WorldWideScience

Sample records for auscultation

  1. Physicians' Abdominal Auscultation

    DEFF Research Database (Denmark)

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

    1998-01-01

    Background: Abdominal auscultation has an important position in the physical examination of the abdomen. Little is known about rater agreement. The aim of this study was to describe rater agreement and thus, indirectly, the value of the examination. Methods: In a semi-virtual setup 12 recordings...

  2. Auscultation of the respiratory system

    OpenAIRE

    2015-01-01

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

  3. Hybrid High-Fidelity Auscultation Scope Project

    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...

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

    Science.gov (United States)

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

    2006-12-01

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

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

    Science.gov (United States)

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

    2006-12-01

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

  6. Auscultation of the Chest and Abdomen by Athletic Trainers.

    Science.gov (United States)

    McChesney, John A.; McChesney, John W.

    2001-06-01

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

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

    DEFF Research Database (Denmark)

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

    2011-01-01

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

  8. Tele-auscultation support system with mixed reality navigation.

    Science.gov (United States)

    Hori, Kenta; Uchida, Yusuke; Kan, Tsukasa; Minami, Maya; Naito, Chisako; Kuroda, Tomohiro; Takahashi, Hideya; Ando, Masahiko; Kawamura, Takashi; Kume, Naoto; Okamoto, Kazuya; Takemura, Tadamasa; Yoshihara, Hiroyuki

    2013-01-01

    The aim of this research is to develop an information support system for tele-auscultation. In auscultation, a doctor requires to understand condition of applying a stethoscope, in addition to auscultatory sounds. The proposed system includes intuitive navigation system of stethoscope operation, in addition to conventional audio streaming system of auscultatory sounds and conventional video conferencing system for telecommunication. Mixed reality technology is applied for intuitive navigation of the stethoscope. Information, such as position, contact condition and breath, is overlaid on a view of the patient's chest. The contact condition of the stethoscope is measured by e-textile contact sensors. The breath is measured by a band type breath sensor. In a simulated tele-auscultation experiment, the stethoscope with the contact sensors and the breath sensor were evaluated. The results show that the presentation of the contact condition was not understandable enough for navigating the stethoscope handling. The time series of the breath phases was usable for the remote doctor to understand the breath condition of the patient. PMID:24110770

  9. 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…

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

    DEFF Research Database (Denmark)

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

    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...

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

    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...

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

    Science.gov (United States)

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

    2016-07-01

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

  13. 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...

  14. A quality assessment of respiratory auscultation material on YouTube.

    Science.gov (United States)

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

    2014-08-01

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

  15. A COMPARATIVE STUDY OF PERINATAL OUTCOME IN LOW RISK PREGNANCIES WITH CTG MONITORING AND INTERMITTENT AUSCULTATION

    Directory of Open Access Journals (Sweden)

    Velimala Ratna

    2015-12-01

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

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

    Institute of Scientific and Technical Information of China (English)

    牛海军; 冯安吉; 万明习; 白培瑞

    2003-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    OpenAIRE

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

    2014-01-01

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

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

    Science.gov (United States)

    Sholapurkar, Shashikant L

    2015-12-01

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

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

    Directory of Open Access Journals (Sweden)

    ARTIERES, Olivier ; BRIANÇON, Laurent ; ROBINET, Alain

    2012-08-01

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

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

    Science.gov (United States)

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

    2002-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ana Maria Furkim

    2009-12-01

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

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

    Institute of Scientific and Technical Information of China (English)

    路荣杰

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    解良勤; 刘彦刚

    2012-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张庆苏; 柴本勇

    2012-01-01

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

  6. 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

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

    Institute of Scientific and Technical Information of China (English)

    刘朝辉; 冯国军; 梁坤; 张佼

    2015-01-01

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

  8. 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

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

    NARCIS (Netherlands)

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

    1996-01-01

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

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

    NARCIS (Netherlands)

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

    1999-01-01

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

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

    Science.gov (United States)

    Giroux, Bernard

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

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

    Science.gov (United States)

    Kaouane, Carole

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

  13. 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…

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

    Institute of Scientific and Technical Information of China (English)

    董文军

    2008-01-01

    闻珍在望闻问切四诊中占有重要位置,以"闻而知之谓之圣"位居第二.五音闻诊在四诊中具有重要意义,古籍中对五音对应五藏和五方四时,正常五音和病变五音等都有详细论述,五音闻诊是一个较完整的诊断方法体系.

