome and are recommended to avoid misdiagnosis and undiagnosis due to similarity. PMID:21226952

  15. Arrhythmogenic right ventricular cardiomyopathy in a dog : case report

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    A.J. Möhr

    2000-07-01

    Full Text Available An 8-month-old Labrador retriever bitch was evaluated for sudden-onset, progressive abdominal distension. Physical examination revealed an exaggerated inspiratory effort, severe ascites, bilateral jugular vein distension, and hypokinetic femoral arterial pulses. Thoracic auscultation detected tachycardia with muffled heart sounds, without audible cardiac murmurs. Thoracic radiographs identified severe right ventricular enlargement and pleural effusion. The electrocardiogram was consistent with incomplete right bundle branch block or right ventricular enlargement. Echocardiography demonstrated severe right ventricular and atrial dilation, secondary tricuspid regurgitation, and thinning and hypocontractility of the right ventricular myocardium. Left heart chamber sizes were slightly decreased, with normal left ventricular contractility. Adiagnosis of arrhythmogenic right ventricular cardiomyopathy was reached, based on the characteristic clinical, electrocardiographic, radiographic and echocardiographic findings, and the exclusion of other causes of isolated right ventricular failure. Treatment effected good control of clinical signs, until acutely decompensated congestive right heart failure led to euthanasia after 4 months. Arrhythmogenic right ventricular cardiomyopathy is a well-described clinical entity in humans, and has previously been documented in 3 male dogs. The condition is characterised by progressive fibro-adipose replacement of right ventricular myocardium, while the left ventricle usually remains unaffected. It should be considered a differential diagnosis in any young dog presented with isolated right heart failure, syncope, or unexplained ventricular tachyarrhythmias. This article reports the 1st case of arrhythmogenic right ventricular cardiomyopathy in a female dog, and highlights its echocardiographic features.

  16. Analysis of the single and combined non-destructive test approaches for on-site concrete strength assessment: General statements based on a real case-study

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    Khoudja Ali-Benyahia

    2017-06-01

    Full Text Available The evaluation of the compressive strength of concrete in existing structures by coring is expensive, technically difficult in certain cases, and even impossible in others. The use of non-destructive testing (NDT is an interesting alternative method (i.e. affordable cost, portable, fast, etc.. However, the NDT estimation of strength requires a procedure of calibration of the model between NDT and compressive strength. The robustness of this calibration is a crucial point allowing better choice of the optimal number of cores. Studies which treat the calibration of proposed models are often based on laboratory experiments or synthetic data. The present study aims at identifying and optimizing the methodology of the calibration model on site. This paper is based on a broad campaign of auscultation using NDT (Rebound and Ultrasound and coring on an existing construction with 205 triplets of data (strengths and NDT results. Statistical data analysis enables to quantify the role of: the number of cores (NC used for the calibration, the use of only one or two-combined NDT techniques and the calibration method. The conclusions are focused on the improvement of the relevance and the effectiveness of NDT techniques in such operational situations.

  17. Rheumatic heart disease screening: Current concepts and challenges

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    Scott Dougherty

    2017-01-01

    Full Text Available Rheumatic heart disease (RHD is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis. However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed.

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

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    Jose Rodrigues Coura

    2013-12-01

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

  19. Traditional Indian medicine (TIM and traditional Korean medicine (TKM: aconstitutional-based concept and comparison

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    Young Min Kang

    2017-06-01

    Full Text Available Traditional and complementary medicine (T&CM plays an integral role in providing health care worldwide. It is based on sound fundamental principles and centuries of practices. This study compared traditional Indian medicine (TIM and traditional Korean medicine (TKM basing on data obtained from peer reviewed articles, respective government institutional reports and World Health Organization reports. Despite the fact that TIM and TKM have individual qualities that are unique from each other including different histories of origin, they share a lot in common. Apart from Homeopathy in TIM, both systems are hinged on similar principle of body constitutional-based concept and similar disease diagnosis methods of mainly auscultation, palpation, visual inspection, and interrogation. Similarly, the treatment methods of TIM and TKM follow similar patterns involving use of medicinal herbs, moxibustion, acupuncture, cupping, and manual therapy. Both T&CM are majorly practiced in well-established hospitals by T&CM doctors who have undergone an average of 6–7 years of specialized trainings. However, unlike TIM which has less insurance coverage, the popularity of TKM is majorly due to its wide national insurance coverage. These two medical traditions occupy increasingly greater portion of the global market. However, TIM especially Ayurveda has gained more global recognition than TKM although the emergence of Sasang Constitutional Medicine in TKM is beginning to become more popular. This comparative analysis between TIM and TKM may provide vital and insightful contribution towards constitutional-based concept for further development and future studies in T&CM.

  20. Coronary Arteriovenous Fistula Causing Hydrops Fetalis

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    Nilüfer Çetiner

    2014-01-01

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

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

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    Hall JM

    2015-08-01

    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 ...

  2. Intermittent bradyarrhythmia in a Hispaniolan Amazon parrot (Amazona ventralis).

    Science.gov (United States)

    Rembert, Melanie S; Smith, Julie A; Strickland, Keith N; Tully, Thomas N

    2008-03-01

    A clinically normal 2-year-old Hispaniolan Amazon parrot (Amazona ventralis) was found to have periodic second-degree atrioventricular (AV) block with variable nodal conductions while anesthetized with isoflurane during a thermal-support research project. Arrhythmias were observed on 5 successive weekly electrocardiograms. A complete cardiac evaluation, including a diagnostic electrocardiogram, revealed intermittent bradyarrhythmias ranging from a 2:1 to a 7:1 second-degree AV block, with concurrent hypotensive episodes during the nodal blocks. Results of a complete blood cell count, plasma biochemical profile, blood gas analysis, and atropine-response test, as well as radiography and auscultation, revealed no obvious cause for the arrhythmias. Echocardiography demonstrated cardiac wall thickness, chamber size, and systolic function similar to other psittacine birds. On return to the colony, the parrot continued to be outwardly asymptomatic despite the dramatic conduction disturbances. Although cardiac arrhythmias, including second-degree AV block, have been widely reported in birds, the wide variation of nodal conductions, the intermittent nature, and an arrhythmia with a 7:1 second-degree AV block that spontaneously reverts to normal as seen in this case have not been well documented in parrots.

  3. Spontaneous Pneumomediastinum with a Rare Presentation

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    Ehsan Bolvardi

    2014-01-01

    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.

  4. [Interstitial lung disease-associated with amyopathic dermatomyositis and anti-MDA5 autoantibodies].

    Science.gov (United States)

    Gerfaud-Valentin, M; Ahmad, K; Piegay, F; Fabien, N; Raphanel, B; Cordier, J-F; Cottin, V

    2014-11-01

    Amyopathic dermatomyositis associated with anti-MDA5 autoantibodies is a rare and very recently described clinical entity. A 58-year-old woman was admitted with subacute onset of dyspnea (NYHA class IV) associated with cough, oligoarthritis of the wrists, myalgia and intermittent fever. Examination demonstrated skin lesions with heliotrope rash, Gottron's papules, "mechanics hands", and basal inspiratory crackles on lung auscultation. Pulmonary function tests showed a restrictive ventilatory defect, with decreased carbon monoxide diffusion capacity and marked hypoxemia (PaO2 61 mmHg). The chest high-resolution computed tomography appearances were consistent with organizing pneumonia. Bronchoalveolar lavage differential cell count demonstrated 22 % neutrophils. Serum creatine kinase and electromyography were normal ; the serum ferritin level was elevated. Antinuclear antibodies were present and anti-MDA5 autoantibodies were identified. Significant improvement was obtained with systemic corticosteroids, later converted to mycophenolate mofetil as a steroid-sparing agent. Amyopathic dermatomyositis associated with anti-MDA5 autoantibodies shares some characteristics with those associated with anti-synthetase antibodies. Muscular involvement may be mild or absent. Early diagnosis and treatment may improve outcome. Copyright © 2014 SPLF. Published by Elsevier Masson SAS. All rights reserved.

  5. Dying art of a history and physical: pulsatile tinnitus.

    Science.gov (United States)

    Lee, Jonathan; Fekete, Zoltan

    2017-11-27

    Modern medicine often leaves the history and physical by the wayside. Physicians instead skip directly to diagnostic modalities like MRI and angiography. In this case report, we discuss a patient who presented with migraine symptoms. Auscultation revealed signs of pulsatile tinnitus. Further imaging concluded that it was secondary to a type I dural arteriovenous fistula. Thanks to a proper and thorough history and physical, the patient was streamlined into an accurate and efficient work-up leading to symptomatic relief and quality of life improvement. Imaging is a powerful adjunctive technique in modern medicine, but physicians must not rely on machines to diagnose their patients. If this trend continues, it will have a tremendous negative impact on the cost and calibre of healthcare. Our hope is that this case will spread awareness in the medical community, urging physicians to use the lost art of a history and physical. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

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    Elif Kupeli

    2010-01-01

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

  7. Hazards of the 'hard cash': hypersensitivity pneumonitis.

    Science.gov (United States)

    Kupeli, Elif; Karnak, Demet; Sak, Serpil Dizbay; Kayacan, Oya

    2010-01-01

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

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

    Science.gov (United States)

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

    2016-09-23

    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 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.

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

    Directory of Open Access Journals (Sweden)

    Susana Corujeira

    2015-01-01

    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.

  10. Hippocrates: the forefather of neurology.

    Science.gov (United States)

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

    2014-09-01

    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.

  11. Age alters the cardiovascular response to direct passive heating

    Science.gov (United States)

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

    1998-01-01

    During direct passive heating in young men, a dramatic increase in skin blood flow is achieved by a rise in cardiac output (Qc) and redistribution of flow from the splanchnic and renal vascular beds. To examine the effect of age on these responses, seven young (Y; 23 +/- 1 yr) and seven older (O; 70 +/- 3 yr) men were passively heated with water-perfused suits to their individual limit of thermal tolerance. Measurements included heart rate (HR), Qc (by acetylene rebreathing), central venous pressure (via peripherally inserted central catheter), blood pressures (by brachial auscultation), skin blood flow (from increases in forearm blood flow by venous occlusion plethysmography), splanchnic blood flow (by indocyanine green clearance), renal blood flow (by p-aminohippurate clearance), and esophageal and mean skin temperatures. Qc was significantly lower in the older than in the young men (11.1 +/- 0.7 and 7.4 +/- 0.2 l/min in Y and O, respectively, at the limit of thermal tolerance; P response (62 +/- 3 and 75 +/- 4% maximal HR in Y and O, respectively, P responses, the older men had a significantly lower increase in total blood flow directed to the skin.

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

    International Nuclear Information System (INIS)

    De Panfilis, S; Peccianti, M; Chiru, O M; Moroni, C; Vashkevich, V; Parisi, G; Cassone, R

    2013-01-01

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

  13. Anaphylaxis with delayed appearance of skin manifestations during general anesthesia: two case reports.

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    Hanamoto, Hiroshi; Kozu, Fumi; Oyamaguchi, Aiko; Inoue, Mika; Yokoe, Chizuko; Niwa, Hitoshi

    2017-07-24

    Anaphylaxis is difficult to diagnose in the absence of skin or mucosal signs and symptoms. We report two cases of anaphylaxis under general anesthesia, in which the initial presentation was in the form of respiratory signs, followed by skin manifestations 10-15 min later. Diagnosis of anaphylaxis was delayed because skin symptoms were absent early on in the presentation. In the first case, a 23-year-old male patient with jaw deformity was scheduled to undergo maxillary alveolar osteotomy. After intubation, auscultation indicated a sudden decrease in breath sounds, together with severe hypotension. Approximately 10 min later, flushing of the skin and urticaria on the thigh appeared and spread widely throughout the body. In the second case, a 21-year-old female patient with jaw deformity was scheduled to undergo maxillomandibular osteotomy. Twenty minutes after the start of dextran infusion, her lungs suddenly became difficult to ventilate, and oxygen saturation decreased to 90%. Approximately 15 min later, flushing of the skin and urticaria were observed. In both cases, there was a time lag between the appearance of respiratory and skin symptoms, which resulted in a delay in the diagnosis, and hence, treatment of anaphylaxis. Our experience highlights the fact that it is difficult to diagnose anaphylaxis under general anesthesia.

  14. Echocardiographic Diagnostics of Myocardial Infarction in Newborns

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    G. V. Revunenkov

    2015-01-01

    Full Text Available Early and correct diagnostics of myocardial infarction in newborns is impossible without modern instrumental methods, among which echocardiography is the leading one. Hypokinesia, akinesia or dyskinesia of local segments of the heart ventricular wall is determined with echocardiography. We examined a 3-days-old baby with circulatory failure requiring cardiotonic support. On auscultation there was a heart murmur. It was an intracardiac conduction disoder and infarction-like changes on ECG, however, a convincing evidence to interpret the patient’s condition as myocardial infarction has not been received. Therefore, it was decided to conduct echocardiography. According to the results of echocardiography the presence of hyperechogenic diskinetic locus in the apical segment of the right ventricle (post-infarction scar, a local pericardial effusion in the same projection, hyperechogenic movable mass (thrombus in the apical segment of the right ventricle were determined that together with the results of the ECG allowed us to set diagnosis myocardial infarction. Transthoracic echocardiography is one of highly informative methods; the data obtained allowed to correctly interpret the clinical picture of heart failure and to reveal the cause of the patien’st dependance on cardiotonic support.

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

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    Raschke RA

    2014-07-01

    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...

  16. Severe Hypotension, Hypoxia, and Subcutaneous Erythema Induced by Indigo Carmine Administration during Open Prostatectomy.

    Science.gov (United States)

    Nandate, Koichiro; Voelzke, Bryan B

    2016-01-01

    Indigo carmine (also known as 5,5'-indigodisulfonic acid sodium salt or indigotine) is a blue dye that is administered intravenously to examine the urinary tract and usually is biologically safe and inert. Indigo carmine rarely may cause adverse reactions. We treated a 66-year-old man who had general anesthesia and radical retropubic prostatectomy for prostate cancer. He had a previous history of allergy to bee sting with nausea, vomiting, and dizziness. Within 1 minute after injection of indigo carmine for evaluation of the ureters, the patient developed hypotension to 40 mmHg, severe hypoxia (the value of SpO2 (peripheral capillary oxygen saturation) was 75% on 40% inspired oxygen concentration), poor air movement and bilateral diffuse wheezing on auscultation, and marked subcutaneous erythema at the upper extremities. After treatment with 100% oxygen, epinephrine (total, 1.5 mg), hydrocortisone (100 mg), diphenhydramine (50 mg), albuterol nebulizer (0.083%), and continuous infusion of epinephrine (0.15 μg/kg/min), the vital signs became stable, and he recovered completely. In summary, indigo carmine rarely may cause life-threatening anaphylactic or anaphylactoid reaction that may necessitate rapid treatment to stabilize cardiovascular, hemodynamic, and pulmonary function.

  17. Severe Hypotension, Hypoxia, and Subcutaneous Erythema Induced by Indigo Carmine Administration during Open Prostatectomy

    Directory of Open Access Journals (Sweden)

    Koichiro Nandate

    2016-01-01

    Full Text Available Indigo carmine (also known as 5,5′-indigodisulfonic acid sodium salt or indigotine is a blue dye that is administered intravenously to examine the urinary tract and usually is biologically safe and inert. Indigo carmine rarely may cause adverse reactions. We treated a 66-year-old man who had general anesthesia and radical retropubic prostatectomy for prostate cancer. He had a previous history of allergy to bee sting with nausea, vomiting, and dizziness. Within 1 minute after injection of indigo carmine for evaluation of the ureters, the patient developed hypotension to 40 mmHg, severe hypoxia (the value of SpO2 (peripheral capillary oxygen saturation was 75% on 40% inspired oxygen concentration, poor air movement and bilateral diffuse wheezing on auscultation, and marked subcutaneous erythema at the upper extremities. After treatment with 100% oxygen, epinephrine (total, 1.5 mg, hydrocortisone (100 mg, diphenhydramine (50 mg, albuterol nebulizer (0.083%, and continuous infusion of epinephrine (0.15 μg/kg/min, the vital signs became stable, and he recovered completely. In summary, indigo carmine rarely may cause life-threatening anaphylactic or anaphylactoid reaction that may necessitate rapid treatment to stabilize cardiovascular, hemodynamic, and pulmonary function.

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

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    Ghandi

    2016-05-01

    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.

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

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    Rafael Vieira Martins

    2013-07-01

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

  20. Chronic resistance training does not affect post-exercise blood pressure in normotensive older women: a randomized controlled trial.

    Science.gov (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

    2015-06-01

    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 After the intervention period, the magnitude and pattern of this phenomenon for systolic, diastolic, and mean BP were similar between groups (TG -8.8, -4.1, and -5.7 mmHg, respectively; P exercise promotes reduction in post-exercise BP and 12 weeks of resistance training program do not change the occurrence or magnitude of this hypotension. (ClinicalTrial.gov: NCT02346981).

  1. The Japan Home-health Apparatus Industrial Association: investigation of home-use electronic sphygmomanometers.

    Science.gov (United States)

    Shirasaki, O; Terada, H; Niwano, K; Nakanishi, T; Kanai, M; Miyawaki, Y; Souma, T; Tanaka, T; Kusunoki, T

    2001-12-01

    The Japanese Home-health Apparatus Industrial Association is an official independent organization comprising ten departments. That concerned with home electronic sphygmomanometers, which has seven participants from different Japanese manufacturers, has already undertaken and is currently involved in various activities related to voluntary standards for performance validation and quality assurance. Because Japanese companies form a large proportion of manufacturers, these activities are important in terms of autonomic regulation. Although many improvements have been made to home electronic sphygmomanometers, some problems still remain unresolved, especially in terms of measurement reliability and easy operation by lay people. Another aspect of the department's work relates to making proposals on major validation standards, such as those of the Association for the Advancement of Medical Instrumentation, the British Hypertension Society and Comité Européen de Normalisation (CEN). Clinical validation should be discussed in order to define a more accurate standard method of measurement using auscultation and more appropriate criteria that are unaffected by primary blood pressure variation.

  2. Design of Wearable Breathing Sound Monitoring System for Real-Time Wheeze Detection

    Directory of Open Access Journals (Sweden)

    Shih-Hong Li

    2017-01-01

    Full Text Available 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.

  3. [Validation of an acute bronchiolitis severity scale].

    Science.gov (United States)

    Ramos Fernández, J M; Cordón Martínez, A; Galindo Zavala, R; Urda Cardona, A

    2014-07-01

    Acute bronchiolitis (AB) is a very common disease, with a high rate of seasonal hospitalization. Its management requires homogeneous clinical interpretations for which there are different approaches depending on the scales, none of which are properly validated today. To create an AB severity scale (ABSS) and to validate it. The development of a parameterized construct with a gradual cumulative score of respiratory rate, heart rate, respiratory effort, auscultation of wheezing and crackles, and the inspiration/expiration ratio. Also, the validation of the ABSS performed on patients diagnosed with AB, the reliability measured by observing the behavior of internal consistency, test-retest, external validity and inter-observer agreement. From a total of 290 measurements a Cronbach's reliability alpha of 0.83 was obtained; Kappa agreement index of 0.93 in the test-retest agreement, and Kappa index of 0.682 (α<0.05) for inter-observer agreement. The ABSS can be a reliable tool for measuring the severity of AB. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

  4. Respiratory failure in tetanic patient: maintenance of airway problem in intensive care unit setting

    Science.gov (United States)

    Utami, I. N.; Arifin; Susilo, R. S. B.; Redhono, D.; Sumandjar, T.

    2018-03-01

    Tetanus is a toxin-mediated disease caused by Clostridium tetani resulting in muscular stiffness and painful spasm. The case fatality rates are high (10-80%), and the most frequent cause of mortality is airway problem that results in respiratory failure. A 52-year-old malecame to the hospital with lockjaw, rhesussardonicus, opisthotonus, and seizure for the last 12 hours, diagnosed with tetanus grade II. We placed the patient in an isolation room, gave 3000U tetanus immunoglobulin, 20mg diazepam in 500ml dextrose 5%/8 hours, and 500mg/6hrs metronidazole. On the seventh day, seizure became frequent, respiratory rate increased with crackles found on the auscultation, and the blood gas analysis showed respiratory failure type II (PCO2 53mmHg). The patientwas immediately sent to the ICU, intubated and given ventilator support. The patientwas sedated with continuous injection of midazolam 3 mg/h, morphine 10mcg/kgBW/h and also levofloxacin 750mg/24hours. Bronchoalveolar lavage culture was positive for Acinetobacter baumanii, so we changed the antibiotic to amikacin injection 500 mg/8hrs. After four days, we extubated the ventilator and transferred from HCU three days later. The patient was fully recovered and discharged after eighteen days of hospitalization.