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

    Institute of Scientific and Technical Information of China (English)

    潘明九; 王颖

    2007-01-01

    借鉴中医诊断的经验,运用"望闻问切"法进行变压器故障信息获取和故障诊断具有简单直观、便于操作、信息全面、费用低廉、针对性强的优点.该文结合收集总结的部分经验知识,介绍了"望闻问切"法在变压器故障诊断方面的应用,希望对相关人员有所帮助.

  16. The electronic stethoscope

    OpenAIRE

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

    2015-01-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

    Anon.

    2004-07-01

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

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

    Directory of Open Access Journals (Sweden)

    Mr. R. OBAD

    2014-12-01

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

  19. 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.

  20. Laser Stethoscope for Use in Noisy Spacecraft Environments Project

    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...

  1. 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

  2. Esophageal rupture due to Sengstaken-Blakemore tube misplacement

    Institute of Scientific and Technical Information of China (English)

    Chee-Fah Chong

    2005-01-01

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

  3. [Normal and Adventitious Breath Sounds].

    Science.gov (United States)

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

    2016-06-01

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

  4. The electronic stethoscope.

    Science.gov (United States)

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

    2015-01-01

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

  5. 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…

  6. 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...

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

    Science.gov (United States)

    White, Pam

    2009-04-01

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

  8. 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.

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

    Energy Technology Data Exchange (ETDEWEB)

    Garrido Garcia, J.; Sarti Fernandez, F.

    2012-07-01

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

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

    NARCIS (Netherlands)

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

    2010-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Jovan Lovrenski

    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.

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

    Directory of Open Access Journals (Sweden)

    Kim Hyung

    2012-06-01

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

  13. Atrial Fibrillation in a Diarrheic Holstein Dairy Calf

    Directory of Open Access Journals (Sweden)

    Aliasghar CHALMEH

    2015-01-01

    Full Text Available Cardiac auscultation of a 10-day-old diarrheic female Holstein dairy calf revealed irregularities in rhythm and absence of 4th heart sound. Electrocardiogram (ECG and blood sample were obtained before and after the treatment. Based on ECG and cardiac auscultation findings, atrial fibrillation (AF was diagnosed. Serum sodium, calcium and magnesium before treatment were significantly lower than their reference ranges and potassium was significantly higher. One day after treating this patient, serum electrolytes were reached to reference ranges and AF was changed to normal sinus rhythm. Based on resolving the AF after treating the patient and correcting the electrolyte imbalances, it can be suggested that electrolyte imbalances were the main cause of the occurrence of AF in the present case.

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

    Directory of Open Access Journals (Sweden)

    M.S. Ahmad

    2014-07-01

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

  15. 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 effect of an adult-oriented, creative, yet practical method for teaching auscultation. PMID:22916626

  16. Subcutaneous Emphysema and Pneumomediastinum after Inhaling Pepper Spray

    OpenAIRE

    Woussen, Sofie; Lemmerling, Marc; Verstraeten, André

    2016-01-01

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

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

    International Nuclear Information System (INIS)

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

    OpenAIRE

    Aya Nakamura; Satoshi Imaizumi

    2013-01-01

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

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

    OpenAIRE

    Kohno, Nobuoki

    1999-01-01

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

  20. Mounier-Kuhn Syndrome

    OpenAIRE

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

    2015-01-01

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

  1. Popliteal Artery Pseudoaneurysm Following Primary Total Knee Arthroplasty

    OpenAIRE

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

    2014-01-01

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

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

    OpenAIRE

    Grmec, S; Mally, S

    2004-01-01

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

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

    OpenAIRE

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

    2014-01-01

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

  4. Monitorování stavu plodu během porodu porodní asistentkou

    OpenAIRE

    Svobodová, Jana

    2013-01-01

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

  5. Frequency shifting approach towards textual transcription of heartbeat sounds

    OpenAIRE

    Safar Khorasani Ehsan; Doraisamy Shyamala; Arvin Farshad

    2011-01-01

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

  6. Cardiac abnormalities in the fragile X syndrome.

    OpenAIRE

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

    1989-01-01

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

  7. 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?