  5. Medical image of the week: septic emboli

    Directory of Open Access Journals (Sweden)

    Malakkla N

    2014-09-01

    Full Text Available No abstract available. Article truncated at 150 words. A 46-year-old man was admitted with altered mental status. His past medical history included HIV/AIDS on HAART therapy, hepatitis B and C, non-Hodgkin's lymphoma (NHL, deep venous thrombosis with insertion of an inferior vena caval filter, and poly-substance abuse. Vitals revealed fever and tachycardia. On exam, he was lethargic and confused, and had bilateral crackles on lung auscultation. Computerized axial tomography (CT of the head was unremarkable and chest X-ray revealed patchy nodular infiltrates in the right upper lobe and bilateral lower lobes. Work up for an infectious cause was initiated including opportunistic infections and he was started on empiric antibiotics for pneumonia. On Day 2, his roommate who came to visit him, revealed that he was recently admitted in another hospital for headache and flu-like symptoms, and discharged with a peripherally inserted central catheter (PICC in place as he was scheduled for a positron emission tomography (PET the next ...

  6. Pericarditis Associated With Human Herpesvirus-6 Reactivation in a Patient After Unrelated Cord Blood Transplant.

    Science.gov (United States)

    Yoshida, Masahiro; Nakamae, Hirohisa; Okamura, Hiroshi; Nishimoto, Mitsutaka; Hayashi, Yoshiki; Koh, Hideo; Nakane, Takahiko; Hino, Masayuki

    2017-04-01

    A 53-year-old woman with myelodysplastic syndrome received a cord blood transplant because she had frequent episodes of febrile neutropenia. As a conditioning regimen for transplant, she received 12 Gy total body irradiation, intravenous cytosine arabinoside 3 g/m2 every 12 hours on days -5 and -4, and cyclophosphamide 60 mg/kg/day on days -3 and -2. She received tacrolimus and short-term methotrexate treatment as prophylaxis for graft-versus-host disease. Her cardiac function was normal before transplant. She developed acute heart failure with a mild pericardial effusion 11 days after transplant, but her failure improved with a diuretic, vasodilator, and inotropic agent. She complained of dyspnea, and chest auscultation revealed pericardial friction rubs on day 28. Massive pericardial effusion was detected by echocardiography and pericarditis was diagnosed. The pericardial space was drained by pericardiocentesis. The pericardial fluid was exudative, but no bacteria or fungi were cultured. On viral polymerase chain reaction examination, human herpesvirus-6 was detected at a level of 3 × 104 copies/mL in the pericardial effusion, but not in the peripheral blood. With conservative treatment alone, that did not include antiviral therapy, her symptoms disappeared on day 56. We conclude that human herpesvirus-6 reactivation may have been associated with her pericarditis.

  7. The consequences of using advanced physical assessment skills in medical and surgical nursing: A hermeneutic pragmatic study.

    Science.gov (United States)

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

    2016-01-01

    The aim of this study was to explore the consequences of the nurse's use of advanced assessment skills on medical and surgical wards. 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. This qualitative study used a hermeneutic pragmatic approach. 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. 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. 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. The nurse's use of advanced assessment skills enables her to contribute to diagnostic reasoning within the acute medical and surgical setting.

  8. Rumenolith formation in a Bapedi ram

    Directory of Open Access Journals (Sweden)

    Rhoda Leask

    2012-04-01

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

  9. Symptoms and signs in pulmonary medicine: old observations and new interpretations.

    Science.gov (United States)

    Sharma, O P

    1995-09-01

    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."

  10. Kangaroo position: Immediate effects on the physiological variables of preterm and low birth weight newborns

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    Érica Cesário Defilipo

    Full Text Available Abstract Introduction: The Kangaroo Mother Care (KMC method is a significant neonatal alternative that ensures better quality humanized care for preterm and low birth weight newborns. Objective: To analyze the immediate physiological effects of the kangaroo position in critically ill newborns. Methods: Open clinical trial with parallel interventions, involving preterm (up to 28 days old low or very low birth weight newborns (minimum weight of 1,250 grams of both sexes, that were clinically stable and undergoing enteral nutrition. The degree of respiratory distress was assessed and quantified using the Silverman-Anderson scoring system. Heart rate and peripheral oxygen saturation were collected using a pulse oximeter. Respiratory rate was determined by auscultation for one minute. The newborns were submitted to the kangaroo position once only, for 90 minutes. Results: Participants were 30 newborns, 56.7% of which were girls. Comparison of the variables before and after application of the kangaroo position using the Wilcoxon test showed a statistically significant reduction in respiratory rate (p = 0.02 and Silverman-Anderson score (p < 0.01. The remaining variables showed no significant differences: heart rate (p = 0.21, peripheral oxygen saturation (p = 0.26 and axillary temperature (p = 0.12. Conclusion: There was a decline in the respiratory rate and Silverman-Anderson score after application of the kangaroo position, while peripheral oxygen saturation, axillary temperature and heart rate remained stable.

  11. 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

    2011-01-01

    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.

  12. 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

    2016-09-01

    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.

  13. Fiber optic tracheal detection device

    Science.gov (United States)

    Souhan, Brian E.; Nawn, Corinne D.; Shmel, Richard; Watts, Krista L.; Ingold, Kirk A.

    2017-02-01

    Poorly performed airway management procedures can lead to a wide variety of adverse events, such as laryngeal trauma, stenosis, cardiac arrest, hypoxemia, or death as in the case of failed airway management or intubation of the esophagus. Current methods for confirming tracheal placement, such as auscultation, direct visualization or capnography, may be subjective, compromised due to clinical presentation or require additional specialized equipment that is not always readily available during the procedure. Consequently, there exists a need for a non-visual detection mechanism for confirming successful airway placement that can give the provider rapid feedback during the procedure. Based upon our previously presented work characterizing the reflectance spectra of tracheal and esophageal tissue, we developed a fiber-optic prototype to detect the unique spectral characteristics of tracheal tissue. Device performance was tested by its ability to differentiate ex vivo samples of tracheal and esophageal tissue. Pig tissue samples were tested with the larynx, trachea and esophagus intact as well as excised and mounted on cork. The device positively detected tracheal tissue 18 out of 19 trials and 1 false positive out of 19 esophageal trials. Our proof of concept device shows great promise as a potential mechanism for rapid user feedback during airway management procedures to confirm tracheal placement. Ongoing studies will investigate device optimizations of the probe for more refined sensing and in vivo testing.

  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

    2004-06-01

    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. 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

    2013-02-01

    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

  16. Frequency and number of ultrasound lung rockets (B-lines) using a regionally based lung ultrasound examination named vet BLUE (veterinary bedside lung ultrasound exam) in dogs with radiographically normal lung findings.

    Science.gov (United States)

    Lisciandro, Gregory R; Fosgate, Geoffrey T; Fulton, Robert M

    2014-01-01

    Lung ultrasound is superior to lung auscultation and supine chest radiography for many respiratory conditions in human patients. Ultrasound diagnoses are based on easily learned patterns of sonographic findings and artifacts in standardized images. By applying the wet lung (ultrasound lung rockets or B-lines, representing interstitial edema) versus dry lung (A-lines with a glide sign) concept many respiratory conditions can be diagnosed or excluded. The ultrasound probe can be used as a visual stethoscope for the evaluation of human lungs because dry artifacts (A-lines with a glide sign) predominate over wet artifacts (ultrasound lung rockets or B-lines). However, the frequency and number of wet lung ultrasound artifacts in dogs with radiographically normal lungs is unknown. Thus, the primary objective was to determine the baseline frequency and number of ultrasound lung rockets in dogs without clinical signs of respiratory disease and with radiographically normal lung findings using an 8-view novel regionally based lung ultrasound examination called Vet BLUE. Frequency of ultrasound lung rockets were statistically compared based on signalment, body condition score, investigator, and reasons for radiography. Ten left-sided heart failure dogs were similarly enrolled. Overall frequency of ultrasound lung rockets was 11% (95% confidence interval, 6-19%) in dogs without respiratory disease versus 100% (95% confidence interval, 74-100%) in those with left-sided heart failure. The low frequency and number of ultrasound lung rockets observed in dogs without respiratory disease and with radiographically normal lungs suggests that Vet BLUE will be clinically useful for the identification of canine respiratory conditions. © 2014 American College of Veterinary Radiology.

  17. TRALI in the perioperative period

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    Berdai MA

    2014-07-01

    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. Phono-spectrographic analysis of heart murmur in children

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    Angerla Anna

    2007-06-01

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

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

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    Saeed Safari

    2014-03-01

    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?

  20. Traumatic tracheal diverticulum corrected with resection and anastomosis during one-lung ventilation and total intravenous anesthesia in a cat.

    Science.gov (United States)

    Sayre, Rebecca S; Lepiz, Mauricio; Wall, Corey; Thieman-Mankin, Kelley; Dobbin, Jennifer

    2016-11-01

    This report describes the clinical findings and diagnostic images of a traumatic intrathoracic tracheal avulsion with a tracheal diverticulum in a cat. Furthermore, a complete description of the tracheal resection and anastomosis using one-lung ventilation (OLV) with total and partial intravenous anesthesia is made. A 3-year-old neutered male domestic shorthair cat weighing 6.8 kg was presented to the University Teaching Hospital for evaluation of increased respiratory noise 3 months following unknown trauma. Approximately 12 weeks prior to presentation, the cat had been seen by the primary care veterinarian for respiratory distress. At that time, the cat had undergone a tracheal ballooning procedure for a distal tracheal stricture diagnosed by tracheoscopy. The tracheal ballooning had provided only temporary relief. At presentation to our institution, the cat had increased respiratory effort with harsh upper airway noise auscultated during thoracic examination. The remainder of the physical examination was normal. Diagnostics included a tracheoscopy and a thoracic computed tomographic examination. The cat was diagnosed with tracheal avulsion, pseudotrachea with a tracheal diverticulum, and stenosis of the avulsed tracheal ends. Surgical correction of the tracheal stricture via a thoracotomy was performed using OLV with total and partial intravenous anesthesia. The cat recovered uneventfully and at last follow-up was active and doing well. This case report describes OLV using standard anesthesia equipment that is available at most private practices. Furthermore, this case describes the computed tomographic images of the intrathoracic tracheal avulsion and offers a positive outcome for tracheal resection and anastomosis. © Veterinary Emergency and Critical Care Society 2015.

  1. PADS (Patient Archiving and Documentation System): a computerized patient record with educational aspects.

    Science.gov (United States)

    Hohnloser, J H; Pürner, F

    1992-01-01

    Rapid acquisition and analysis of information in an Intensive Care Unit (ICU) setting is essential, even more so the documentation of the decision making process which has vital consequences for the lives of ICU patients. We describe an Ethernet based local area network (LAN) with clinical workstations (Macintosh fx, ci). Our Patient Archiving and Documentation System (PADS) represents a computerized patient record presently used in a university hospitals' ICU. Taking full advantage of the Macintosh based graphical user interface (GUI) our system enables nurses and doctors to perform the following tasks: admission, medical history taking, physical examination, generation of problem lists and follow up notes, access to laboratory data and reports, semiautomatic generation of a discharge summary including full word processor capabilities. Furthermore, the system offers rapid, consistent and complete automatic encoding of diagnoses following the International Classification of Disease (ICD; WHO, [1]). For educational purposes the user can also view disease entities or complications related to the diagnoses she/he encoded. The system has links to other educational programs such as cardiac auscultation. A MEDLINE literature search through a CD-ROM based system can be performed without exiting the system; also, CD-ROM based medical textbooks can be accessed as well. Commercially available Macintosh programs can be integrated in the system without existing the main program thus enabling users to customize their working environment. Additional options include automatic background monitoring of users learning behavior, analyses and graphical display of numerous epidemiological and health care related problems. Furthermore, we are in the process of integrating sound and digital video in our system. This system represents one in a line of modular departmental models which will eventually be integrated to form a decentralized Hospital Information System (HIS).

  2. Is 10-second electrocardiogram recording enough for accurately estimating heart rate in atrial fibrillation.

    Science.gov (United States)

    Shuai, Wei; Wang, Xi-Xing; Hong, Kui; Peng, Qiang; Li, Ju-Xiang; Li, Ping; Chen, Jing; Cheng, Xiao-Shu; Su, Hai

    2016-07-15

    At present, the estimation of rest heart rate (HR) in atrial fibrillation (AF) is obtained by apical auscultation for 1min or on the surface electrocardiogram (ECG) by multiplying the number of RR intervals on the 10second recording by six. But the reasonability of 10second ECG recording is controversial. ECG was continuously recorded at rest for 60s to calculate the real rest HR (HR60s). Meanwhile, the first 10s and 30s ECG recordings were used for calculating HR10s (sixfold) and HR30s (twofold). The differences of HR10s or HR30s with the HR60s were compared. The patients were divided into three sub-groups on the HR60s 100bpm. No significant difference among the mean HR10s, HR30s and HR60s was found. A positive correlation existed between HR10s and HR60s or HR30s and HR60s. Bland-Altman plot showed that the 95% reference limits were high as -11.0 to 16.0bpm for HR10s, but for HR30s these values were only -4.5 to 5.2bpm. Among the three subgroups with HR60s 100bpm, the 95% reference limits with HR60s were -8.9 to 10.6, -10.5 to 14.0 and -11.3 to 21.7bpm for HR10s, but these values were -3.9 to 4.3, -4.1 to 4.6 and -5.3 to 6.7bpm for HR30s. As 10s ECG recording could not provide clinically accepted estimation HR, ECG should be recorded at least for 30s in the patients with AF. It is better to record ECG for 60s when the HR is rapid. Copyright © 2016. Published by Elsevier Ireland Ltd.

  3. Heart lesion after the first attack of the rheumatic Fever 22 years experience in single centre.

    Science.gov (United States)

    Bejiqi, Ramush A; Retkoceri, Ragip; Zeka, Naim; Bejiqi, Hana; Retkoceri, Arber

    2015-02-01

    Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years. In this study we aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting. To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children, hospitalized and treated before 1999, diagnosis of rheumatic fever was decided basing on the clinical and laboratory findings whereas in second group (221 children treated from1999 to 2010) clinical and lab diagnosis were amplified also on the detection by echocardiography. In second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded.

  4. [Supraventricular tachycardia in utero. Apropos of a personal case, review of the literature].

    Science.gov (United States)

    Pelletier, P; Delarue, T; Souplet, J P; Foissey, A; Oudry, B; Lefrançois, C

    1983-01-01

    After describing a case of early hydrops fetalis in a fetus demonstrating supraventricular tachycardia (TSVF) the authors review the literature: First they note the increase in the number of cases of TSVF published in the last few years, thanks to better means of monitoring pregnancies and to the place taken by TSVF among the different other troubles of fetal heart rhythm than can occur. The second section enumerates and analyses the pathological associations and the complications that have been observed in cases of TSVF that have been indexed. All have a poor prognosis: as far as those cases where there are faults in the rhythm which are associated with or alternate with TSVF, congestive heart failure occurs in 50% of cases, and organic heart pathological conditions in 20% of cases. 19.1% die. The third section analyses the means available for diagnosis and prognosis and the value of these means. Diagnosis rests on screening by clinical observation (careful auscultation in every pregnancy, observation of the raised height of the uterine fundus and a lessening in active fetal movements) and by monitoring. Only the ECG can confirm the diagnosis. Congestive heart failure is diagnosed by using ultrasound. A cardiac malformation should be searched for thoroughly by ultrasound. Monitoring in labour has no use as a prognostic indicator. Only repeated measurements of pH can demonstrate fetal distress in labour. The last section is concerned with management: digitalisation is strongly to be recommended before the fetus is mature. Propranolol should be reserved for resistant and severe cases: when there is no congestive heart failure a wait and see policy under strict observation can be followed. If there is congestive heart failure, caesarean section must be carried out. After delivery resuscitation with vagal stimulation is often sufficient, but when it is not digitalisation can be used and very rarely electric cardioversion is needed. Relapses are frequent and treatment

  5. Aspirating and Nonaspirating Swallow Sounds in Children: A Pilot Study.

    Science.gov (United States)

    Frakking, Thuy; Chang, Anne; O'Grady, Kerry; David, Michael; Weir, Kelly

    2016-12-01

    Cervical auscultation (CA) may be used to complement feeding/swallowing evaluations when assessing for aspiration. There are no published pediatric studies that compare the properties of sounds between aspirating and nonaspirating swallows. To establish acoustic and perceptual profiles of aspirating and nonaspirating swallow sounds and determine if a difference exists between these 2 swallowing types. Aspiration sound clips were obtained from recordings using CA simultaneously undertaken with videofluoroscopic swallow study. Aspiration was determined using the Penetration-Aspiration Scale. The presence of perceptual swallow/breath parameters was rated by 2 speech pathologists who were blinded to the type of swallow. Acoustic data between groups were compared using Mann Whitney U-tests, while perceptual differences were determined by a test of 2 proportions. Combinations of perceptual parameters of 50 swallows (27 aspiration, 23 no aspiration) from 47 children (57% male) were statistically analyzed using area under a receiver operating characteristic (aROC), sensitivity, specificity, and positive and negative predictive values to determine predictors of aspirating swallows. The combination of post-swallow presence of wet breathing and wheeze and absence of GRS and normal breathing was the best predictor of aspiration (aROC = 0.82, 95% CI, 0.70-0.94). There were no significant differences between these 2 swallow types for peak frequency, duration, and peak amplitude. Our pilot study has shown that certain characteristics of swallow obtained using CA may be useful in the prediction of aspiration. However, further research comparing the acoustic swallowing sound profiles of normal children to children with dysphagia (who are aspirating) on a larger scale is required. © The Author(s) 2016.

  6. Accuracy of symptoms, signs, and C-reactive protein for early chronic obstructive pulmonary disease

    Science.gov (United States)

    Broekhuizen, Berna DL; Sachs, Alfred PE; Verheij, Theo J; Janssen, Kristel JM; Asma, Gerard; Lammers, Jan-Willem J; Hage, René; Lammers, Ernst; Hoes, Arno W; Moons, Karel G

    2012-01-01

    Background Guidelines recommend detection of early chronic obstructive pulmonary disease (COPD), but evidence on the diagnostic work-up for COPD only concerns advanced and established COPD. Aim To quantify the accuracy of symptoms and signs for early COPD, and the added value of C-reactive protein (CRP), in primary care patients presenting with cough. Design and setting Cross-sectional diagnostic study of 73 primary care practices in the Netherlands Method Four hundred primary care patients (182 males, mean age 63 years) older than 50 years, presenting with persistent cough (>14 days) without established COPD participated, of whom 382 completed the study. They underwent a systematic diagnostic work-up of symptoms, signs, conventional laboratory CRP level, and hospital lung functions tests, including body plethysmography, and an expert panel decided whether COPD was present (reference test). The independent value of all items was estimated by multivariable logistic regression analysis. Results According to the expert panel, 118 patients had COPD (30%). Symptoms and signs with independent diagnostic value were age, sex, current smoking, smoking more than 20 pack-years, cardiovascular comorbidity, wheezing complaints, diminished breath sounds, and wheezing on auscultation. Combining these items resulted in an area under the receiver operating characteristic curve (ROC area) of 0.79 (95% confidence interval = 0.74 to 0.83) after internal validation. The proportion of subjects with elevated CRP was higher in those with early COPD, but CRP added no relevant diagnostic information above symptoms and signs. Conclusion In subjects presenting with persistent cough, the CRP level has no added value for detection of early COPD. PMID:22947584

  7. Prevalence of congenital heart disease in rural communities of pakistan

    International Nuclear Information System (INIS)

    Rizvi, S.F.U.; Mustafa, G.; Khan, M.A.; Kundi, A.