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

    Energy Technology Data Exchange (ETDEWEB)

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

    2005-05-15

    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)

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

    OpenAIRE

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

    2014-01-01

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

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

    OpenAIRE

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

    2012-01-01

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

  11. 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.

  12. Acoustic cardiac signals analysis: a Kalman filter-based approach.

    Science.gov (United States)

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

    2012-01-01

    Auscultation of the heart is accompanied by both electrical activity and sound. Heart auscultation provides clues to diagnose many cardiac abnormalities. Unfortunately, detection of relevant symptoms and diagnosis based on heart sound through a stethoscope is difficult. The reason GPs find this difficult is that the heart sounds are of short duration and separated from one another by less than 30 ms. In addition, the cost of false positives constitutes wasted time and emotional anxiety for both patient and GP. Many heart diseases cause changes in heart sound, waveform, and additional murmurs before other signs and symptoms appear. Heart-sound auscultation is the primary test conducted by GPs. These sounds are generated primarily by turbulent flow of blood in the heart. Analysis of heart sounds requires a quiet environment with minimum ambient noise. In order to address such issues, the technique of denoising and estimating the biomedical heart signal is proposed in this investigation. Normally, the performance of the filter naturally depends on prior information related to the statistical properties of the signal and the background noise. This paper proposes Kalman filtering for denoising statistical heart sound. The cycles of heart sounds are certain to follow first-order Gauss-Markov process. These cycles are observed with additional noise for the given measurement. The model is formulated into state-space form to enable use of a Kalman filter to estimate the clean cycles of heart sounds. The estimates obtained by Kalman filtering are optimal in mean squared sense. PMID:22745550

  13. PREDICTIVE VALUE OF CTG IN POST-DATED PREGNANCY

    Directory of Open Access Journals (Sweden)

    Suganthi

    2016-05-01

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

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

    Science.gov (United States)

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

    2012-01-01

    Auscultation of the heart is accompanied by both electrical activity and sound. Heart auscultation provides clues to diagnose many cardiac abnormalities. Unfortunately, detection of relevant symptoms and diagnosis based on heart sound through a stethoscope is difficult. The reason GPs find this difficult is that the heart sounds are of short duration and separated from one another by less than 30 ms. In addition, the cost of false positives constitutes wasted time and emotional anxiety for both patient and GP. Many heart diseases cause changes in heart sound, waveform, and additional murmurs before other signs and symptoms appear. Heart-sound auscultation is the primary test conducted by GPs. These sounds are generated primarily by turbulent flow of blood in the heart. Analysis of heart sounds requires a quiet environment with minimum ambient noise. In order to address such issues, the technique of denoising and estimating the biomedical heart signal is proposed in this investigation. Normally, the performance of the filter naturally depends on prior information related to the statistical properties of the signal and the background noise. This paper proposes Kalman filtering for denoising statistical heart sound. The cycles of heart sounds are certain to follow first-order Gauss-Markov process. These cycles are observed with additional noise for the given measurement. The model is formulated into state-space form to enable use of a Kalman filter to estimate the clean cycles of heart sounds. The estimates obtained by Kalman filtering are optimal in mean squared sense.

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

    Science.gov (United States)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    ADELMIR SOUZA-MACHADO

    2001-07-01

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

  17. Evolution de la déflexion observée sur les chaussées souples modernes

    OpenAIRE

    LEPERT, P

    2006-01-01

    La mesure de deflexion a conservé un rôle important dans les campagnes d'auscultation et de suvi des chaussées. Or, bien qu'ayant fait l'objet d'études multiples, la question de l'évolution de la déflexion sur les chaussées modernes reste ouverte. Cette question est abordée avec des moyens statistiques en utilisant les nombreuses observations recueillies sur ces chaussées depuis plus de dix ans. L'analyse porte sur une population de 1 680 sections dites souples, c'est-à-dire essentiellement à...

  18. [Sonography in pleural effusion of horses].