    2015-01-01

    Prevalence of congenital heart disease (CHD) is well established in most of the developed countries, where childbirth is obligatory in hospital and allied facilities. In rural Pakistan the situation is reverse, where most of deliveries take place in homes by traditional birth attendants' therefor true prevalence of CHD in our population is unknown. in rural Pakistan almost 80% children are born at home hence the figures are unknown. This study was designed, to determine the prevalence of congenital heart disease in rural Pakistan. Methods: During a cross-sectional survey of rural population belonging to major ethnic groups living in three provinces of Pakistan to determine the prevalence of rheumatic heart disease (RHD), CHD rates were calculated as a sub study. Nine thousand four hundred and seventy-six (9476) subjects of all ages were screened using cluster sampling technique. Socio-demographic variables were recorded. Auscultation and short physical examination performed for initial screening and final diagnosis was confirmed on M-mode/2D/Doppler. Results: Thirty two patients had RHD, 25 Patients identified with CHD and another 7 patients had mixed CHD and RHD. Overall prevalence for CHD was 3.4/1000. The commonest lesion was Atrial Septal Defect (ASD) 40%, Ventricular Septal Defect (VSD) 35%, Aortic Stenosis (AS) 10%, Atrio Ventricular Septal Defect (AVSD) 5%. Conclusion: This is the first study to report CHD prevalence from multiethnic representative sample from rural communities of Pakistan. Apparently CHD rate seems less compared with facility based data because records of still stillbirths are not available and autopsies are not performed as routine. Very high infant mortality from rural areas of Pakistan also favours high prevalence for CHD; however these figures represent an overall picture of CHD in a community where medical facilities are lacking. (author)

  8. [Ultrasound evaluation of the nasogastric tube position in prehospital].

    Science.gov (United States)

    Brun, P-M; Chenaitia, H; Bessereau, J; Leyral, J; Barberis, C; Pradel-Thierry, A-L; Stephan, J; Benner, P; Querellou, E; Topin, F

    2012-05-01

    To assess the feasibility and actual performance of ultrasound control in verification of the correct positioning of a nasogastric tube in pre-hospital settings. Prospective, observational, single-centre study. Correct positioning of nasogastric tubes in patients intubated in a pre-hospital setting was verified by ultrasound and routinely compared with the results of two pre-hospital tests, namely a test involving insufflation of air through a syringe coupled with epigastric auscultation and a test involving aspiration of gastric fluid with a syringe. Routine x-ray control was carried out and compared with the pre-hospital results. Ninety-six patients were included. Mean age was 52 years (median: 53.5 years, SD: 23 years). In 83% of the patients (n=80), the nasogastric tube was located by ultrasound immediately during the insertion procedure. The mean times to ultrasound confirmation of correct positioning of the nasogastric tube were 7s (median: 2s; SD: 16s) and 19s for the syringe tests (median 19s, SD: 5s). Eight ultrasound control tests were negative. Location coupled with insufflation of air through a syringe allowed detection of the nasogastric tube in the stomach but without providing confirmation of the actual gastric position. The pre-hospital ultrasound results were confirmed by subsequent radiological controls at the hospital. The ultrasound test performed in our study to verify correct positioning of a nasogastric tube is feasible in a pre-hospital setting. This technique is rapid and non-irradiating and is more sensitive and specific than the syringe tests commonly used in pre-hospital settings, and it may be performed in place of the latter tests. Copyright © 2012 Société française d’anesthésie et de réanimation (Sfar). Published by Elsevier SAS. All rights reserved.

  9. Role of atypical pathogens in nursing home-acquired pneumonia.

    Science.gov (United States)

    Ma, Hon Ming; Ip, Margaret; Hui, Elsie; Chan, Paul K S; Hui, David S C; Woo, Jean

    2013-02-01

    No international consensus has been reached on the empirical use of antibiotics with atypical coverage in nursing home-acquired pneumonia (NHAP). Aspiration is an important cause of NHAP, but it may not require antimicrobial treatment. This study aimed to investigate the prevalence and clinical characteristics of AP infections and review the need for empirical antibiotics with atypical coverage in NHAP. A prospective cohort study. Four nursing homes with a total number of 772 residents. Patients were aged ≥ 65 years, hospitalized for NHAP, which was defined as the presence of respiratory symptoms and abnormal chest radiographs, from April 2006 to March 2007. Demographics, clinical parameters, and investigation results were recorded. Microbial investigations comprised sputum routine and mycobacterial cultures, blood and urine cultures, serology, and nasopharyngeal aspirate viral culture and polymerase chain reaction tests. Suspected aspiration pneumonitis was arbitrarily defined as NHAP without pathogens identified. After excluding lone bacteriuria, 108 episodes of NHAP in 94 patients were included. Twelve APs were detected in 11 patients. There was no clinical feature to distinguish between infections caused by APs and other pathogens. The commonest APs were Mycoplasma pneumoniae (6) and Chlamydophila pneumoniae (3). No Legionella pneumophila was detected by urinary antigen test. None of the patients with AP infection received antibiotics indicated for AP infections. However, AP infections did not result in mortality. No pathogen was isolated in 31.5% of cases. Patients without pathogens isolated were less likely to have purulent sputum and crepitations on chest auscultation, compared with those with pneumonia caused by identified pathogens. Atypical pathogens (APs) were not associated with mortality even in cases where the prescribed antibiotics did not cover APs. NHAP may not necessarily be treated with empirical antibiotics covering APs. Copyright © 2013

  10. Nursing physical assessment for patient safety in general wards: reaching consensus on core skills.

    Science.gov (United States)

    Douglas, Clint; Booker, Catriona; Fox, Robyn; Windsor, Carol; Osborne, Sonya; Gardner, Glenn

    2016-07-01

    To determine consensus across acute care specialty areas on core physical assessment skills necessary for early recognition of changes in patient status in general wards. Current approaches to physical assessment are inconsistent and have not evolved to meet increased patient and system demands. New models of nursing assessment are needed in general wards that ensure a proactive and patient safety approach. A modified Delphi study. Focus group interviews with 150 acute care registered nurses at a large tertiary referral hospital generated a framework of core skills that were developed into a web-based survey. We then sought consensus with a panel of 35 senior acute care registered nurses following a classical Delphi approach over three rounds. Consensus was predefined as at least 80% agreement for each skill across specialty areas. Content analysis of focus group transcripts identified 40 discrete core physical assessment skills. In the Delphi rounds, 16 of these were consensus validated as core skills and were conceptually aligned with the primary survey: (Airway) Assess airway patency; (Breathing) Measure respiratory rate, Evaluate work of breathing, Measure oxygen saturation; (Circulation) Palpate pulse rate and rhythm, Measure blood pressure by auscultation, Assess urine output; (Disability) Assess level of consciousness, Evaluate speech, Assess for pain; (Exposure) Measure body temperature, Inspect skin integrity, Inspect and palpate skin for signs of pressure injury, Observe any wounds, dressings, drains and invasive lines, Observe ability to transfer and mobilise, Assess bowel movements. Among a large and diverse group of experienced acute care registered nurses consensus was achieved on a structured core physical assessment to detect early changes in patient status. Although further research is needed to refine the model, clinical application should promote systematic assessment and clinical reasoning at the bedside. © 2016 John Wiley & Sons Ltd.

  11. An examination of factors related to aspiration and silent aspiration in older adults requiring long-term care in rural Japan.

    Science.gov (United States)

    Sakai, K; Hirano, H; Watanabe, Y; Tohara, H; Sato, E; Sato, K; Katakura, A

    2016-02-01

    Swallowing disorders are a growing problem among the elderly in long-term care (LTC), and they can cause aspiration pneumonia. In order to detect swallowing disorders early, simple tools are needed to assess aspiration and silent aspiration (SA). To compile a sample of elderly people requiring LTC, and categorise them as having suspected aspiration and/or SA using simple screening tools. In addition, oral ability, severity of dementia, vital functions and nutritional status were compared in these groups. A total of 393 elderly people in LTC (89 men and 304 women; age ranging from 65 to 100 years) were included in the study. The modified water swallow test, cervical auscultation and cough test were used to assess swallowing function. The participants were categorised as having suspected aspiration and/or SA, and the following assessments were performed: (i) oral ability (lips function, tongue function, rinsing and gargling ability), (ii) dementia severity, (iii) vital functions and (iv) nutritional status. Suspected aspiration was apparent in 50.5% of patients, of which 24.0% had suspected SA. Those with suspected aspiration showed worsened oral ability, dementia severity, vital functions and nutritional status. Similarly, those with suspected SA showed worsened dementia severity, vital functions and nutritional status. Logistic regression analysis revealed that lip closure, lingual movement and rinsing ability were significantly associated with suspected aspiration. Dementia severity was the best predictor of suspected SA. Simple screening tools can be used to identify suspected aspiration and SA, which may facilitate early detection of aspiration pneumonia or swallowing disorder risk. © 2015 John Wiley & Sons Ltd.

  12. The effects of feeding and fasting on gastrointestinal sounds in adult horses.

    Science.gov (United States)

    Naylor, Jonathan M; Poirier, Kristin L; Hamilton, Donald L; Dowling, Patricia M

    2006-01-01

    The effect of changes in feed intake on auscultatable gastrointestinal sounds has not been systematically studied. Disagreement also is present in the literature about variation in sounds according to the quadrant of auscultation. Gastrointestinal sounds were recorded over the center of the left dorsal, left ventral, right ventral, and right dorsal quadrants and over the middle of the right abdominal flank. During 24 hours (n = 4) or 48 hours (n = 5) of fasting, there was a reduction in the intensity of gastrointestinal sounds as assessed by analysis of sound recordings. There was also a reduction in the number of mixing-like and propulsive-like sounds heard by 2 blinded observers. After refeeding, there was a marked increase in sound. Sound intensity varied among abdominal quadrants, but blinded observers did not notice significant differences in the number of mixing-like sounds. The left dorsal quadrant was quieter than others during fasting and refeeding. The right ventral quadrant appeared to be least affected by fasting, and sounds were louder over the right ventral and right middle quadrants than over the others. The blinded observers' perceptions of sound correlated poorly with one another and with objective measures of sound intensity. This experiment demonstrates the effectiveness of computerized analysis of abdominal sound in detecting a reduction in the intensity of gastrointestinal sounds during fasting and their return during refeeding. The left dorsal quadrant was quieter than other quadrants, likely because of its position over the small colon. There was considerable observer variation in the number of intestinal sounds heard.

  13. Management of severe childhood pneumonia by day care approach in developing countries.

    Science.gov (United States)

    Jahan, Yasmin; Rahman, Sm Atiqur; Chowdhury, Abu Sayeed; Moshiur Rahman, Md

    2018-01-01

    Background: Pneumonia is a major cause of child mortality among children under 5 years, worldwide. Pneumonia infection may be caused by bacteria, viruses, or fungi in single or in both lungs. According to recent criteria developed by the World Health Organization(WHO) in September (2013), pneumonia can be classified into severe pneumonia, pneumonia and no pneumonia. Most of the deaths occur from severe pneumonia. Methods: Disease management of severe childhood pneumonia requires early identification,prompt referral and the availability of intensive quality care. Under 5 years old children with severe pneumonia should receive day care, with antibiotic treatment, feeding, and supportive care with similar 24-hour hospital treatment. Results: Considering that difficulties, International Centre for Diarrheal Disease Research,Bangladesh (ICDDR, B) initiated Day Care Approach (DCA) model, as an innovative, safe,effective and less expensive alternative to hospital management of severe childhood pneumonia.A 24 months old girl came to the health care center with severe breathing difficulty, cough,history of fever and head nodding. The management described below was continued daily until there was clinical improvement; no fever, no fast breathing, no lower chest wall in drawing, no danger signs, no rales on auscultation, and no hypoxemia. Conclusion: Considering the WHO case management protocol for severe pneumonia, DCA recommends that diagnosis of severe pneumonia should be based primarily on visible clinical parameters. On that basis, severe childhood pneumonia can be successfully managed at daycare clinics including for children with hypoxemia who is required prolong (4-6 hours) oxygen therapy.

  14. Novel aspects in diagnostic approach to respiratory patients: is it the time for a new semiotics?

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    Soldati, Gino; Smargiassi, Andrea; Mariani, Alberto A; Inchingolo, Riccardo

    2017-01-01

    Medical approach to patients is a fundamental step to get the correct diagnosis. The aim of this paper is to analyze some aspects of the reasoning process inherent in medical diagnosis in our era. Pathologic signs (anamnestic data, symptoms, semiotics, laboratory and strumental findings) represent informative phenomena to be integrated for inferring a diagnosis. Thus, diagnosis begins with "signs" and finishes in a probability of disease. The abductive reasoning process is the generation of a hypothesis to explain one or more observations (signs) in order to decide between alternative explanations searching the best one. This process is iterative during the diagnostic activity while collecting further observations and it could be creative generating new knowledge about what has not been experienced before. In the clinical setting the abductive process is not only theoretical, conversely the physical exploitation of the patient (palpation, percussion, auscultation) is always crucial. Through this manipulative abduction, new and still unexpressed information is discovered and evaluated and physicians are able "to think through doing" to get the correct diagnosis. Abductive inferential path originates with an emotional reaction (discovery of the signs), step by step explanations are formed and it ends with another emotional reaction (diagnosis). Few bedside instruments are allowed to physicians to amplify their ability to search for signs. Stethoscope is an example. Similarities between ultrasound exploration and percussion can be found. Bedside ultrasonography can be considered an external amplifier of signs, a particular kind of percussion and represents a valid example of abductive manipulation. In this searching for signs doctors act like detectives and sometimes the discovering of a strategic, unsuspected sign during abductive manipulation could represent the key point for the correct diagnosis. This condition is called serendipity. Ultrasound is a powerful tool

  15. New clinical validation method for automated sphygmomanometer: a proposal by Japan ISO-WG for sphygmomanometer standard.

    Science.gov (United States)

    Shirasaki, Osamu; Asou, Yosuke; Takahashi, Yukio

    2007-12-01

    Owing to fast or stepwise cuff deflation, or measuring at places other than the upper arm, the clinical accuracy of most recent automated sphygmomanometers (auto-BPMs) cannot be validated by one-arm simultaneous comparison, which would be the only accurate validation method based on auscultation. Two main alternative methods are provided by current standards, that is, two-arm simultaneous comparison (method 1) and one-arm sequential comparison (method 2); however, the accuracy of these validation methods might not be sufficient to compensate for the suspicious accuracy in lateral blood pressure (BP) differences (LD) and/or BP variations (BPV) between the device and reference readings. Thus, the Japan ISO-WG for sphygmomanometer standards has been studying a new method that might improve validation accuracy (method 3). The purpose of this study is to determine the appropriateness of method 3 by comparing immunity to LD and BPV with those of the current validation methods (methods 1 and 2). The validation accuracy of the above three methods was assessed in human participants [N=120, 45+/-15.3 years (mean+/-SD)]. An oscillometric automated monitor, Omron HEM-762, was used as the tested device. When compared with the others, methods 1 and 3 showed a smaller intra-individual standard deviation of device error (SD1), suggesting their higher reproducibility of validation. The SD1 by method 2 (P=0.004) significantly correlated with the participant's BP, supporting our hypothesis that the increased SD of device error by method 2 is at least partially caused by essential BPV. Method 3 showed a significantly (P=0.0044) smaller interparticipant SD of device error (SD2), suggesting its higher interparticipant consistency of validation. Among the methods of validation of the clinical accuracy of auto-BPMs, method 3, which showed the highest reproducibility and highest interparticipant consistency, can be proposed as being the most appropriate.

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

    Directory of Open Access Journals (Sweden)

    Mustafa Karaçelik

    2015-12-01

    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. 

  17. Traumatic lung injury attributed to tornadic activity-induced barometric pressure changes in two dogs.

    Science.gov (United States)

    Cichocki, Brandy N; Dugat, Danielle R; Snider, Timothy A

    2016-06-01

    CASE DESCRIPTION A 7-year-old castrated male Italian Greyhound (dog 1) and an approximately 1-year-old female Labrador Retriever (dog 2) were evaluated because of respiratory distress 8 and 10 days, respectively, after a tornado. CLINICAL FINDINGS No obvious external injuries were identified auscultation revealed decreased bronchovesicular sounds in the affected hemithorax of both dogs. Clinicopathologic changes were mild, with evidence of inflammation in both dogs. Thoracic radiography of both dogs revealed pneumothorax and pleural effusion with effacement of the diaphragm; findings on CT included severe pulmonary atelectasis of affected lung lobes with normal bronchial tree configurtion and no evidence of diaphragmatic hernia. TREATMENT AND OUTCOME Exploratory thoracotomy of both dogs confirmed CT findings Pulmonary parenchymal damage consistent with a large rupture was found in both patients. A large hematoma was adhered to the ruptured lung lobe of dog 1. Grossly affected lung tissue was removed; histologic examination revealed atelectasis, pulmonary fib osis, thrombosis, and minimal (dog 1) to marked (dog 2) inflammation Microbial culture of lung tissue yielded no growth for dog 1 and Streptococcus spp and Escherichia coli susceptible to amoxicillin-clavulanic acid for dog 2. Dog 1 had a recurrence of pneumothorax treated by drainage with a thoracostomy tube 1 month after surgery. Eighteen months after surgery, both dogs were reportedly doing well. CLINICAL RELEVANCE Development of clinical signs after a tornado, together with clinical, diagnostic imaging, surgical, and histologic findings led to a presumptive diagnosis of pulmonary barotrauma for both dogs. Long-term outcome for these dogs, treated at a referral hospital, was good.

  18. Vital parameters of Holstein calves from birth to weaning.

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    Bruno Toledo Silva

    2016-09-01

    Full Text Available ABSTRACT. Silva B.T., Henklein A., Marques R. De S., de Oliveira P.L., Leite S.B.P., Novo S.M.F., Baccili C.C., Reis J.F. & Gomes V. Vital parameters of Holstein calves from birth to weaning. [Parâmetros vitais de bezerros Holandeses do nascimento ao desmame.] Revista Brasileira de Medicina Veterinária, 38(3:299- 304, 2016. Departamento de Clínica Médica, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, Av. Prof. Dr. Orlando Marques de Paiva 87, São Paulo, SP 05508-270, Brasil. E-mail: brunotoledovet@hotmail.com The neonatal period is represented by the inability of newborns to adapt themselves to extra-uterine environment and execution of vital functions until then executed by the mother, such as thermoregulation, basic acid balance, cardiorespiratory functions, nutrition and development of the immune system. This study aimed to evaluate the physiological adaptations of Holstein calves during milk-feeding period (60 days. We selected 22 newborn Holstein male calves, born between the months of September to March (n = 18 and April to August (n = 4. Heart rate values (HR, respiratory rate (RR were recorded daily for 60 days by semiotic technique of auscultation, and the rectal temperature (RT was measured with the use of digital clinical thermometer. The daily results of the experiment were divided in periods of six days each (P1 to P10. The first week of postnatal life was marked by physiological changes related to the adaptation of cardiorespiratory functions of newborns, observing stabilization of HR and RR on subsequent periods, with few variations probably attributed to climate fluctuation (10 a 37ºC of the calves’ rearing environment. These data demonstrated direct impact of extra-uterine adaptation period on physiological parameters of newborn calves.