    Science.gov (United States)

    Stadtbäumer, G

    1989-01-01

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

  19. Remote auscultatory patient monitoring during magnetic resonance imaging

    DEFF Research Database (Denmark)

    Henneberg, S; Hök, B; Wiklund, L;

    1992-01-01

    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...... 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...

  20. 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.

  1. HW 02-1 IS IT THE END OF A LONG AND PRODUCTIVE ERA?: THE FUTURE OF THE MERCURY SPHYGMOMANOMETER AND THE STETHOSCOPE.

    Science.gov (United States)

    Shin, Jinho

    2016-09-01

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

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

    Energy Technology Data Exchange (ETDEWEB)

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

    1989-07-01

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

  3. Best evidence: nasogastric tube placement verification.

    Science.gov (United States)

    Longo, M Anne

    2011-08-01

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

  4. A computational model of cardiovascular physiology and heart sound generation.

    Science.gov (United States)

    Watrous, Raymond L

    2009-01-01

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

  5. Dispne Etyolojisinde Nadiren Karşılaşılan Bir Etken: TİMİK KİST

    OpenAIRE

    YILMAN, M.; KOLBAKIR, F.; KEÇELİGİL, H.T.; ERK, M.K.

    2010-01-01

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

  6. Opphavet til og distribusjonen av normale lungelyder

    OpenAIRE

    2005-01-01

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

  7. 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.

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

    Science.gov (United States)

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

    2016-01-01

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

  9. 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.

  10. Práticas de Inclusão de Alunos com perturbações do espetro do autismo

    OpenAIRE

    Lourenço, Dídia; Leite, Teresa

    2015-01-01

    Este artigo surge no âmbito de um estudo mais vasto que tem como principal objetivo identificar as Necessidades de Formação dos Docentes de Ensino Regular e de Educação Especial para a inclusão de alunos com Perturbações do Espetro do Autismo (PEA) nas escolas do ensino regular. Para a realização desse estudo, realizámos observações diretas em sala de aula e auscultámos os vários agentes educativos que podem contribuir para a inclusão efetiva destes alunos, nomeadamente os docentes de ensino ...

  11. 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.

  12. Multiple pulmonary rheumatoid nodules.

    Science.gov (United States)

    Sargin, Gokhan; Senturk, Taskin

    2015-01-01

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

  13. 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.

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

    Science.gov (United States)

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

    2015-11-01

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

  15. 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

  16. 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.

  17. 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. PMID:24109851

  18. 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.

  19. 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

  20. 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.

  1. Management of a Patient With Faciocervical Burns and Inhalational Injury Due to Hydrofluoric Acid Exposure.

    Science.gov (United States)

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

    2014-05-01

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

  2. Thoracic and abdominal blastomycosis in a horse.

    Science.gov (United States)

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

    1999-05-01

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

  3. 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.

  4. 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.

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

    Institute of Scientific and Technical Information of China (English)

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

    2015-01-01

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

  6. Design of wireless electronic stethoscope based on zigbee

    CERN Document Server

    Patil, D D Kadam

    2012-01-01

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

  7. Acute Psychosis as Major Clinical Presentation of Legionnaires' Disease.

    Science.gov (United States)

    Coentre, Ricardo; Silva-Dos-Santos, Amílcar; Talina, Miguel Cotrim

    2016-01-01

    We report a case of a 61-year-old woman who presented with acute psychosis as a major manifestation of Legionnaires' disease in the absence of other neuropsychiatric symptoms. Clinical history revealed dry cough and nausea. Observation showed fever and auscultation crackles in the lower lobe of the right lung. Laboratory testing demonstrated elevated C-reactive protein and lung chest radiograph showed patchy peribronchial and right lower lobe consolidation. Soon after admission, she started producing purulent sputum. Epidemiological data suggested Legionella pneumophila as possible cause of the clinical picture that was confirmed by urinary antigen detection and polymerase chain reaction of the sputum. She was treated with levofloxacin 750 mg/day for 10 days with complete remission of pulmonary and psychiatric symptoms. She has not had further psychotic symptoms. PMID:27547478

  8. 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. PMID:25391395

  9. [A case of acute disseminated pneumomycosis in a cow].