  19. Nociceptive thermal threshold testing in horses – effect of neuroleptic sedation and neuroleptanalgesia at different stimulation sites

    Science.gov (United States)

    2013-01-01

    Background Aim of the study was to compare the effect of neuroleptic sedation with acepromazine and neuroleptanalgesia with acepromazine and buprenorphine on thermal thresholds (TT) obtained at the nostrils and at the withers. The study was carried out as a randomized, blinded, controlled trial with cross-over design. Thermal thresholds were determined by incremental contact heat applied to the skin above the nostril (N) or the withers (W). Eleven horses were treated with saline (S), acepromazine (0.05 mg/kg) (ACE) or acepromazine and buprenorphine (0.0075 mg/kg) (AB) intravenously (IV). Single stimulations were performed 15 minutes prior and 15, 45, 75, 105, 165, 225, 285, 405 and 525 minutes after treatment. Sedation score, gastrointestinal auscultation score and occurrence of skin lesions were recorded. Data were analysed with analysis of variance for repeated measurements. Results There were no significant differences in TT between N and W with all treatments. The TT remained constant after S and there was no difference in TT between S and ACE. After AB there was a significant increase above baseline in TT until 405 minutes after treatment. Restlessness occurred 30–90 minutes after AB in 7 horses. All horses had reduced to absent borborygmi after AB administration for 165 to 495 minutes. Conclusion Thermal stimulation at both described body areas gives comparable results in the assessment of cutaneous anti-nociception in horses. There is no differential influence of neuroleptic sedation or neuroleptanalgesia on TTs obtained at N or W. Buprenorphine combined with acepromazine has a long lasting anti-nociceptive effect associated with the typical opioid induced side effects in horses. PMID:23837730

  20. Heart Lesion After the First Attack of the Rheumatic Fever 22 Years Experience in Single Centre

    Science.gov (United States)

    Bejiqi, Ramush A.; Retkoceri, Ragip; Zeka, Naim; Bejiqi, Hana; Retkoceri, Arber

    2015-01-01

    Background: Acute rheumatic fever and its sequels, rheumatic heart diseases, remain major unsolved preventable health problems in Kosovo population, particularly among the disadvantages indigenous Albanian and Egyptians people. In Kosovo, despite of performing secondary prophylaxis with benzathine penicillin, acute rheumatic fever hospitalization rates have remained essentially unchanged for the last 20 years. The role of echocardiography in the diagnosis of acute rheumatic carditis was established over the last 20 years. Aims: In this study we aimed to determine the prevalence of rheumatic heart disease in children from Kosovo population with first attack of acute rheumatic fever. Also, we presented that echocardiography examination detects a greater prevalence of rheumatic heart disease than other diagnostic procedures. We aimed to compare the sensitivity and specificity of cardiac auscultation, ECG record, lab analysis to echocardiography and to determine the feasibility of specific age in this setting. Methods: To optimize accurate diagnosis of rheumatic fever and rheumatic heart disease, we utilized two group models. In the first group of 388 children, hospitalized and treated before 1999, diagnosis of rheumatic fever was decided basing on the clinical and laboratory findings whereas in second group (221 children treated from1999 to 2010) clinical and lab diagnosis were amplified also on the detection by echocardiography. Conclusion: In second group, using echocardiography as a method of diagnosis and assessment children with rheumatic fever, we found high rates of undetected rheumatic heart disease in this high-risk group population. Echocardiographic examination of children with rheumatic fever for rheumatic heart disease may over diagnose rheumatic heart disease unless congenital mitral valve anomalies and physiological regurgitation are excluded. PMID:25870479

  1. 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.

  2. Use of ethylene-vinyl alcohol copolymer as a liquid embolic agent to treat a peripheral arteriovenous malformation in a dog

    Science.gov (United States)

    Culp, William T. N.; Glaiberman, Craig B.; Pollard, Rachel E.; Wisner, Erik R.

    2015-01-01

    Case Description An 11-year-old castrated male Tibetan Mastiff was evaluated because of a visibly enlarged blood vessel and progressively worsening swelling of the right hind limb. Clinical Findings On physical examination, the right hind limb was markedly larger than the left hind limb and the dog was minimally weight bearing on the affected limb. A bruit was auscultated over the affected region. Ultrasonography of the tarsal region of the right hind limb revealed an artery with turbulent flow that communicated with venous drainage. A CT scan confirmed the presence of an arteriovenous malformation (AVM). Treatment and Outcome Embolization of the AVM with a liquid embolic agent (ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide) was elected. An arteriogram was performed prior to treatment and delineated the vessels that were targeted for embolization. The embolic agent was infused into the AVM, and a postinjection arteriogram confirmed complete occlusion of the AVM nidus and normal arterial flow to the paw with subsequent normal venous drainage. The circumference of the abnormal paw was 51 cm before the procedure and 22.9 cm at 4 weeks after the procedure. Additionally, the gait of the dog dramatically improved. No complications associated with the procedure developed. Clinical Relevance Peripheral AVMs in dogs are uncommon, and described treatment options are limited and generally associated with serious morbidity. A liquid embolic agent, ethylene-vinyl alcohol copolymer dissolved in dimethyl sulfoxide, was successfully administered in this case, and no morbidity was observed secondary to the procedure. Clinical success was characterized by substantial improvement in limb swelling and marked improvement in the gait of the dog. PMID:24984133

  3. [Early resumption of food intake after cesarean section in black African women: liquid versus solid food].

    Science.gov (United States)

    Zoumenou, E; Denakpo, J L; Assouto, P; Tchaou, B; Lokossou, T; Chobli, M

    2011-04-01

    The purpose of this study was to compare the effects of early resumption of solid versus liquid food intake after emergency cesarean section in black African women, in terms of gastrointestinal complications and maternal satisfaction. A total of 120 patients were randomly distributed into two groups of 60 each. In group L, liquid food intake in the form of sweetened citronella drink was allowed at will starting 6 six hours after the procedure but no solid food was allowed for 24 hours. In group S, normal solid food intake was resumed six hours after the procedure. The two study groups were not significantly different with regard to age, medical history, ASA class, obstetrical status, indications for cesarean section, anesthetic protocol, mean procedural duration, and postoperative analgesia. Study variables included tolerance of food intake, gastro-intestinal complications, time necessary to resume full activity and patient satisfaction. Overall, 6% of patients reported complications involving nausea, vomiting and bloating. There was no statistical difference between the two groups. Normal intestinal transit resumed earlier in group S but the difference was not significant. Auscultation of the abdomen at 16 hours after the procedure demonstrated presence of peristalsis in 59 patients in group S and 51 in group L (p = 0.008). The maternal satisfaction rate was 92% in group S and 43% in group L (p food in case of future cesarean. Early solid food intake after cesarean in black African women is as well tolerated as early liquid feeding. Resumption of solid food intake allows earlier rehabilitation and improves patient satisfaction.

  4. Classification of lung sounds using higher-order statistics: A divide-and-conquer approach.

    Science.gov (United States)

    Naves, Raphael; Barbosa, Bruno H G; Ferreira, Danton D

    2016-06-01

    Lung sound auscultation is one of the most commonly used methods to evaluate respiratory diseases. However, the effectiveness of this method depends on the physician's training. If the physician does not have the proper training, he/she will be unable to distinguish between normal and abnormal sounds generated by the human body. Thus, the aim of this study was to implement a pattern recognition system to classify lung sounds. We used a dataset composed of five types of lung sounds: normal, coarse crackle, fine crackle, monophonic and polyphonic wheezes. We used higher-order statistics (HOS) to extract features (second-, third- and fourth-order cumulants), Genetic Algorithms (GA) and Fisher's Discriminant Ratio (FDR) to reduce dimensionality, and k-Nearest Neighbors and Naive Bayes classifiers to recognize the lung sound events in a tree-based system. We used the cross-validation procedure to analyze the classifiers performance and the Tukey's Honestly Significant Difference criterion to compare the results. Our results showed that the Genetic Algorithms outperformed the Fisher's Discriminant Ratio for feature selection. Moreover, each lung class had a different signature pattern according to their cumulants showing that HOS is a promising feature extraction tool for lung sounds. Besides, the proposed divide-and-conquer approach can accurately classify different types of lung sounds. The classification accuracy obtained by the best tree-based classifier was 98.1% for classification accuracy on training, and 94.6% for validation data. The proposed approach achieved good results even using only one feature extraction tool (higher-order statistics). Additionally, the implementation of the proposed classifier in an embedded system is feasible. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

  5. Chapter 19: Hypersensitivity pneumonitis.

    Science.gov (United States)

    Blatman, Karen Hsu; Grammer, Leslie C

    2012-01-01

    Hypersensitivity pneumonitis (HP), also referred to as extrinsic allergic alveolitis, is characterized by non-IgE-mediated inflammation of the parenchyma, alveoli, and terminal airways of the lung initiated by inhaled antigens in a susceptible host. Etiologic agents of HP are either organic high molecular weight compounds such as bacteria, fungi, amoebae, plant, and animal proteins or inorganic low molecular weight haptens such as isocyanate and drugs including amiodarone, nitrofurantoin, and minocycline. Six significant predictors have been identified that provide ∼95% diagnostic accuracy. These six predictors are (1) exposure to a known offending allergen, (2) positive precipitating antibodies to the offending antigen, (3) recurrent episodes of symptoms, (4) inspiratory crackles on lung auscultation, (5) symptoms occurring 4-8 hours after exposure, and (6) weight loss. HP is staged into acute, subacute, and chronic. In the acute stage after direct exposure to the antigen, there is fever, chills, nonproductive cough, dyspnea, malaise, and myalgias, all resembling influenza. However, if obtained, a chest radiograph shows nodular infiltrates, and pulmonary function testing is restrictive (unless the cause is avian in which obstruction or obstruction with restriction is present). In the chronic stage, fever and chills are absent, but weight loss can occur. The immunologic response includes activated macrophages and CD8(+) cytotoxic lymphocytes, and bronchoalveolar lavage fluid reveals marked lymphocytosis with a ratio of CD4(+) cells to CD8(+) cells <1. Activated macrophages have increased expression of CD80/CD86, and T cells have increased expression of its counter-ligand CD28, evidence for heightened antigen presentation.

  6. [Lung ultrasound in acute and critical care medicine].

    Science.gov (United States)

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

    2012-07-01

    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.

  7. Lung disease with chronic obstruction in opium smokers in Singapore

    Science.gov (United States)

    Da Costa, J. L.; Tock, E. P. C.; Boey, H. K.

    1971-01-01

    Fifty-four opium smokers with chronic obstructive lung disease were studied for two-and-a-half years. Forty-eight patients had a cough for at least two years before the onset of inappropriate exertional dyspnoea. Fine, bubbling adventitious sounds suggesting small airway disease were heard on auscultation over the middle and lower lobes in 38 patients. The prevalence of inflammatory lung disease and chronic respiratory failure in this series is suggested as the main cause for the frequent finding of right ventricular hypertrophy and congestive heart failure. Physiological studies revealed moderate to severe airways obstruction with gross over-inflation and, in 32 patients, an additional restrictive defect probably due to peribronchiolar fibrosis. Radiological evidence of chronic bronchitis and bronchiolitis was observed in 45 patients, `pure' chronic bronchiolitis in six patients, and `widespread' emphysema in 25 patients respectively. Necropsy examinations in nine patients, however, showed destructive emphysema of variable severity in all. Chronic bronchiolitis often associated with striking bronchiolectasis was present in six cases. More severe bronchiolar rather than bronchial inflammation was noted. The heavy opium smokers had characteristic nodular shadows on chest radiography, sometimes associated with a striking reticular pattern not seen in `pure' cigarette smokers. This was due to gross pigmented dust (presumably carbon) deposition in relation to blood vessels, lymphatics, and bronchioles, and also within the alveoli. It is speculated that the initial lesion is an acquired bronchiolitis. Opium smoking induces an irritative bronchopathy favouring repeated attacks of acute bronchiolitis and eventually resulting in obliterative bronchiolitis, peribronchiolar fibrosis, chronic bronchitis, and destructive emphysema. Images PMID:5134057

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

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    Gerald Shambira

    2010-07-01

    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.

  9. Prevalence of asthma and related symptoms in junior high school children in Isfahan, Iran.

    Science.gov (United States)

    Golshan, M; Mohammad-Zadeh, Z; Khanlar-Pour, A; Iran-Pour, R

    2002-02-01

    Asthma is the most common chronic disease in children. There are scattered epidemiological data concerning the prevalence of this disorder in developing countries. From October 1998 to May 1999 we studied 4069 randomly selected, junior high-school children in urban areas of Isfahan for asthma and related symptoms. The ages were expected to be 12-15 years. The children completed a questionnaire, and 3924 completed questionnaires were returned (response rate = 96.4%). Pupils with chronic respiratory symptoms were interviewed, physically examined at hospital and 1710 of them also underwent post exercise spirometry. The overall prevalence of asthma ever in life was 9.5%, with a male to female ratio of 2/1. The frequencies of current asthma, wheezing ever in life and exercise induced wheezy breathing were 7.3%, 19.1% and 14.2% respectively. Wheeze was heard on chest auscultation in 4.1% of the children. Pulmonary function tests revealed forced expiratory volume in 1 sec (FEV1) children. All of the later findings strongly correlate with history of asthma. Parental smoking, similar illness in parents and/or siblings, lower levels of parental education and presence of cats, cockroaches and chicken in the household were significant risk factors. The prevalence of asthma in the students of the junior high schools of Isfahan is not far less than the average rates reported in many parts of the world, and it seems necessary to pay more attention to poorly controlled air pollution in Isfahan as an industrial city.

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

    Science.gov (United States)

    Araújo, Fátima Derlene da Rocha; Goulart, Eugênio Marcos Andrade; Meira, Zilda Maria Alves

    2012-07-01

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

  11. [Otto Ulmgren--a distinguished pioneer in oral surgery].

    Science.gov (United States)

    Nordenram, Ake

    2006-01-01

    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.

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

    Science.gov (United States)

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

    2015-12-01

    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.

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

    Directory of Open Access Journals (Sweden)

    Tatiane Totta

    2013-10-01

    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.

  14. Validation of the Welch Allyn SureBP (inflation) and StepBP (deflation) algorithms by AAMI standard testing and BHS data analysis.

    Science.gov (United States)

    Alpert, Bruce S

    2011-04-01

    We evaluated two new Welch Allyn automated blood pressure (BP) algorithms. The first, SureBP, estimates BP during cuff inflation; the second, StepBP, does so during deflation. We followed the American National Standards Institute/Association for the Advancement of Medical Instrumentation SP10:2006 standard for testing and data analysis. The data were also analyzed using the British Hypertension Society analysis strategy. We tested children, adolescents, and adults. The requirements of the American National Standards Institute/Association for the Advancement of Medical Instrumentation SP10:2006 standard were fulfilled with respect to BP levels, arm sizes, and ages. Association for the Advancement of Medical Instrumentation SP10 Method 1 data analysis was used. The mean±standard deviation for the device readings compared with auscultation by paired, trained, blinded observers in the SureBP mode were -2.14±7.44 mmHg for systolic BP (SBP) and -0.55±5.98 mmHg for diastolic BP (DBP). In the StepBP mode, the differences were -3.61±6.30 mmHg for SBP and -2.03±5.30 mmHg for DBP. Both algorithms achieved an A grade for both SBP and DBP by British Hypertension Society analysis. The SureBP inflation-based algorithm will be available in many new-generation Welch Allyn monitors. Its use will reduce the time it takes to estimate BP in critical patient care circumstances. The device will not need to inflate to excessive suprasystolic BPs to obtain the SBP values. Deflation is rapid once SBP has been determined, thus reducing the total time of cuff inflation and reducing patient discomfort. If the SureBP fails to obtain a BP value, the StepBP algorithm is activated to estimate BP by traditional deflation methodology.

  15. Risk factors for a poor outcome among children admitted with clinically severe pneumonia to a university hospital in Rabat, Morocco.

    Science.gov (United States)

    Jroundi, Imane; Mahraoui, Chafiq; Benmessaoud, Rachid; Moraleda, Cinta; Tligui, Houssain; Seffar, Myriam; Kettani, Salma Ech-Cherif El; Benjelloun, Badr Sououd; Chaacho, Saad; Muñoz-Almagro, Carmen; Ruiz, Joaquim; Alonso, Pedro L; Bassat, Quique

    2014-11-01

    Data on prognostic factors among children with severe pneumonia are scarce in middle-income countries. We investigated prognostic factors for an adverse outcome among children admitted to the Hôpital d'Enfants de Rabat, Morocco with World Health Organization-defined clinically severe pneumonia (CSP). Children aged 2-59 months admitted to the hospital and fulfilling the CSP definition were recruited into this 13-month prospective study. A poor prognosis was defined as death, a need for intensive care, or a Respiratory Index of Severity in Children (RISC) score ≥3. Multivariate logistic regression was performed to ascertain independent predictive factors for a poor prognosis. Of the 689 children included in this analysis, 55 (8.0%) required intensive care and 28 died (4.0%). Five hundred and two (72.8%) children were classified as having a good prognosis and 187 (27.2%) as having a poor prognosis. A history of prematurity (odds ratio (OR) 2.50, 95% confidence interval (CI) 1.24-5.04), of fever (OR 2.25, 95% CI 1.32-3.83), living in a house with smokers (OR 1.79, 95% CI 1.18-2.72), impaired consciousness (OR 10.96, 95% CI 2.88-41.73), cyanosis (OR 2.09, 95% CI 1.05-4.15), pallor (OR 2.27, 95% CI 1.34-3.84), having rhonchi on auscultation (OR 2.45, 95% CI 1.58-3.79), and human metapneumovirus infection (OR 2.13, 95% CI 1.13-4.02) were all independent risk factors for an adverse outcome, whereas a history of asthma (OR 0.46, 95% CI 0.25-0.84) was the only independent risk factor for a positive outcome. The early identification of factors associated with a poor prognosis could improve management strategies and the likelihood of survival of Moroccan children with severe pneumonia.

  16. Serial echocardiographic and clinical evaluation of valvular regurgitation before, during, and after treatment with fenfluramine or dexfenfluramine and mazindol or phentermine.

    Science.gov (United States)

    Ryan, D H; Bray, G A; Helmcke, F; Sander, G; Volaufova, J; Greenway, F; Subramaniam, P; Glancy, D L

    1999-07-01

    The prevalence of cardiac valvular regurgitation demonstrated by echocardiography in patients who took appetite-suppressant medication for weight loss has been assessed at 5%-30%. We studied 86 patients who had echocardiograms before treatment with appetite suppressants to determine the incidence of new cases and to evaluate the clinical implication of the echocardiographic findings. We studied 69 men [Mean+/-Standard Deviation (S) age 49+/-8] and 17 women (mean+/-S age 50+/-7) who had 233 echocardiograms before, during, and after a weight-loss program that used predominantly fenfluramine (or dexfenfluramine) with mazindol (or phentermine). Mean drug exposure was 17 months. Blinded echocardiographic readings were performed to identify and grade aortic regurgitation (AR) or mitral regurgitation (MR). Seven of 86 patients (8%) had pre-existing regurgitation with five (6%) meeting our case definition. Thirteen (16.5%) of initially normal patients developed valvular regurgitation and were new cases. Of the new cases, 12 were grade I/IV AR and one was both grade II/III MR and II/IV AR. All 13 patients were asymptomatic, and only two aortic insufficiency murmurs could be auscultated. There was significantly greater risk for developing valvulopathy for those who took medications longer than 6 months (p = 0.03), and no new cases were observed in patients exposed for less than 8 months. No increased risk associated with age, presence of hypertension, or exposure to fenfluramine-phentermine combination was demonstrated. Although there was a higher incidence of new regurgitation in women (31% vs. 13% for men), this was not statistically significant (p = 0.093). Some patients who had normal echocardiograms at baseline developed cardiac valvular regurgitation after exposure to fenfluramine or dexfenfluramine with mazindol or phentermine. The development of valvulopathy was significantly correlated with duration of exposure. The clinical implications of echocardiographically

  17. Role of High-Resolution Chest Computed Tomography in a Child with Persistent Tachypnoea and Intercostal Retractions: A Case Report of Neuroendocrine Cell Hyperplasia

    Science.gov (United States)

    Lelii, Mara; Patria, Maria Francesca; Pinzani, Raffaella; Tenconi, Rossana; Mori, Alessandro; Bonelli, Nicola; Principi, Nicola

    2017-01-01

    Background: Chronic interstitial lung diseases in children (chILD) are a heterogeneous group of disorders that can represent a clinical challenge for pediatric pneumologists. Among them, neuroendocrine cell hyperplasia of infancy (NEHI) is a diffuse lung disease prevalent in the first years of life that spontaneously improves over time. The clinical presentation of NEHI is indistinguishable from other interstitial lung diseases, so a correct and non-invasive diagnosis by chest computed tomography (CT) without lung biopsy might not be simple. Case presentation: An 8-month-old male infant presented with a history of chronic tachypnoea and dyspnoea since 6 months of age. The patient was born at term, with APGAR scores of 9 and 10 at 1 and 5 min, respectively. Since his second month of life, the patient suffered from abnormal breathing, which was characterized by mild tachypnoea and costal retractions that worsened during breastfeeding, crying, and respiratory infections. Bilateral inspiratory crackles, preferential to the lung bases, without oxygen desaturation were detected. A chest X-ray showed a diffuse over-inflation of the lungs, but laboratory tests did not reveal any abnormalities. High-resolution chest CT documented patchy areas of ground-glass opacity involving the right upper lobe, middle lobe, and lingula, and showed mosaic areas of air-trapping, suggesting a diagnosis of NEHI. The infant was discharged without therapy and gradually improved over time. At 1 year of age, the patient was eupnoeic and chest auscultation had normalized. Conclusions: NEHI is an interstitial disease of infancy characterized by tachypnoea from the first months of life, with a good prognosis and for which a rational diagnostic approach is crucial for making a specific, early diagnosis. Initially, clinical suspicions can be confirmed with reasonable accuracy by a CT scan of the chest. Other more invasive and more expensive investigations should be reserved for selected cases that do

  18. Rheumatic fever recurrence prevention: a nurse-led programme of 28-day penicillin in an area of high endemnicity.

    Science.gov (United States)

    Spinetto, Heather; Lennon, Diana; Horsburgh, Margaret

    2011-04-01

    To evaluate safety and effectiveness of 28-day long-acting penicillin to prevent recurrences of acute rheumatic fever (ARF).   Historical cohort study using the regional RF register for Auckland, New Zealand, in a 5-14-year-old population with ARF rates of ~40-80/100,000. Consented patients were referred to a population-based delivery programme of free benzathine penicillin every 28 days by community nurses with discharge after the longer of 10 years of treatment or aged 21 years. First-episode and recurrent ARF cases classified as definite (Jones criteria 1992) or probable (Jones criteria 1956) were the main outcome measures. Of the 360 cases meeting the case definitions, 20 recurrences occurred in 19 people (median age 21 years). The age at first episode was 2-52 years (mode 11 years), median age 21.3 (8-40). ARF recurred 0-21 years after penicillin was discontinued. Seventy-two per cent of recurrent cases occurred within 5 years, and 12% between 5 years and 10 years. The 4-weekly long-acting penicillin failure rate (n= 1) was 0.07/100 patient years. The programme failure rate (Auckland residents) was 1.4/100 patient years (n= 20). Patient non-adherence accounted for 55% of recurrences. Two recurrences after discharge from prophylaxis as per the New Zealand guidelines occurred 3 years and 13 years later. In this environment, 28-day long-acting penicillin prophylaxis for at least 10 years delivered by community nurses is safe and effective for patients with no or mild cardiac disease by auscultation at discharge off penicillin. Penicillin delivery every 21 days (as suggested by a recent Cochrane review) would add to costs and complexity. © 2011 The Authors. Journal of Paediatrics and Child Health © 2011 Paediatrics and Child Health Division (Royal Australasian College of Physicians).

  19. [Pulse oximetry versus electrocardiogram for heart rate assessment during resuscitation of the preterm infant].

    Science.gov (United States)

    Iglesias, B; Rodríguez, M J; Aleo, E; Criado, E; Herranz, G; Moro, M; Martínez Orgado, J; Arruza, L

    2016-05-01

    Heart rate (HR) assessment is essential during neonatal resuscitation, and it is usually done by auscultation or pulse oximetry (PO). The aim of the present study was to determine whether HR assessment with ECG is as fast and reliable as PO during preterm resuscitation. Thirty-nine preterm (<32 weeks of gestational age and/or<1.500g of birth weight) newborn resuscitations were video-recorded. Simultaneous determinations of HR using ECG and PO were registered every 5s for the first 10min after birth. Time needed to place both devices and to obtain reliable readings, as well as total time of signal loss was registered. The proportion of reliable HR readings available at the beginning of different resuscitation manoeuvres was also determined. Time needed to connect the ECG was shorter compared with the PO (26.64±3.01 vs. 17.10±1.28 s, for PO and ECG, respectively, P<.05). Similarly, time to obtain reliable readings was shorter for the ECG (87.28±12.11 vs. 26.38±3.41 s, for PO and ECG, respectively, P<.05). Availability of reliable HR readings at initiation of different resuscitation manoeuvres was lower with the PO (PO vs. ECG for positive pressure ventilation: 10.52 vs. 57.89% P<.05; intubation: 33.33 vs. 91.66%, P<.05). PO displayed lower HR values during the first 6min after birth (P<.05, between 150 and 300s). Reliable HR is obtained later with the PO than with the ECG during preterm resuscitation. PO underestimates HR in the first minutes of resuscitation. Copyright © 2015 Asociación Española de Pediatría. Published by Elsevier España, S.L.U. All rights reserved.

  20. Prevalence of long QT syndrome and other cardiac defects in deaf-mute children

    International Nuclear Information System (INIS)

    Niaz, A.; Rizvi, S.F.U.; Khurram, D.

    2011-01-01

    Background: Long QT syndrome is considered a fatal disease because of its association with ventricular arrhythmias and sudden cardiac death. Objectives of study were to determine the prevalence of long QT syndrome and other heart diseases, in deaf-mute children. Methods: A Cross-sectional descriptive study was conducted at Cholistan special education centre and Cardiology department, Sheikh Zayed hospital Rahim Yar Khan, Pakistan in September 2006. A total of 104 congenitally deaf-mute children were assessed. Height, weight and blood pressure measured, 12-lead electrocardiogram done and QTc calculated using Bazette's formula. Children with prolonged QTc underwent 24-hour ambulatory ECG recording. All were auscultated following complete protocol. A child with murmur was further evaluated with colour Doppler echocardiography. Audiometry was performed on all the children and the result interpreted according to WHO recommendations. Diagnosis of LQTS was based on Revised Schwartz criteria. Results: Out of 104 children, 62 were male with mean age 11.89 yrs. The average systolic and diastolic BP was 97/67 mmHg. Average height was 126 Cm. All children had moderate to severe bilateral sensorineural hearing loss (40-80 dB). One child had associated Patent Ductus Arteriosis. Fifteen had an innocent murmur. Prevalence of congenital heart disease was found to be 0.1/1000. Four children had QT interval more than 440 mSec, (range 0.46-0.47 mSec.). Both genders were equally affected. Three children had high probability of LQTS and one had intermediate probability. Screening of family of these 4 patients showed prolonged QT interval in the sibling of one patient. Conclusion: Our study highlights the significant prevalence of Jervell Lange-Nielsen Syndrome in Pakistani deaf-mute children, which may be associated to the high level of consanguinity in this region. Awareness of this syndrome among health care providers is needed as timely diagnosis and subsequent treatment may prevent

  1. Management of severe childhood pneumonia by day care approach in developing countries

    Directory of Open Access Journals (Sweden)

    Yasmin Jahan

    2018-01-01

    Full Text Available Background: Background: Pneumonia is a major cause of child mortality among children under 5 years, worldwide. Pneumonia infection may be caused by bacteria, viruses, or fungi in single or in both lungs. According to recent criteria developed by the World Health Organization(WHO in September (2013, pneumonia can be classified into severe pneumonia, pneumonia and no pneumonia. Most of the deaths occur from severe pneumonia.Methods: Disease management of severe childhood pneumonia requires early identification,prompt referral and the availability of intensive quality care. Under 5 years old children with severe pneumonia should receive day care, with antibiotic treatment, feeding, and supportive care with similar 24-hour hospital treatment.Discussion: Considering that difficulties, International Centre for Diarrheal Disease Research,Bangladesh (ICDDR, B initiated Day Care Approach (DCA model, as an innovative, safe,effective and less expensive alternative to hospital management of severe childhood pneumonia.A 24 months old girl came to the health care center with severe breathing difficulty, cough,history of fever and head nodding. The management described below was continued daily until there was clinical improvement; no fever, no fast breathing, no lower chest wall in drawing, no danger signs, no rales on auscultation, and no hypoxemia. Conclusion: Considering the WHO case management protocol for severe pneumonia, DCA recommends that diagnosis of severe pneumonia should be based primarily on visible clinical parameters. On that basis, severe childhood pneumonia can be successfully managed at daycare clinics including for children with hypoxemia who is required prolong (4-6 hours oxygen therapy.

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

    International Nuclear Information System (INIS)

    Araújo, Fátima Derlene da Rocha; Goulart, Eugênio Marcos Andrade; Meira, Zilda Maria Alves

    2012-01-01

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

  3. Design and evaluation of a parametric model for cardiac sounds.

    Science.gov (United States)

    Ibarra-Hernández, Roilhi F; Alonso-Arévalo, Miguel A; Cruz-Gutiérrez, Alejandro; Licona-Chávez, Ana L; Villarreal-Reyes, Salvador

    2017-10-01

    Heart sound analysis plays an important role in the auscultative diagnosis process to detect the presence of cardiovascular diseases. In this paper we propose a novel parametric heart sound model that accurately represents normal and pathological cardiac audio signals, also known as phonocardiograms (PCG). The proposed model considers that the PCG signal is formed by the sum of two parts: one of them is deterministic and the other one is stochastic. The first part contains most of the acoustic energy. This part is modeled by the Matching Pursuit (MP) algorithm, which performs an analysis-synthesis procedure to represent the PCG signal as a linear combination of elementary waveforms. The second part, also called residual, is obtained after subtracting the deterministic signal from the original heart sound recording and can be accurately represented as an autoregressive process using the Linear Predictive Coding (LPC) technique. We evaluate the proposed heart sound model by performing subjective and objective tests using signals corresponding to different pathological cardiac sounds. The results of the objective evaluation show an average Percentage of Root-Mean-Square Difference of approximately 5% between the original heart sound and the reconstructed signal. For the subjective test we conducted a formal methodology for perceptual evaluation of audio quality with the assistance of medical experts. Statistical results of the subjective evaluation show that our model provides a highly accurate approximation of real heart sound signals. We are not aware of any previous heart sound model rigorously evaluated as our proposal. Copyright © 2017 Elsevier Ltd. All rights reserved.

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

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    Frendin Jan HM

    2010-04-01

    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.

  5. Adverse reactions of α2-adrenoceptor agonists in cats reported in 2003-2013 in Finland.

    Science.gov (United States)

    Raekallio, Marja R; Virtanen, Marika; Happonen, Irmeli; Vainio, Outi M

    2017-07-01

    To describe suspected adverse drug reactions in cats associated with use of α 2 -adrenoceptor agonists. Retrospective study. A total of 90 cats. Data were collected from reports on adverse reactions to veterinary medicines sent to the Finnish Medicines Agency during 2003-2013. All reports of suspected adverse reactions associated with use of α 2 -adrenoceptor agonists in cats were included. Probable pulmonary oedema was diagnosed based on post mortem or radiological examination, or presence of frothy or excess fluid from the nostrils or trachea. If only dyspnoea and crackles on auscultation were reported, possible pulmonary oedema was presumed. Pulmonary oedema was suspected in 61 cases. Of these cats, 37 were categorised as probable and 24 as possible pulmonary oedema. The first clinical signs had been noted between 1 minute and 2 days (median, 15 minutes) after α 2 -adrenoceptor agonist administration. Many cats probably had no intravenous overhydration when the first clinical signs were detected, as either they presumably had no intravenous cannula or the signs appeared before, during or immediately after cannulation. Of the 61 cats, 43 survived, 14 died and for four the outcome was not clearly stated. Pulmonary oedema is a perilous condition that may appear within minutes of an intramuscular administration of sedative or anaesthetic agent in cats. The symptoms were not caused by intravenous overhydration, at least in cats having no venous cannula when the first clinical signs were detected. Copyright © 2017 Association of Veterinary Anaesthetists and American College of Veterinary Anesthesia and Analgesia. Published by Elsevier Ltd. All rights reserved.

  6. Right Tracheobronchial Injury Due to Endotracheal Tube Malpositioning: A Case Presentation

    Directory of Open Access Journals (Sweden)

    Serkan Uçkun

    2015-12-01

    Full Text Available Our case was a 49-year old female patient operated for hepatic hydatid disease under general anesthesia. The operation was stopped due to development of desaturation (SpO2<80% at the 30th minute and detection of subcutaneous emphysema of neck and chest. The administration of anesthetic gases was interrupted and 100% oxygen ventilation was initiated. Auscultation revealed reduction of the breath sounds in the left lung. The lung graphy and fiberoptic bronchoscopy (FOB of the patient revealed left lung atelectasis and diffuse subcutaneous mediastinal emphysema. No tracheobronchial injury or tracheoesophageal rupture was considered in the first FOB evaluation. The patient was inserted a left thoracic tube and operation was proceeded by fixation of this tube. After the operation that lasted for 70 minutes without a complication, a lung graphy was performed while the patient was intubated and thoracic tomography and transferred to the intensive care unit. The patient was initiated monitorization and supportive treatment on synchronized intermittent mandatory ventilation (SIMV-PC mode under sedoanalgesia. The second FOB evaluation revealed air bubble and a right thoracic tube was connected to the patient. No additional surgery was planned. The lung graphy performed in the 5th admission day showed expansion of the right lung and the right thoracic tube was withdrawn. Weaning was attempted in the 5th admission day. The patient was extubated and connected to O2 mask (4 lt/min. The patient with stable vital findings and normal levels of blood gases was transferred to the relevant clinic.

  7. The pacemaker-twiddler's syndrome: an infrequent cause of pacemaker failure.

    Science.gov (United States)

    Salahuddin, Mohammad; Cader, Fathima Aaysha; Nasrin, Sahela; Chowdhury, Mashhud Zia

    2016-01-20

    The pacemaker-twiddler's syndrome is an uncommon cause of pacemaker malfunction. It occurs due to unintentional or deliberate manipulation of the pacemaker pulse generator within its skin pocket by the patient. This causes coiling of the lead and its dislodgement, resulting in failure of ventricular pacing. More commonly reported among elderly females with impaired cognition, the phenomenon usually occurs in the first year following pacemaker implantation. Treatment involves repositioning of the dislodged leads and suture fixation of the lead and pulse generator within its pocket. An 87 year old Bangladeshi lady who underwent a single chamber ventricular pacemaker (VVI mode: i.e. ventricle paced, ventricle sensed, inhibitory mode) implantation with the indication of complete heart block, and presented to us again 7 weeks later, with syncopal attacks. She admitted to repeatedly manipulating the pacemaker generator in her left pectoral region. Physical examination revealed a heart rate of 42 beats/minute, blood pressure 140/80 mmHg and bilateral crackles on lung auscultation. She had no cognitive deficit. An immediate electrocardiogram showed complete heart block with pacemaker spikes and failure to capture. Chest X-ray showed coiled and retracted right ventricular lead and rotated pulse generator. An emergent temporary pace maker was set at a rate of 60 beats per minute. Subsequently, she underwent successful lead repositioning with strong counselling to avoid further twiddling. Twiddler's syndrome should be considered as a cause of pacemaker failure in elderly patients presenting with bradyarrythmias following pacemaker implantation. Chest X-ray and electrocardiograms are simple and easily-available first line investigations for its diagnosis. Lead repositioning is required, however proper patient education and counselling against further manipulation is paramount to long-term management.

  8. Educação em valores e promoção da saúde: um estudo quantitativo sobre o uso de técnicas psicoterapêuticas com recurso à imaginação

    Directory of Open Access Journals (Sweden)

    Paula Alves Molarinho

    2017-01-01

    Full Text Available The unstructured families have been increasing and, consequently, also the school failure in young adolescents from these families. These present more and more psychological disorders of difficult control. In this study we highlight the loss of quality of life of these young people and risk deportments. This essentially quantitative research allowed perform an intervention in the school through relaxation techniques applied by Simões (2003, 2013 and associated to the contents of positive psychology and used by Neto and Marujo (2004, 2011. These include guided meditation techniques already applied in the health area. From research about the representation of teachers and the role of parents in the school (Faria; Pedro, 1995, and later on the representation of parents on teachers’ identity (Faria; Tavares, 2011, It can be concluded that both have specific roles and an important mission in the educational process. Following these studies, we questioned the interest of parents and teachers (educational stakeholders about which values they consider most important to develop in school with their children and that may be directly associated with their deportments. For this purpose, we applied an appreciative survey (from the scope of positive psychology, as used by Marujo; Neto; Caetano e Rivero (2007, which allowed us to determine the most important values to be applied to young people, more balanced deportments and better learning. The calculated values seem directly associated with the forces of character designated by Seligman & Peterson (2004 in the scope of positive psychology. This auscultation of the opinion of the educational agents allowed the realization of the “base-line” for the construction of the visual analogue scale that measured the evolution of the students throughout the intervention. The results point to significant differences, over time, in the groups where the intervention was performed.

  9. Continuous cardiotocography (CTG) as a form of electronic fetal monitoring (EFM) for fetal assessment during labour.

    Science.gov (United States)

    Alfirevic, Zarko; Devane, Declan; Gyte, Gillian Ml; Cuthbert, Anna

    2017-02-03

    Cardiotocography (CTG) records changes in the fetal heart rate and their temporal relationship to uterine contractions. The aim is to identify babies who may be short of oxygen (hypoxic) to guide additional assessments of fetal wellbeing, or determine if the baby needs to be delivered by caesarean section or instrumental vaginal birth. This is an update of a review previously published in 2013, 2006 and 2001. To evaluate the effectiveness and safety of continuous cardiotocography when used as a method to monitor fetal wellbeing during labour. We searched the Cochrane Pregnancy and Childbirth Group Trials Register (30 November 2016) and reference lists of retrieved studies. Randomised and quasi-randomised controlled trials involving a comparison of continuous cardiotocography (with and without fetal blood sampling) with no fetal monitoring, intermittent auscultation intermittent cardiotocography. Two review authors independently assessed study eligibility, quality and extracted data from included studies. Data were checked for accuracy. We included 13 trials involving over 37,000 women. No new studies were included in this update.One trial (4044 women) compared continuous CTG with intermittent CTG, all other trials compared continuous CTG with intermittent auscultation. No data were found comparing no fetal monitoring with continuous CTG. Overall, methodological quality was mixed. All included studies were at high risk of performance bias, unclear or high risk of detection bias, and unclear risk of reporting bias. Only two trials were assessed at high methodological quality.Compared with intermittent auscultation, continuous cardiotocography showed no significant improvement in overall perinatal death rate (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.59 to 1.23, N = 33,513, 11 trials, low quality evidence), but was associated with halving neonatal seizure rates (RR 0.50, 95% CI 0.31 to 0.80, N = 32,386, 9 trials, moderate quality evidence). There was no

  10. Mediastinal nodal angiomatosis - an unusual mass lesion in the superior mediastinum

    International Nuclear Information System (INIS)

    Steinke, Karin; Sanadgol, Babak; Singh, Mahendra

    2011-01-01

    Full text: A 54-year-old male, lifelong non-smoker, presented to the authors' hospital with a 5-day history of fever and productive cough, not improving on oral amoxicillin. His past medical history was unremarkable. On examina tion, he was febrile, tachycardic and tachypneic, and had right basal crackles on auscultation. Initial blood tests revealed a leucocytosis with increased neutrophils and normal lymphocytes. C-reactive protein was elevated at 312 mg/L 5). The coagulation profile was unremarkable. The initial chest X-ray (CXR) showed areas of opacifi cation in the right lower lobe and a right paratracheal mediastinal bulging (Fig, 1). A previous CXR from 6 years before, unrelated to this recent presentation, was normal. Further evaluation by contrast-enhanced chest CT (SIEMENS Sensation 16 (Siemens, Erlangen, Germany); slice thickness 3 mm) showed a well-defined heteroge neous 4.0 x 4.8 cm mass lesion in the superior mediast num with densities of 60-70 HU, separate from vessels, the esophagus or the trachea (Fig. 2a) along with bilateral lower lobe patchy confluent pulmonary infiltrates (not shown), more conspicuous on the right. The patient's hospital stay was complicated by a non-ST elevation myocardial infarction, which precluded him from having a transbronchial biopsy of the mediastinal mass. The patient's serum tested positive for mycoplasma pneumo niae antibodies with a titre of 640 40); the pneumonia was successfully treated with a course of oral doxycycline administered over 14 days, the symptoms fully resolving. He was eventually discharged, having recovered from the pneumonia and from the myocardial infarction. A subs quent CT scan performed 3 months later showed persis tence of the mediastinal mass with no significant changes in size or density (Fig. 2b); the bilateral pneumonic infil trates have fully resolved. The ensuing endobronchial ultrasound (EBUS)-guided needle aspiration with biopsy of the mediastinal mass produced a sample of macrophages

  11. The relevance of echocardiography heart measures for breeding against the risk of subaortic and pulmonic stenosis in Boxer dogs.