    Science.gov (United States)

    Pusterla, N; Ossent, P; Braun, U

    1996-01-01

    The case of a five year old Swiss Braunvieh cow suffering from an acute disseminated mycotic pneumonia caused by an Aspergillus fumigatus infection is presented. The animal had calved one month previously and was admitted to the clinic because of recurrent fever. Clinical findings included a reduced general condition, a rectal temperature of 40.6 degrees C, an increased respiratory rate, coughing and serous nasal discharge. On auscultation increased bronchovesicular sounds and moist rales could be heard. Radiographs of the thorax showed a diffuse interstitial nodular pattern throughout the lung. The cow had to be slaughtered in spite of intensive therapy. Necropsy showed multiple nodules measuring up to 4 mm in diameter covering the entire surface of the lungs. Histology revealed an acute disseminated necrotising bronchopneumonia containing numerous branched, septate fungal hyphae identified as Aspergillus fumigatus. A primary aerogenous infection caused by inhalation of spores originating from mouldy hay or soil was suspected.

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

    Institute of Scientific and Technical Information of China (English)

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

    2013-01-01

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

  11. French influence on the development of medicine in Louisiana.

    Science.gov (United States)

    Duffy, J

    1990-01-01

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

  12. Electronic stethoscope with frequency shaping and infrasonic recording capabilities.

    Science.gov (United States)

    Gordon, E S; Lagerwerff, J M

    1976-03-01

    A small electronic stethoscope with variable frequency response characteristics has been developed for aerospace and research applications. The system includes a specially designed piezoelectric pickup and amplifier with an overall frequency response from 0.7 to 5,000 HZ (-3 dB points) and selective bass and treble boost or cut of up to 15 dB. A steep slope, high pass filter can be switched in for ordinary clinical auscultation without overload distortion from strong infrasonic signal inputs. A commercial stethoscope-type headset, selected for best overall response, is used which can adequately handle up to 100 mW of audio power delivered from the amplifier. The active components of the amplifier consist of only four opamp-type integrated circuits. PMID:1244193

  13. [The Use of a Tracheal Tube for Guiding Nasogastric Tube Insertion].

    Science.gov (United States)

    Saima, Shunsuke; Asai, Takashi; Okuda, Yasuhisa

    2016-04-01

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

  14. Shone's complex with dextrocardia and situs inversus totalis: a case report.

    Science.gov (United States)

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

    2012-10-01

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

  15. 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.

  16. Lung herniation: an uncommon presentation of Poland's syndrome in a neonate at birth.

    Science.gov (United States)

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

    2013-08-06

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

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

    Science.gov (United States)

    Dabbagh, Ali; Bolourian, Ali Asghar

    2011-01-01

    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.

  18. A diagnostic challenge of an unusual presentation of pneumomediastinum

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

  19. A diagnostic challenge of an unusual presentation of pneumomediastinum

    Directory of Open Access Journals (Sweden)

    Hatamabadi Hamid Reza

    2014-02-01

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

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

    Directory of Open Access Journals (Sweden)

    Carlan Wendler

    2012-12-01

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

  1. Temporomandibular joint sounds: a critique of techniques for recording and analysis.

    Science.gov (United States)

    Widmer, C G

    1989-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ricardo Coentre

    2016-01-01

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

  3. LAPAROSCOPIC GASTROPEXY FOR CORRECTION OF A HIATAL HERNIA IN A NORTHERN ELEPHANT SEAL (MIROUNGA ANGUSTIROSTRIS).

    Science.gov (United States)

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

    2015-06-01

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

  4. Auscultatory versus oscillometric measurement of blood pressure in octogenarians

    DEFF Research Database (Denmark)

    Pedersen, Sidsel Arnspang

    2012-01-01

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

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

    Science.gov (United States)

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

    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

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

    International Nuclear Information System (INIS)

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

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

    Science.gov (United States)

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

    2011-10-04

    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.

  8. 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.

  9. Acoustic heart. Interpretation of Phonocardiograms by computer

    International Nuclear Information System (INIS)

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

  10. Lymphoma and broncho-pneumonia in a calf

    International Nuclear Information System (INIS)

    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

  11. 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.