    Science.gov (United States)

    Menegazzo, L; Bussadori, C; Chiavegato, D; Quintavalla, C; Bonfatti, V; Guglielmini, C; Sturaro, E; Gallo, L; Carnier, P

    2012-02-01

    The aims of this study were to investigate the role and relative importance of auscultation and echocardiography traits as risk factors for the diagnosis of subaortic (SubAS) and pulmonic (PS) stenosis and to estimate the heritability (h(2)) of cardiac measurements taken through echocardiography for a random sample of Italian Boxer dogs. The data were cardiovascular examination results of 1,283 Italian Boxer dogs (686 females and 597 males) enrolled in the national screening program for heart defects arranged by the Italian Boxer Club. Examinations were performed during a 6-yr period by a group of 7 veterinary cardiologists following a standard protocol. Occurrence and severity of SubAS and PS were diagnosed, taking into account clinical and echocardiography findings such as the grade of cardiac murmur, direct ultrasound imaging of the anatomic obstructive lesions, and values of aortic or pulmonary blood flow velocities. A Bayesian logistic regression analysis was performed to identify clinical and echocardiography variables related to SubAS and PS diagnosis. Estimation of variance components for clinical and echocardiography traits was performed using a mixed linear animal model, Bayesian procedures, and the Gibbs sampler. Prevalence of SubAS (PS) was 8.4% (2.2) and 10.7% (6.4) for female and male dogs, respectively. Cardiac murmur, peak velocities, and annulus areas behaved as risk factors for SubAS and PS. The risk of a positive diagnosis for SubAS was 3 times greater for dogs with aortic annulus area 2.37 cm(2), 84 times greater for dogs showing aortic peak velocities >2.19 m/s relative to dogs with peak velocities <1.97 m/s, and 41 times greater for dogs with moderate to severe murmur grades relative to dogs with absent murmur. Similar results were obtained for PS. The estimated h(2) for the occurrence of cardiac defects was 23.3% for SubAS and 8.6% for PS. Echocardiography and cardiac murmur grades exhibited moderate h(2) estimates and exploitable additive

  12. Frequency Dynamics of the First Heart Sound

    Science.gov (United States)

    Wood, John Charles

    Cardiac auscultation is a fundamental clinical tool but first heart sound origins and significance remain controversial. Previous clinical studies have implicated resonant vibrations of both the myocardium and the valves. Accordingly, the goals of this thesis were threefold, (1) to characterize the frequency dynamics of the first heart sound, (2) to determine the relative contribution of the myocardium and the valves in determining first heart sound frequency, and (3) to develop new tools for non-stationary signal analysis. A resonant origin for first heart sound generation was tested through two studies in an open-chest canine preparation. Heart sounds were recorded using ultralight acceleration transducers cemented directly to the epicardium. The first heart sound was observed to be non-stationary and multicomponent. The most dominant feature was a powerful, rapidly-rising frequency component that preceded mitral valve closure. Two broadband components were observed; the first coincided with mitral valve closure while the second significantly preceded aortic valve opening. The spatial frequency of left ventricular vibrations was both high and non-stationary which indicated that the left ventricle was not vibrating passively in response to intracardiac pressure fluctuations but suggested instead that the first heart sound is a propagating transient. In the second study, regional myocardial ischemia was induced by left coronary circumflex arterial occlusion. Acceleration transducers were placed on the ischemic and non-ischemic myocardium to determine whether ischemia produced local or global changes in first heart sound amplitude and frequency. The two zones exhibited disparate amplitude and frequency behavior indicating that the first heart sound is not a resonant phenomenon. To objectively quantify the presence and orientation of signal components, Radon transformation of the time -frequency plane was performed and found to have considerable potential for pattern

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

    Directory of Open Access Journals (Sweden)

    Joana Moreira

    2011-12-01

    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

  14. Endovascular repair of posttraumatic multiple femoral-femoral and popliteal-popliteal arteriovenous fistula with Viabahn and excluder stent graft

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    Šarac Momir

    2011-01-01

    Full Text Available Background. Traumatic arteriovenous (AV fistula is considered to be a pathologic communication between the arterial and venous systems following injury caused mostly by firearms, sharp objects or blasting agents. Almost 50% of all traumatic AV fistulas are localized in the extremities. In making diagnosis, besides injury anamnesis data, clinical image is dominated by palpable thrill and auscultator continual sounds at the site of fistula, extremities edemas, ischemia distally of fistula, pronounced varicose syndrome, and any signs of the right heart load in high-flow fistulas. Case report. We presented a male 32-year-old patient self-injured the region of the right lower and upper leg by shotgun during hunting in 2005. The same day the patient was operated on in a tertiary traumatology health care institution under the diagnosis of vulnus sclopetarium femoris et cruris dex; AV fistula reg popliteae dex; fractura cruris dex. The performed surgery was ligatura AV fistulae; reconstructio a. popliteae cum T-T anastomosis; fasciotomia cruris dex. Postoperatively, in the patient developed a multiple AV fistula of the femoral and popliteal artery and neighboring veins. The patient was two more times operated on for closing the fistula but with no success. Three years later the patient was referred to the Clinic for Vascular Surgery, Military Medical Academy, Belgrade, Serbia. A physical examination on admission showed the right upper leg edema, pronounced varicosities and high thrill, signs of the skin induration and initial ischemia with ulceration in the right lower leg, as well as numerous scars in the inner side of the leg from the previously performed operations. Due to the right heart load there were also present easy getting tired, tachypnoea and tachycardia. CT and contrast angiography verified the presence of multiple traumatic AV fistulas in the surface femoral and popliteal artery and neighboring veins of the highest diameter being 1 cm

  15. The impact of computers on electrocardiography.

    Science.gov (United States)

    Rautaharju, P M

    1978-09-01

    The development of the electrocardiograph was the culmination of a scientific effort aimed at perfection of a device conceived for the elucidation of a physiologic phenomenon. The development of the digital computer was the culmination of a scientific effort aimed at perfection of warfare. Both of these fairly recent innovations of modern technology have been moderately successful in their initial objectives. Electrocardiography has had a profound influence on the practice of medicine. On the global scene, computers have so far had an insignificant influence on the practice of electrocardiography. In North America, however, computer interpretation of ECGs has already made a modest impact, perhaps more in terms of commercial gains rather than producing a substantial benefits to health care. The introduction of computers into clinical electrocardiography has not resulted in any widespread application of improved diagnostic criteria. The automation of ECG interpretation has not resulted in reduction of the cost of health care, on the contrary, in general it has increased the cost. Perhaps the most dismal failure has been the negligible use of computers in epidemiologic studies and heart disease prevention efforts. Palmistry, astrology, the art of palpation of the pulse, auscultation and acupuncture have had a more profound influence on the practice of medicine than computer analysis of the electrocardiogram. On the positive side, one of the beneficial effects of the use of computers has been the increasing awareness of the limited diagnostic accuracy of currently used ECG criteria, and the recognition of the fact that a substantial improvement is warranted; if such improvement can not be achieved in the foreseeable future, electrocardiography will lose much of its current clinical utility. Computers have had a profound influence on research in electrocardiology, and although a very few tangible concrete results have thus far diffused into clinical electrocardiography

  16. Pre-anaesthetic screening of geriatric dogs

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    K.E. Joubert

    2007-05-01

    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

  17. Fresh-cow handling practices and methods for identification of health disorders on 45 dairy farms in California.

    Science.gov (United States)

    Espadamala, A; Pallarés, P; Lago, A; Silva-Del-Río, N

    2016-11-01

    The aim of the present study was to describe fresh-cow handling practices and techniques used during fresh cow evaluations to identify postpartum health disorders on 45 dairy farms in California ranging from 450 to 9,500 cows. Fresh cow practices were surveyed regarding (a) grouping and housing, (b) scheduling and work organization, (c) screening for health disorders, and (d) physical examination methods. Information was collected based on cow-side observations and responses from fresh cow evaluators. Cows were housed in the fresh cow pen for 3 to 14 (20%), 15 to 30 (49%), or >31 (31%) d in milk. Fresh cow evaluations were performed daily (78%), 6 times a week (11%), 2 to 5 times a week (9%), or were not routinely performed (2%). There was significant correlation between the duration of fresh cow evaluations and the number of cows housed in the fresh pen. Across all farms, the duration of evaluations ranged from 5 to 240 min, with an average of 16 s spent per cow. During fresh cow checks, evaluators always looked for abnormal vaginal discharge, retained fetal membranes, and down cows. Dairies evaluated appetite based on rumen fill (11%), reduction of feed in the feed bunk (20%), rumination sensors (2%), or a combination of these (29%). Milk yield was evaluated based on udder fill at fresh cow checks (40%), milk flow during milking (11%), milk yield records collected by milk meters (2%), or a combination of udder fill and milk meters (5%). Depressed attitude was evaluated on 64% of the dairies. Health-monitoring exams for early detection of metritis were implemented on 42% of the dairies based on rectal examination (13%), rectal temperature (22%), or both (7%). Dairies implementing health-monitoring exams took longer to perform fresh cow evaluations. Physical examination methods such as rectal examination, auscultation, rectal temperature evaluation, and cow-side ketosis tests were used on 76, 67, 38, and 9% of dairies, respectively. Across dairies, we found large

  18. Clinical management of parasitic gastroenteritis (PGE concurrent with moderate pneumonia in a goat: a clinical veterinary case report

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    Faez Firdaus Abdullah Jesse

    2017-09-01

    Materials and methods: The Jamnapari cross goat aged two years and weighing 40 Kg was presented to the Universiti Veterinary Hospital, Universiti Putra Malaysia with the history of diarrhea and depression. The goat was examined physically. Blood and fecal samples were collected for complete blood count, serum biochemistry analysis and parasitological examination. Standard treatment plan was applied for the correction of the the problem. Results: Physical examination findings revealed the goat was in poor body condition, dull and depressed. Wet and dry fecal traces were observed around the groin region. The temperature was slightly elevated (39.5°C, the heart rate was increased (160 b/min while other parameters were within normal range. Upon auscultation of the thoracic region, moderate crackle lung sound was determined. Visual observation of the nasal cavity indicated a bilateral mucopurulent nasal discharge. The hemogram result revealed evidence of a normocytic normochromic anemia, leukocytosis, neutrophilia with left shift and monocytosis. Serum biochemistry revealed increases in gamma-glutamyl transferase (GGT, sodium, chloride, creatine kinase (CK, and hyperglobulinemia. Fecal examination revealed increased in Strongyle egg count of about 2,700 eggs per gram of feces using the Modified Mcmaster technique. From the history, physical examination and laboratory findings the goat was diagnosed with clinical parasitic gastroenteritis (PGE concurrent with moderate pneumonia infection. The therapeutic plan for this case were 45 mL of kaolin-pectin (30 mL/Kg body weight orally SID for 3 days as anti-diarrhea, 12 mL Levamisole (12 mg/Kg bwt was administered orally once as anthelminthic, fluid therapy was instituted using 1.5 L of Lactated Ringers’ solution once via intravenously. Trimethoprim-Sulfamethoxazole (1 mL/16 Kg bwt was administered intramuscularly SID for 3 days. Conclusion: Follow up examination of the goat a week post treatment indicated a good prognosis

  19. Availability and components of maternity services according to providers and users perspectives in North Gondar, northwest Ethiopia

    Science.gov (United States)

    2013-01-01

    Background The goal of reducing maternal mortality can be achieved when women receive important service components at the time of their maternity care. This study attempted to assess the availability and the components of maternity services according to the perspectives of service users and providers. Method A linked facility and population-based survey was conducted over three months (January to March 2012) in North Gondar Zone. Twelve kebeles (clusters) were selected randomly from six districts to identify maternity clients cared for by skilled providers. Then 12 health centers and 3 hospitals utilized by the corresponding cluster population were selected for facility survey. Interview with facility managers/heads, providers and clients and observations were used for data collection. Data were entered using Epi Info and were exported to SPSS software for analysis. Results Antenatal and delivery care were available in most of the visited facilities. However, the majority of them were not fully functioning for EmOC according to their level. Signal functions including administration of anticonvulsants and assisted vaginal delivery were missing in seven and five of the 12 health centers, respectively. Only one hospital met the criteria for comprehensive emergency obstetric care (performed cesarean section). Only 24% of the providers used partograph consistently. About 538 (32.3%) and 231 (13.8%) of the women received antenatal and delivery care from skilled providers, respectively. Most of the services were at health centers by nurses/midwives. At the time of the antenatal care, women received the important components of the services (percentage of users in bracket) like blood pressure checkup (79%), urine testing (35%), tetanus immunization (45%), iron supplementation (64%), birth preparedness counseling (51%) and HIV testing (71%). During delivery, 80% had their blood pressure measured, 78% were informed on labor progress, 89% had auscultation of fetal heartbeat

  20. [Blood pressure measurement by primary care physicians: comparison with the standard method].

    Science.gov (United States)

    Asai, Y; Kawamoto, R; Nago, N; Kajii, E

    2000-04-01

    To examine the usual methods of blood pressure (BP) measurement by primary care physicians and to compare them with the standard methods. Cross-sectional survey by self-administered questionnaire. Primary care physicians who graduated from Jichi Medical School and were working at clinics. Each standard method for 20 items was defined as the one that was most frequently recommended by 6 guidelines (USA 3, UK 1, Canada 1, Japan 1) and a recent comprehensive review about BP measurement. Of 333 physicians, 190 (58%) responded (median age 33, range 26 to 45 years). Standard methods and percentages of physicians who follow them are: [BP measurement, 17 items] supported arm 96%; measurement to 2 mmHg 91%; sitting position 86%; mercury sphygmomanometer 83%; waiting > or = 1 minute between readings 58%; palpation to assess systolic BP before auscultation 57%; check accuracy of home BP monitor 56%; Korotkoff Phase V for diastolic BP 51%; bilateral measurements on initial visit 44%; small cuff available 41%; > or = 2 readings in patients with atrial fibrillation 38%; > or = 2 readings on one visit 20%; cuff deflation rate of 2 mmHg/pulse 14%; large cuff available 13%; check accuracy of monitor used for home visit 8%; waiting time > or = 5 minute 3%; readings from the arm with the higher BP 1%. [Knowledge about BP monitor, 2 items] appropriate size bladder: length 11%; width 11%. [Check of sphygmomanometer for leakage, inflate to 200 mmHg then close valve for 1 minute] leakage < 2 mmHg 6%; median 10 (range 0-200) mmHg. Average percentage of all 20 items was 39%. Number of methods physicians follow as standard: median 8 (range 4 to 15) and this number did not correlate with any background characteristics of the physicians. Furthermore, we also obtained information on methods not compared with the standard. Fifty-four percentage of physicians used more standard methods in deciding the start or change of treatment than in measuring BP of patients with good control. About 80% of

  1. Simple and non-invasive techniques to evaluate the function of CircuLite Synergy.

    Science.gov (United States)

    Mohite, Prashant N; Bowles, Christopher T; Sabashnikov, Anton; Popov, Aron-Frederik; Patil, Nikhil P; Sáez, Diana García; Banner, Nicholas R; Simon, André R

    2014-11-01

    The Synergy CircuLite micropump is a novel partial-support miniature left ventricular assist device that propels 2-3 l/min blood from the left atrium into the right subclavian artery. The ability of currently available investigative modalities to confirm Synergy pump malfunction is limited. The Synergy speed fluctuates periodically (at 10-s intervals) from the baseline to a transient decrease followed by a transient increase (alternating speed algorithm, ASA) with the purpose of changing the blood flow behaviour, thereby reducing thrombogenicity. The aim of this study was to develop a simple non-invasive monitoring technique to assess pump function based on the detection of the ASA in the peripheral microcirculation. Between February 2012 and July 2013, 10 patients with advanced chronic heart failure underwent Synergy implantation at our institution. The pump function was assessed by echocardiography and invasive monitoring according to standard protocols; additionally, the pump speed and power consumption were monitored. During the pump function assessment, the pulse oximeter waveform was recorded from the index fingers of the left and right hand with simultaneous pump auscultation using a stethoscope positioned on the pump (right infra-clavicular pocket). The pulse oximeter waveform was readily detectable from the right and left hand of all study patients. If the Synergy function was normal, there was a significant difference in the morphology of the pulse oximeter waveform from each hand: the ASA algorithm produced a more pronounced variation (giant wave) in the trace from the right hand than from the left. The giant waves invariably coincided with the sound variation associated with the ASA algorithms, which were detected regularly at 10-s intervals. We describe a simple, readily applicable, inexpensive, non-invasive technique that allows evaluation of Synergy pump function and may have diagnostic utility under conditions of suspected pump thrombus

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

    Directory of Open Access Journals (Sweden)

    Upadhayay N

    2017-03-01

    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  

  3. A TRAGÉDIA DA DOENÇA - BASES FENOMENOLÓGICAS DA MEDICINA NARRATIVA.

    Directory of Open Access Journals (Sweden)

    Carlos E. Pompilo

    2016-01-01

     professionals’ careful auscultation and their discursive in-tervention are themselves a Therapy. Keywords: Narrative, Unheimlichkeit, Medicine.

  4. A tragédia da doença - bases fenomenológicas da medicina narrativa.

    Directory of Open Access Journals (Sweden)

    Carlos E. Pompilo

    2016-01-01

     professionals’ careful auscultation and their discursive in-tervention are themselves a Therapy.Keywords: Narrative, Unheimlichkeit, Medicine.

  5. Subsurface defect detection in first layer of pavement structure and reinforced civil engineering structure by FRP bonding using active infrared thermography

    Science.gov (United States)

    Dumoulin, Jean; Ibos, Laurent

    2010-05-01

    In many countries road network ages while road traffic and maintenance costs increase. Nowadays, thousand and thousand kilometers of roads are each year submitted to surface distress survey. They generally lean on pavement surface imaging measurement techniques, mainly in the visible spectrum, coupled with visual inspection or image processing detection of emergent distresses. Nevertheless, optimisation of maintenance works and costs requires an early detection of defects within the pavement structure when they still are hidden from surface. Accordingly, alternative measurement techniques for pavement monitoring are currently under investigation (seismic methods, step frequency radar). On the other hand, strengthening or retrofitting of reinforced concrete structures by externally bonded Fiber Reinforced Polymer (FRP) systems is now a commonly accepted and widespread technique. However, the use of bonding techniques always implies following rigorous installing procedures. To ensure the durability and long-term performance of the FRP reinforcements, conformance checking through an in situ auscultation of the bonded FRP systems is then highly suitable. The quality-control program should involve a set of adequate inspections and tests. Visual inspection and acoustic sounding (hammer tap) are commonly used to detect delaminations (disbonds) but are unable to provide sufficient information about the depth (in case of multilayered composite) and width of debonded areas. Consequently, rapid and efficient inspection methods are also required. Among the non destructive methods under study, active infrared thermography was investigated both for pavement and civil engineering structures through experiments in laboratory and numerical simulations, because of its ability to be also used on field. Pulse Thermography (PT), Pulse Phase Thermography (PPT) and Principal Component Thermography (PCT) approaches have been tested onto pavement samples and CFRP bonding on concrete

  6. Transposición corregida de grandes vasos Corrected transposition of the great arteries

    Directory of Open Access Journals (Sweden)

    José Rafael Escalona Aguilera

    2012-09-01

    Full Text Available Se presenta una paciente de sexo femenino, de 9 años de edad, que acude a su médico de familia y se le auscultó un soplo al examen físico y sintomatología que se comportaba como una comunicación interventricular. Luego de los estudios correspondientes, se permitió hacer el diagnóstico de transposición corregida de grandes vasos. La paciente tenía asociada una anomalía de Ebstein, comunicación interauricular, una comunicación interventricular, y una persistencia del conducto arterioso, todo lo cual agravaba su cuadro clínico. Primero es intervenida quirúrgicamente, y se cierra el ducto; de manera espontánea, cierra la comunicación interauricular, y la anomalía de Ebstein parchea la comunicación interventricular. La niña desarrolla una insuficiencia cardiaca e hipertensión pulmonar, a consecuencia de las anomalías asociadas. El caso es de interés, ya que son pocos los publicados en la literatura internacional con esta cardiopatía congénita asociada a otras anomalías estructurales del corazón, que modifican su historia natural.This paper presented a 9 years-old female patient, who went to the family's doctor and was physically examined to detect heart murmur and symptoms of ventricular septal defect. After the corresponding studies, the diagnosis was the corrected transposition of the great arteries. The patient also suffered Ebstein anomaly, atrial septal defect, ventricular septal defect and persistence of arteriose duct, all of which worsened her clinical picture. First, she was operated on and the duct was closed. Later the atrial septal defect closed spontaneously, and the Ebstein anomaly patched the ventricular septal defect. The girl developed heart failure and pulmonary hypertension, as a result of associated anomalies. The case is interesting since few cases like this one, associated with other structural heart anomalies that change its natural course, are presented in the international literature.

  7. Twenty-four-hour ambulatory electrocardiography characterization of heart rhythm in Vipera berus-envenomed dogs.

    Science.gov (United States)

    Vestberg, Anna Rave; Tidholm, Anna; Ljungvall, Ingrid

    2017-05-03

    Vipera berus has a worldwide distribution and causes high morbidity in dogs annually. A complication to envenomation may be cardiac arrhythmias. The purpose of this study was to investigate the prevalence, types, and timing of arrhythmias, using 24-h ambulatory electrocardiography (24-AECG), in dogs bitten by V. berus in the first 24-32 h after envenomation. In addition, this study aimed to investigate if there were differences in selected clinical and hematological- and biochemical variables (including cardiac troponin I) at admission between V. berus-envenomed dogs with and without detected pathologic arrhythmias. Seventeen prospectively recruited client-owned dogs acutely envenomed by V. berus, were therefore examined clinically and echocardiographically, sampled for blood, hospitalized, and monitored by 24-AECG. Clinically significant pathologic arrhythmias in this study were of ventricular origin, such as frequent single ventricular premature contractions (VPCs) and couplets of VPCs, episodes of ventricular tachycardia and idioventricular rhythm, and "R-on-T phenomenon". Variations of these arrhythmias were detected by 24-AECG in eight (47%) of included dogs. No arrhythmias were detected by cardiac auscultation. Twenty-four hours following envenomation, four out of eight dogs experienced decreases (all P dogs experienced increases (all P dogs bitten on a limb developed pathologic arrhythmias. Otherwise, no significant differences in clinical, hematological or biochemical variables were seen between dogs with pathologic arrhythmias and those without. Forty-seven percent of dogs bitten by V. berus included in this study experienced pathologic arrhythmias of abnormal ventricular depolarization. During the first 24-32 h from the snakebite, some dogs experienced a decrease in arrhythmic episodes and others an increase in arrhythmic episodes. These findings indicate a potential value of repeated or prolonged electrocardiography monitoring of envenomed dogs for

  8. Idiopathic pulmonary fibrosis

    Directory of Open Access Journals (Sweden)

    Noble Paul W

    2008-03-01

    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

  9. Two-Phase Reactive Transport Model CO2-Brine at Hontomín Technological Development Plant (Burgos)

    International Nuclear Information System (INIS)

    Rodrigo-Naharro, J.; Recreo-Jiménez, F.

    2015-01-01

    The option of storing CO2 in carbonate formations is a minority in the literature on CO2 Deep Geological Storage (CO2-DGS). However, there is sufficient bibliography on systems where CO2 natural accumulations have remained for centuries in carbonate formations (e.g. McElmo Dome, USA), as well as projects related to the enhanced oil recovery (Weyburn Project, Canada). Both cases can represent natural or industrial analogues of a CO2-DGS. The Technological Development Plant (TDP) at Hontomín (Burgos) was initially designed to inject supercritical CO2 or dissolved CO2 in a Lower Jurassic limestone-dolomite formation of the Burgos Platform, at 1500 m depth approximately. The Dogger Aquifer in the Paris Basin, together with the overlying Albian aquifer, is one of these potential analogues of the Underground Structure of Hontomín due to their stratigraphic, lithological and hydrogeological similarities. However, the drilling of the wells HI (injection) and HA (auscultation) in the TDP at Hontomín in 2014, which have allowed to access to the storage and seal formations, as well as the petrophysical measurements performed by CIUDEN and Fundación Instituto Petrofísico on core samples from both wells, and the hydraulic tests for the dynamic reservoir characterisation, have advised to include the more permeable formation levels of the Norian-Rhaetian “carniolas” in the initially selected storage formation. This formation is located at the bottom of the Sopeña dolomitic Fm., at a depth of 1595-1605 m in the well HI. The existence of sulphates (anhydrite and gypsum) in these levels introduces lithological and geochemical features not present in the Dogger aquifer of the Paris Basin which, in turn, advises to consider the lessons learned from the Weyburn Project. In this report a study of the system CO2–brine–storage rock, close to the well HI, is presented, where the deep aquifer of the Underground Structure of Hontomín could be affected in the chemical

  10. [Outcomes of Planned Out-of-Hospital and Low-Risk Hospital Births in Lower Saxony].

    Science.gov (United States)

    Petersen, Antje; Köhler, Lea-Marie; Schwarz, Christiane; Vaske, Bernhard; Gross, Mechthild M

    2017-08-01

    Introduction Internationally, there is debate on the safety of different birth settings inside and outside of hospitals. Low-risk women in Germany can choose where they give birth, and out-of-hospital births are especially necessary in regions lacking infrastructure. To date, national studies are required. Materials and Methods We investigated planned out-of-hospital (OH) and hospital births in Lower Saxony, Germany, in 2005. Women with a singleton fetus in the vertex position were included once they reached 34+0 gestational weeks. 1 273 out of 4 424 births were included via risk assessment. Outcomes were compared using Pearson's chi-squared test, the Mann-Whitney test, and logistic regression. Results 152 (36.6%) nulliparae (NP) and 263 (63.4%) multiparae (MP) gave birth out of hospital, 439 (51.2%) nulliparae and 419 (48.8%) multiparae in a hospital. 10.1% of women whose care started outside of the hospital needed a transfer to the hospital. Women who planned OH were older and had a higher level of education. Women without a migration background displayed an increased rate of out-of-hospital birth. A higher proportion received their antenatal care from midwives rather than medical doctors. Induction of labor was less likely for women with planned out-of-hospital births, as were other intrapartum interventions. In hospital births, fetal monitoring was more likely performed via cardiotocograph instead of intermittent auscultation. Duration of labor was significantly longer in OH births (median: NP: 9.01 h vs. 7.38 h; MP: 4.53 h vs. 4.25 h). Nulliparae had more spontaneous births out-of-hospital (94.7%) than in hospital (73.6%). There was no difference in adverse fetal outcomes, blood loss, and severe perineal lacerations. The perineum was less frequently intact in hospital births. Retained placenta was more often documented in out-of-hospital births. Conclusions In an out-of-hospital setting, fewer interventions were performed, spontaneous births

  11. [Effects of morphine, butorphanol and levomethadone in different doses on thermal nociceptive thresholds in horses].

    Science.gov (United States)

    Dönselmann Im Sande, Paula; Hopster, Klaus; Kästner, Sabine

    2017-04-19

    Various opioids are available for use in equine medicine. Studies directly comparing their analgesic effects and side effects are rare. Therefore, the aim of this study was to compare the antinociceptive effect and the duration of analgesia of two different doses of morphine, butorphanol and levomethadone in horses. Eight adult, healthy horses were used for this randomized, placebo-controlled, blinded cross-over trail. Each horse received placebo (P = 0.9% saline) and morphine (M 0.1  = 0.1 mg/kg; M 0.2  = 0.2 mg/kg), butorphanol (B 0.1  = 0.1 mg/kg; B 0.2  = 0.2 mg/kg) and levomethadone (L 0.1  = 0.1 mg/kg; L 0.2  = 0.2 mg/kg) in a low and a high dose and with a wash-out period of 14 days. Thermal thresholds were determined by incremental contact heat applied to the skin at the withers. Single stimulations were performed 15 minutes prior and 10, 30, 60, 90, 120, 180, 240, 300, 360, 420, 540 and 1350 minutes after treatment. Threshold values, gastrointestinal auscultation score and horses' behavior were recorded. Data were analyzed with analysis of variance for repeated measurements (p thermal thresholds did not reach significance. Thermal threshold increased significantly in the groups M 0.2 , B 0.1 , B 0.2 , L 0.1 and L 0.2 for 240, 90, 90, 60 and 300 minutes, respectively. Behavioural changes, increased locomotion and decreased bowel sounds as well as delayed time until defecation were noticed in all groups. Levomethadone induced a dose-dependent increase and prolongation of analgesia, whereas with butorphanol there was no difference between dosages regarding duration and intensity of analgesia. Morphine provided detectable analgesia only in the high dose of 0.2 mg/kg. Levomethadone and morphine in the low dose (0.1 mg/kg) produced only minor and short lived anti-nociception and further studies are necessary to give a profound dose recommendation for the use of these drugs in horses.

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

    Science.gov (United States)

    Lee, Joon; Blain, Stefanie; Casas, Mike; Kenny, Dave; Berall, Glenn; Chau, Tom

    2006-01-01

    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 The proposed aspiration

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

    Directory of Open Access Journals (Sweden)

    Blain Stefanie

    2006-07-01

    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

  14. Integrating wireless sensor network for monitoring subsidence phenomena

    Science.gov (United States)

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

    2016-04-01

    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. Clinical picture and epidemiology of atypical and pertussis-related pneumonia in unsuccessfully treated paediatric outpatients, hospitalised during the infectious season of 2015–2016

    Directory of Open Access Journals (Sweden)

    Maciej Pawłowski

    2017-03-01

    Full Text Available The incidence of respiratory tract infections caused by Mycoplasma, Chlamydophila pneumoniae and Bordetella pertussis in children increases in the infectious season of autumn-winter-spring. Infection with atypical bacteria manifests with slightly increased body temperature, dry cough and headaches. However, these clinical signs are insufficient to determine the aetiology of individual atypical forms of pneumonia. The aim of the study was to outline the clinical picture of children with atypical and pertussis-related pneumonia unsuccessfully treated as outpatients and hospitalised at the Department of Paediatric and Allergy during the infectious season of 2015–2016. In this period of time, 507 patients at the age from 5 weeks to 17.5 years were hospitalised. Pneumonia caused by Mycoplasma pneumoniae and Chlamydophila pneumoniae was confirmed by the presence of IgA and/or IgM antibodies (positive result >1.1 RU/mL, and infection caused by Bordetella pertussis – by IgA antibodies in the serum (positive result >2 IU/mL. Most of the patients had chest X-ray performed. Mycoplasma pneumoniae and/or Chlamydophila pneumoniae were detected in 51 children, and pertussis – in 131 children. Patients admitted to hospital usually presented lung signs on auscultation such as wheezing, crepitation and rales; some of them also presented rash and fever. The radiological image indicated densities depending on interstitial, parenchymal or mixed changes. Fever and rash usually occurred in younger children (2.5% and 5%, respectively, whilst 38% of patients did not present with auscultatory signs or fever at admission (mainly older children. This study reveals that clinical symptoms of atypical and pertussis-related infections can be very uncharacteristic, and delay in making a proper diagnosis results in improper treatment.

  16. PREVALENCE OF ASTHMA IN ISFAHAN JUNIOR HIGH SCHOOL CHILDREN (1998-1999

    Directory of Open Access Journals (Sweden)

    M GOLSHAN

    2000-06-01

    Full Text Available Introduction. Asthma is the most common chronic disease in children. Unfortunately there are not exact epidemiologic data concerning the prevalence of this disorder in Iranian children. The purpose of this study was to estimate the prevalence of asthma or respiratory symptoms in Isfahan Junior high school children. Methods. From 1998 Oct. to 1999 May. 3986 children from urban junior high schools children were selected by a proportional random cluster sampling. A self administered questionnaire prepared by International Study of Asthma and Allergies in Childhood (ISSAC modified by several supplementary questions was distributed among the selected children. The response rate was 98.5 percent (N=3924. Of these children, 2588 pupils who had at least one positive answer referring to respiratory symptoms were invited to AL-Zahra medical center for further evaluation, but 1710 pupils (66 percent of the invited attended the clinic and underwent complete medical interview, physical examination and post-exercise pulmonary function testing. Those children who failed to attend the clinic were examined at their schools (774 cases and 104 absent pupils were not examined. Our criterion for the diagnosis of asthma was the positive history of wheezing and dyspnea. Results. The overall prevalence of asthma was 19.6 percent with a male to female ratio of 1.7:1 (P<0.0001. The frequencies of wheezing ever in life and sleep disturbed by wheeze were 31.7 percent and 9.5 percent, respectively. Wheeze and rhoncus on chest auscultation while the children were examined in clinic or school was recorded in 4.2 percent and 3.5 percent of the population, respectively. Pulmonary function tests revealed FEV1:5,80 percent of predicted value (prd in 5.9 percent, FEF 25-75£70 Percent prd in 9.6 percent and FEF75£70 percent prd in 20.5 percent of tested children. The three later findings correlated to history of wheezing and dyspnea (P < 0.0001. Discussion. The prevalence of

  17. [The Eustachian tube and its role in the history of otology. Images from the history of otorhinolaryngology, presented by instruments from the collection of the Ingolstadt German History Museum].

    Science.gov (United States)

    Feldmann, H

    1996-12-01

    Even in ancient times the existence of an open pathway between the ear and the respiratory tract was assumed. Up to the middle ages, however, Aristotle's idea that the air in the ear is an innate part of the body prevailed. The first anatomical description of the tube was given by Eustachius (1563). He still adhered to the concept of "innate air" and regarded the tube only as a pathway for draining pathological matter from the tympanic cavity. Duverney (1683) realized that an important function of the tube was replacing and adjusting the pressure of the air in the tympanic cavity. He thought that the tube is permanently open, thus offering a vent to the air, when the tympanic membrane is moving inwards and outwards. Valsalva (1704) discovered a muscle for opening the tube, and he presumed that in hearing this muscle would come into action. He described the maneuver that is named after him as a method to expel pus from the tympanic cavity into the external auditory canal. E.G. Guyot, a postmaster in Versailles, was the first to try catheterization of his own Eustachian tube via the mouth. Cleland (1741) inserted the catheter via the nose, and Wathen (1756) after studies on corpses described in detail the technique how to carry out this procedure. The therapeutic application of Eustachian catheterization as practiced by physicians such as Itard (1821) centered around irrigation with water and medications as well as inflation of various fumes. Deleau (1836) later advocated a douche of pure air and, in analogy to the auscultation of the lung, described the different noises that could be perceived during this procedure. Numerous models of pumps were constructed for this air douche, which became one of the most widely used therapeutical means in otology. There were also lethal incidents caused by cutaneous emphysemata. Toynbee realized that at rest the tube is closed and that there is a constant absorption of air in the tympanic cavity. The tube would be opened only by

  18. Two-Phase Reactive Transport Model CO2-Brine at Hontomín Technological Development Plant (Burgos); Modelo de Transporte Reactivo Bifásico CO –Salmuera en el Emplazamiento de la Planta de Desarrollo Tecnológico de Hontomín (Burgos)

    Energy Technology Data Exchange (ETDEWEB)

    Rodrigo-Naharro, J.; Recreo-Jiménez, F.

    2015-07-01

    The option of storing CO2 in carbonate formations is a minority in the literature on CO2 Deep Geological Storage (CO2-DGS). However, there is sufficient bibliography on systems where CO2 natural accumulations have remained for centuries in carbonate formations (e.g. McElmo Dome, USA), as well as projects related to the enhanced oil recovery (Weyburn Project, Canada). Both cases can represent natural or industrial analogues of a CO2-DGS. The Technological Development Plant (TDP) at Hontomín (Burgos) was initially designed to inject supercritical CO2 or dissolved CO2 in a Lower Jurassic limestone-dolomite formation of the Burgos Platform, at 1500 m depth approximately. The Dogger Aquifer in the Paris Basin, together with the overlying Albian aquifer, is one of these potential analogues of the Underground Structure of Hontomín due to their stratigraphic, lithological and hydrogeological similarities. However, the drilling of the wells HI (injection) and HA (auscultation) in the TDP at Hontomín in 2014, which have allowed to access to the storage and seal formations, as well as the petrophysical measurements performed by CIUDEN and Fundación Instituto Petrofísico on core samples from both wells, and the hydraulic tests for the dynamic reservoir characterisation, have advised to include the more permeable formation levels of the Norian-Rhaetian “carniolas” in the initially selected storage formation. This formation is located at the bottom of the Sopeña dolomitic Fm., at a depth of 1595-1605 m in the well HI. The existence of sulphates (anhydrite and gypsum) in these levels introduces lithological and geochemical features not present in the Dogger aquifer of the Paris Basin which, in turn, advises to consider the lessons learned from the Weyburn Project. In this report a study of the system CO2–brine–storage rock, close to the well HI, is presented, where the deep aquifer of the Underground Structure of Hontomín could be affected in the chemical

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

    Science.gov (United States)

    Fisher, Gordon; Brown, Andrew W.; Bohan Brown, Michelle M.; Alcorn, Amy; Noles, Corey; Winwood, Leah; Resuehr, Holly; George, Brandon; Jeansonne, Madeline M.; Allison, David B.

    2015-01-01

    Purpose 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. Methods 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. Results 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 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 obese

  20. 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

  1. NURSING PROCESS: A PROPOSAL OF TEACHING THROUGH THE PROBLEM-BASED LEARNING.

    Directory of Open Access Journals (Sweden)

    Adélia Yaeko Kiosen Nakatani

    2002-12-01

    Full Text Available The way that teaching has been organized at the schools can represent na obstacle for the acquisition of theabilities to think, to reflect and to make decisions, influencing the coping with practical problems during the NursingProcess. The goal of the present study is to analyze the implementation of a proposal of teaching Nursing Processthrough the Problematical method, particularly through the Arch Method. This is an action-research project,developed at the Nursing School of the Federal University of Goiás, during 1998 and 1999. The subjects weresecond year students of Nursing, attending the course “Methodology of Nursing Assistence”. To collect the data weuse activity and self-evaluation reports from students, field data and instruments of cognitive, affective andpsychomotor evaluation. The evaluation of the reports was done following the established guidelines for teaching ineach phase, and most of the scores obtained were medium to high (3 to 5, with the exception of the nursingassistance phase evaluation, with scores between 1 and 2. In the affective evaluation the majority of the studentsmentioned that the implementation of the nursing process phases, does not happen as the literature suggests, andmanifested the importance of the Nursing Process to improve the quality of assistance and the desire of use itduring the professional practical. The psychomotor evaluation was performed through physical lunge exam and theimplementation of technical procedures. More than 50% of the students had scores between 4 and 5 in the items ofinspection and auscultation, presenting difficulties to perform the abilities of palpation and percussion. The scoreobtained in the evaluation of procedures implementation ranged from 4 to 5. The cognitive evaluation of theNursing Process phases was realized through a write test with mean grades between 33,4 and 51,4, with amaximum of 100 points. The differences between written evaluation and reports may be due to

  2. Age alters the cardiovascular response to direct passive heating

    Science.gov (United States)

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

    1998-01-01

    During direct passive heating in young men, a dramatic increase in skin blood flow is achieved by a rise in cardiac output (Qc) and redistribution of flow from the splanchnic and renal vascular beds. To examine the effect of age on these responses, seven young (Y; 23 +/- 1 yr) and seven older (O; 70 +/- 3 yr) men were passively heated with water-perfused suits to their individual limit of thermal tolerance. Measurements included heart rate (HR), Qc (by acetylene rebreathing), central venous pressure (via peripherally inserted central catheter), blood pressures (by brachial auscultation), skin blood flow (from increases in forearm blood flow by venous occlusion plethysmography), splanchnic blood flow (by indocyanine green clearance), renal blood flow (by p-aminohippurate clearance), and esophageal and mean skin temperatures. Qc was significantly lower in the older than in the young men (11.1 +/- 0.7 and 7.4 +/- 0.2 l/min in Y and O, respectively, at the limit of thermal tolerance; P < 0. 05), despite similar increases in esophageal and mean skin temperatures and time to reach the limit of thermal tolerance. A lower stroke volume (99 +/- 7 and 68 +/- 4 ml/beat in Y and O, respectively, P < 0.05), most likely due to an attenuated increase in inotropic function during heating, was the primary factor for the lower Qc observed in the older men. Increases in HR were similar in the young and older men; however, when expressed as a percentage of maximal HR, the older men relied on a greater proportion of their chronotropic reserve to obtain the same HR response (62 +/- 3 and 75 +/- 4% maximal HR in Y and O, respectively, P < 0.05). Furthermore, the older men redistributed less blood flow from the combined splanchnic and renal circulations at the limit of thermal tolerance (960 +/- 80 and 720 +/- 100 ml/min in Y and O, respectively, P < 0. 05). As a result of these combined attenuated responses, the older men had a significantly lower increase in total blood flow directed to

  3. 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

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    Giselle de Castro

    2011-12-01

    , 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

  4. Cardiopatia congênita no recém-nascido: da solicitação do pediatra à avaliação do cardiologista Congenital heart diseases in the newborn: from the pediatrician's request to the cardiologist's evaluation

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    Ivan Romero Rivera

    2007-07-01

    symptoms suggestive of CHD. Patent ductus arteriosus (PDA without clinical and/or hemodynamic consequences was not considered a heart disease. RESULTS: From 1999 to 2002, 358 out of 3716 NB were studied, and 49 cases of CHD and 128 of PDA were found. The prevalence of CHD was 13.2:1000 NB. The main reason for referral to the cardiologist was heart murmur in 256 (72% NB, of which 39 (15% had CHD, and in 91% of the 128 cases of PDA. In 14 (4% NB, the reason for referral was cyanosis, and eight of these patients (57% had a CHD. Heart failure was the reason for referral in 37 (10% NB, of whom 17 (46% had CHD. Arrhythmia, associated congenital malformations, or chromosome disorders were the reasons for referral in 14% of the cases. CONCLUSION: The main reason for referral was detection of a heart murmur on cardiac auscultation. Although cyanosis and heart failure were uncommon reasons for referral, their presence indicated a high probability of the diagnosis of heart disease. Pediatric screening plays a key role in this diagnosis.

  5. A Modern Method to Monitor Office Blood Pressure

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    Emiliya Khazan

    2017-10-01

    Full Text Available The diagnosis and management of hypertension relies on accurate and precise blood pressure (BP measurements and monitoring techniques. Variability in traditional office based BP readings can contribute to misclassification and potential misdiagnosis of hypertension, leading to inappropriate treatment and possibly avoidable adverse drug events. Both home blood pressure monitoring (HBPM and 24-hour ambulatory blood pressure monitoring (ABPM can improve characterization of BP status over traditional office values and can predict cardiovascular morbidity and mortality risk; however, they are limited by availability and/or practical use in many situations. Available in-office blood pressure measuring methods include manual auscultation, automated oscillometric, and automated office blood pressure (AOBP devices. A strong correlation exists between AOBP and awake ABPM measurements and has been linked to better prediction of end-organ damage and white coat response compared to standard office BP methods. While AOBP does not provide nocturnal BP readings, it can be utilized in several outpatient settings, and has the capability to decrease utilization of ABPM, white coat effect, and improve optimization of cardiovascular assessment, evaluation, and therapeutic assessment in clinical practice. Hypertension affects over 80 million adults in the United States (US and is a major risk factor for cardiovascular morbidity and mortality [1]. The condition’s ubiquitous nature and broad impact potentially makes understanding the diagnosis and treatment of hypertension key elements of managing cardiovascular risk. Though much attention is paid to the treatment of hypertension, from 2009 to 2012, 45.9% of US patients with hypertension were uncontrolled [1]. Appreciating the aspects of proper assessment of blood pressure is crucial and creates the foundation for approaching hypertension management. Until recently, hypertension was defined as an appropriately

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

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    Marchamalo, M.

    2010-09-01

    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

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

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    Leda Maria Tavares Alves

    2011-12-01

    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

  8. 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

    2008-03-01

    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

  9. Automatic adventitious respiratory sound analysis: A systematic review.

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    Renard Xaviero Adhi Pramono

    (11.69% on rhonchi, and 18 (23.38% on other sounds such as pleural rub, squawk, as well as the pathology. Instrumentation used to collect data included microphones, stethoscopes, and accelerometers. Several references obtained data from online repositories or book audio CD companions. Detection or classification methods used varied from empirically determined thresholds to more complex machine learning techniques. Performance reported in the surveyed works were converted to accuracy measures for data synthesis.Direct comparison of the performance of surveyed works cannot be performed as the input data used by each was different. A standard validation method has not been established, resulting in different works using different methods and performance measure definitions.A review of the literature was performed to summarise different analysis approaches, features, and methods used for the analysis. The performance of recent studies showed a high agreement with conventional non-automatic identification. This suggests that automated adventitious sound detection or classification is a promising solution to overcome the limitations of conventional auscultation and to assist in the monitoring of relevant diseases.

  10. 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

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    Marcela Maria Alves da Silva

    2011-03-01

    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.

  11. 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

    1971-03-01

    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.

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

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    Roselene Ecco

    2009-06-01

    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.

  13. Avaliação da qualidade da assistência ao parto normal Evaluation of the quality of care for normal delivery

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    Margareth Rocha Peixoto Giglio

    2011-10-01

    recommended practices. RESULTS: The Bologna score presented an average value of 1.04 (95%CI=0.9-1.1. The elective caesarian rate was 30%, the emergency caesarian rate was 10%, and the rate of induced childbirth was 1.6% The percentage of childbirths attended by health care professionals was 100%, but pediatricians in the delivery room were present only in 30% of the time. During labor, half of the women had no evaluation of the uterine dynamics and 29% had no auscultation fetal monitoring. The partogram was used for only 28.5% of the women, whereas the use of oxytocin was 45.8%. CONCLUSIONS: The results indicate a poor quality of childbirth care with low values of the Bologna score, high elective and emergency caesarians rates, a high number of unnecessary and potentially harmful interventions, and an insufficient frequency of beneficial interventions.

  14. 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

    2010-10-01

    : 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.

  15. Spontaneous Pneumomediastinum: Hamman Syndrome

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    Tushank Chadha, BS

    2018-04-01

    pneumomediastinum. Hamman’s sign, crepitus heard with auscultation of the chest, is understood to be a more specific indicator of pneumomediastinum.3,4 CT is the ideal diagnostic modality in order to most accurately determine the presence of free air in the mediastinum.3 For this patient, treatment involved symptom management and brief hospitalization for observation purposes. Typical standard of care encourages bed rest with limited physical activity and pain management sometimes also with oxygen administration, anti-anxiety drugs, and cough suppressants, all with the intent to decrease alveolar stress.3 While spontaneous pneumomediastinum may be a more benign condition when ultimately diagnosed, it is important to recognize and seriously consider the differential diagnosis for pneumomediastinum because it includes conditions that demand urgent diagnosis, workup and often definitive treatment. Topics: Pneumomediastinum, Hamman’s syndrome, gastric cancer, computerized tomography

  16. Procedures for measuring and verifying gastric tube placement in newborns: an integrative review.

    Science.gov (United States)

    Dias, Flávia de Souza Barbosa; Emidio, Suellen Cristina Dias; Lopes, Maria Helena Baena de Moraes; Shimo, Antonieta Keiko Kakuda; Beck, Ana Raquel Medeiros; Carmona, Elenice Valentim

    2017-07-10

    to investigate evidence in the literature on procedures for measuring gastric tube insertion in newborns and verifying its placement, using alternative procedures to radiological examination. an integrative review of the literature carried out in the Cochrane, LILACS, CINAHL, EMBASE, MEDLINE and Scopus databases using the descriptors "Intubation, gastrointestinal" and "newborns" in original articles. seventeen publications were included and categorized as "measuring method" or "technique for verifying placement". Regarding measuring methods, the measurements of two morphological distances and the application of two formulas, one based on weight and another based on height, were found. Regarding the techniques for assessing placement, the following were found: electromagnetic tracing, diaphragm electrical activity, CO2 detection, indigo carmine solution, epigastrium auscultation, gastric secretion aspiration, color inspection, and evaluation of pH, enzymes and bilirubin. the measuring method using nose to earlobe to a point midway between the xiphoid process and the umbilicus measurement presents the best evidence. Equations based on weight and height need to be experimentally tested. The return of secretion into the tube aspiration, color assessment and secretion pH are reliable indicators to identify gastric tube placement, and are the currently indicated techniques. investigar, na literatura, evidências sobre procedimentos de mensuração da sonda gástrica em recém-nascidos e de verificação do seu posicionamento, procedimentos alternativos ao exame radiológico. revisão integrativa da literatura nas bases Biblioteca Cochrane, LILACS, CINAHL, EMBASE, MEDLINE e Scopus, utilizando os descritores "intubação gastrointestinal" e "recém-nascido" em artigos originais. dezessete publicações foram incluídas e categorizadas em "método de mensuração" ou "técnica de verificação do posicionamento". Como métodos de mensuração, foram encontrados os de tomada

  17. Efficacy and tolerability of myrtol standardized in acute bronchitis. A multi-centre, randomised, double-blind, placebo-controlled parallel group clinical trial vs. cefuroxime and ambroxol.

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    Matthys, H; de Mey, C; Carls, C; Ryś, A; Geib, A; Wittig, T

    2000-08-01

    Myrtol standardized (Gelomyrtol forte) is a phytotherapeutic extract (distillate) consisting mainly of three monoterpenes: (+)alpha-pinene, d-limonene and 1,8-cineole. This study describes and compares the efficacy, safety and tolerability of a 2-week treatment with myrtol stand. (4 x 300 mg, day 1-14), cefuroxime (CAS 55268-75-2) (2 x 250 mg daily for day 1-6), ambroxol (CAS 18683-91-5) (3 x 30 mg for day 1-3, 2 x 30 mg for days 4-14) and matched placebo in acute bronchitis. 676 male and female outpatients, aged > or = 18 years, with acute bronchitis of recent onset (within last 5 days), with an FEV1 > 75% of the normal EGKS-value and without evidence or suspicion of chronic pulmonary disease or any further confounding illness were included in the study. Patients were randomly assigned to a 2-week treatment course with either myrtol stand. (N = 170), cefuroxime (N = 171), ambroxol (N = 163) or placebo (N = 172) in a double-blind, placebo-matched, parallel-group fashion. Evaluations were at baseline (visit 1), after 1 and 2 weeks of treatment (visits 2 and 3) and at 2 weeks after conclusion of the treatments (visit 4). Responder- and non-responder rates (primary), signs (abnormal auscultation), symptoms (daily diary data on nightly cough, coughing fits during the day, sputum consistence and general well-being; visit data on bronchial hyperreactivity and absence/presence of associated symptoms), FEV1, overall efficacy, absence of relapse, safety and tolerability (adverse events, laboratory screens, vital signs and physical examination). Criteria were evaluated for the intention-to-treat data-set (ITT) and the 'efficacy evaluable' sample (EAP), i.e. excluding patients with missing values (incl. discontinued non-responders and drop-outs for other reasons) at the time of assessment. The signs and symptoms of acute bronchitis regressed readily in all treatment groups, but regression was slower and less complete in the patients treated with placebo. In patients treated

  18. 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

    2013-01-01

    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

  19. 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

    2012-01-01

    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

  20. MONITORING OF LARGE INSTABLE AREAS: system reliability and new tools.

    Science.gov (United States)

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

    2009-04-01

    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

  1. 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

    2005-06-01

    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

  2. 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

    2013-02-01

    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.

  3. Interferon therapy of acute respiratory viral infections in children

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    A.E. Abaturov

    2017-04-01

    Full Text Available The purpose of our study was to evaluate the efficacy and tolerability of nasal spray Laferobionum® (100,000 IU/ml in children with acute respiratory viral infections. Materials and methods. The study included 84 children aged 12 to 18 years. Children of the main group (42 persons received Laferobionum® spray in addition to the standard treatment for acute respiratory viral infections. The drug was administered to children of 12–14 years for 2 spray doses in each nasal passage 4–5 times a day at regular intervals (with the exception of sleep time, children aged 14–18 years received 3 spray-doses per each nasal passage 5–6 times a day at regular intervals (excluding sleep time. The course of treatment for all subjects was 5 days. Children of the control group received standard treatment for acute respiratory viral infections without Laferobionum®. Objective research included: auscultation of the heart and lungs, examination of the skin and mucous membranes, measurement of heart rate, blood pressure and body temperature. All patients underwent a general blood test, a general urinalysis, identification of the pathogen using the method of direct immunofluorescence (in smears taken from the nasal passages in the laboratory “Medical Diagnostic Center of Dnipropetrovsk Medical Academy”. Results. In the non-epidemic period, the respiratory syncytial virus and adenoviruses were the leading viral pathogens of acute respiratory viral infections. The main clinical manifestations of acute respiratory viral infection in the observed patients were signs of general inflammatory and catarrhal syndromes. All patients had not severe course of the disease. The data of the physical examination performed before the beginning of treatment indicated the absence of clinically significant deviations from the cardiovascular system in the children of the main and control groups. Arterial blood pressure and heart rate in the subjects of both groups were

  4. Normotensos com resposta pressórica exagerada ao exercício possuem tônus vagal cardíaco aumentado Normotensos con respuesta presora exagerada al ejercicio poseen tono vagal cardíaco aumentado Normotensive individuals with exaggerated exercise blood pressure response have increased cardiac vagal tone

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    Plínio Santos Ramos

    2010-07-01

    (cardiac vagal tone and cardiopulmonary exercise test (CPET performed in a cycle-ergometer, with BP measurements being taken every minute through auscultation. Based on the maximum SBP value obtained at the CPET, the sample was divided in tertiles, comparing CVT, maximum workload and VO2 max. RESULTS: The CVT results differed between individuals in the lower tertile and upper tertile for the SBP response to the CPET, respectively: 1.57 ± 0.03 and 1.65 ± 0.04 (mean ± standard error of mean (p = 0.014. The two tertiles also differed regarding the VO2 max (40.7 ± 1.3 vs 46.4 ± 1.3 ml/kg-1.min-1; p = 0.013 and the maximum workload (206 ± 6.3 vs 275 ± 8.7 watts; p < 0.001. CONCLUSIOn: An increased BP response during the CPET in healthy adult males is accompanied by indicators of good clinical prognosis, including higher levels of aerobic fitness and cardiac vagal tone.

  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

    2007-04-01

    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. Twenty-Four-Hour Ambulatory Blood Pressure Monitoring in Hypertension

    Science.gov (United States)

    2012-01-01

    Executive Summary Objective The objective of this health technology assessment was to determine the clinical effectiveness and cost-effectiveness of 24-hour ambulatory blood pressure monitoring (ABPM) for hypertension. Clinical Need: Condition and Target Population Hypertension occurs when either systolic blood pressure, the pressure in the artery when the heart contracts, or diastolic blood pressure, the pressure in the artery when the heart relaxes between beats, are consistently high. Blood pressure (BP) that is consistently more than 140/90 mmHg (systolic/diastolic) is considered high. A lower threshold, greater than 130/80 mmHg (systolic/diastolic), is set for individuals with diabetes or chronic kidney disease. In 2006 and 2007, the age-standardized incidence rate of diagnosed hypertension in Canada was 25.8 per 1,000 (450,000 individuals were newly diagnosed). During the same time period, 22.7% of adult Canadians were living with diagnosed hypertension. A smaller proportion of Canadians are unaware they have hypertension; therefore, the estimated number of Canadians affected by this disease may be higher. Diagnosis and management of hypertension are important, since elevated BP levels are related to the risk of cardiovascular disease, including stroke. In Canada in 2003, the costs to the health care system related to the diagnosis, treatment, and management of hypertension were over $2.3 billion (Cdn). Technology The 24-hour ABPM device consists of a standard inflatable cuff attached to a small computer weighing about 500 grams, which is worn over the shoulder or on a belt. The technology is noninvasive and fully automated. The device takes BP measurements every 15 to 30 minutes over a 24-to 28-hour time period, thus providing extended, continuous BP recordings even during a patient’s normal daily activities. Information on the multiple BP measurements can be downloaded to a computer. The main detection methods used by the device are auscultation and

  7. 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

    2008-02-01

    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.

  8. Guidelines for the Management of a Pregnant Trauma Patient.

    Science.gov (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

    2015-06-01

    in the trauma unit or emergency room to rule out major injuries. (III-C) Evaluation of a pregnant trauma patient in the emergency room 12. In cases of major trauma, the assessment, stabilization, and care of the pregnant women is the first priority; then, if the fetus is viable (≥ 23 weeks), fetal heart rate auscultation and fetal monitoring can be initiated and an obstetrical consultation obtained as soon as feasible. (II-3B) 13. In pregnant women with a viable fetus (≥ 23 weeks) and suspected uterine contractions, placental abruption, or traumatic uterine rupture, urgent obstetrical consultation is recommended. (II-3B) 14. In cases of vaginal bleeding at or after 23 weeks, speculum or digital vaginal examination should be deferred until placenta previa is excluded by a prior or current ultrasound scan. (III-C) Adjunctive tests for maternal assessment 15. Radiographic studies indicated for maternal evaluation including abdominal computed tomography should not be deferred or delayed due to concerns regarding fetal exposure to radiation. (II-2B) 16. Use of gadolinium-based contrast agents can be considered when maternal benefit outweighs potential fetal risks. (III-C) 17. In addition to the routine blood tests, a pregnant trauma patient should have a coagulation panel including fibrinogen. (III-C) 18. Focused abdominal sonography for trauma should be considered for detection of intraperitoneal bleeding in pregnant trauma patients. (II-3B) 19. Abdominal computed tomography may be considered as an alternative to diagnostic peritoneal lavage or open lavage when intra-abdominal bleeding is suspected. (III-C) Fetal assessment 20. All pregnant trauma patients with a viable pregnancy (≥ 23 weeks) should undergo electronic fetal monitoring for at least 4 hours. (II-3B) 21. Pregnant trauma patients (≥ 23 weeks) with adverse factors including uterine tenderness, significant abdominal pain, vaginal bleeding, sustained contractions (> 1/10 min), rupture of the membranes

  9. Antenatal and intrapartum interventions for preventing cerebral palsy: an overview of Cochrane systematic reviews.

    Science.gov (United States)

    Shepherd, Emily; Salam, Rehana A; Middleton, Philippa; Makrides, Maria; McIntyre, Sarah; Badawi, Nadia; Crowther, Caroline A

    2017-08-08

    evidence ranged from very low to high. Effective interventions: high-quality evidence of effectiveness There was a reduction in cerebral palsy in children born to women at risk of preterm birth who received magnesium sulphate for neuroprotection of the fetus compared with placebo (risk ratio (RR) 0.68, 95% confidence interval (CI) 0.54 to 0.87; five RCTs; 6145 children). Probably ineffective interventions: moderate-quality evidence of harm There was an increase in cerebral palsy in children born to mothers in preterm labour with intact membranes who received any prophylactic antibiotics versus no antibiotics (RR 1.82, 95% CI 0.99 to 3.34; one RCT; 3173 children). There was an increase in cerebral palsy in children, who as preterm babies with suspected fetal compromise, were born immediately compared with those for whom birth was deferred (RR 5.88, 95% CI 1.33 to 26.02; one RCT; 507 children). Probably ineffective interventions: moderate-quality evidence of lack of effectiveness There was no clear difference in the presence of cerebral palsy in children born to women at risk of preterm birth who received repeat doses of corticosteroids compared with a single course (RR 1.03, 95% CI 0.71 to 1.50; four RCTs; 3800 children). No conclusions possible: low- to very low-quality evidence Low-quality evidence found there was a possible reduction in cerebral palsy for children born to women at risk of preterm birth who received antenatal corticosteroids for accelerating fetal lung maturation compared with placebo (RR 0.60, 95% CI 0.34 to 1.03; five RCTs; 904 children). There was no clear difference in the presence of cerebral palsy with interventionist care for severe pre-eclampsia versus expectant care (RR 6.01, 95% CI 0.75 to 48.14; one RCT; 262 children); magnesium sulphate for pre-eclampsia versus placebo (RR 0.34, 95% CI 0.09 to 1.26; one RCT; 2895 children); continuous cardiotocography for fetal assessment during labour versus intermittent auscultation (average RR 1.75, 95% CI

  10. 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

    2004-12-01

    % 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.

  11. 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

    2004-08-01

    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.