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

    Science.gov (United States)

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

    2014-10-01

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

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

    Science.gov (United States)

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

    2012-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Sun Xiaobo

    2002-12-01

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

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

    International Nuclear Information System (INIS)

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

  16. Use of a respiratory clinical score among different providers.

    Science.gov (United States)

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

    2004-03-01

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

  17. 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.

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

    Institute of Scientific and Technical Information of China (English)

    张宇; 金亚明; 王忆勤

    2013-01-01

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

  19. Computer-aided diagnosis of knee-joint disorders via vibroarthrographic signal analysis: a review.

    Science.gov (United States)

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

    2010-01-01

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

  20. 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.

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

    Institute of Scientific and Technical Information of China (English)

    Arthur de Sá Ferreira

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Cibele Fontoura Cagliari

    2009-10-01

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

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

    Institute of Scientific and Technical Information of China (English)

    张迪

    2015-01-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    International Nuclear Information System (INIS)

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

  6. Resistencia del hormigón en estructuras terminadas

    Directory of Open Access Journals (Sweden)

    Tobío, J. M.

    1968-09-01

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

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

    Science.gov (United States)

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

    1994-07-01

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

  8. Brucella endocarditis in a non-endemic area presenting as pyrexia of unknown origin

    Science.gov (United States)

    Manade, Vivek Vilas; Kakrani, Arjun; Gadage, Siddharth Narayan; Misra, Rabindra

    2014-01-01

    A 67-year-old man with type 2 diabetes mellitus and hypertension since 7 years presented with a 3-month history of low-grade fever and malaise. Cardiac auscultation revealed the presence of an ejection systolic murmur in the primary aortic area. Most of the investigations for febrile illness were reported normal. His two-dimensional (2D) echocardiogram revealed a calcified aortic valve with mild aortic stenosis. In view of the prolonged fever and calcified aortic valve with mild aortic stenosis, a transoesophageal echocardiogram was performed, which showed small vegetation noted on right coronary cusp about 2.2 mm with free independent mobility. Blood culture was positive for Brucella spp from all the three venepuncture sites. Medical therapy for brucellosis was given with ciprofloxacin, doxycycline, co-trimoxazole and streptomycin, resulting in complete recovery. Brucella endocarditis is a rare, mostly ignored and missed clinical infection. It requires a high index of clinical suspicion for prompt diagnosis and treatment. PMID:25239983

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

    Directory of Open Access Journals (Sweden)

    Nusbaumer Charly

    2007-03-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

    D. Prakash

    2013-05-01

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

  12. November 2015 critical care case of the month

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    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 ...

  13. Spontaneous Pneumomediastinum with a Rare Presentation

    Directory of Open Access Journals (Sweden)

    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.

  14. 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.

  15. PSEUDOANEURYSM OF INTERNAL ILIAC ARTERY

    Directory of Open Access Journals (Sweden)

    Seema Khanna

    2014-04-01

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

  16. [NASO-OROGASTRIC TUBE IN PAEDIATRIC PATIENTS. REVIEW OF METHODS OF CONFIRMATION OF PLACEMENT].

    Science.gov (United States)

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

    2014-09-01

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

  17. 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.

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

    Directory of Open Access Journals (Sweden)

    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. Mainstream time-capnography: an aid to select an appropriate uncuffed endotracheal tube in small children.

    Science.gov (United States)

    Neema, Praveen Kumar; Jayant, Aveek; Sethuraman, Manikandan; Rathod, Ramesh C

    2008-12-01

    Uncuffed endotracheal tubes are commonly used in children in an attempt to decrease the potential for pressure induced tracheal injury. However, uncuffed endotracheal tube may increase the risk of aspiration and lead to erratic delivery of preset tidal volume during mechanical ventilation. Therefore, it is desirable to intubate trachea with an appropriate but not an oversized endotracheal tube. In children, for selecting an endotracheal tube, a variety of formulas and techniques are used to find the endotracheal tube size that minimizes both pressure induced tracheal injury and aspiration potential or variable ventilation. Air-leak following tracheal intubation can be recognized by the presence of audible leak, by auscultation over the trachea, by palpation over the trachea and by observing effects of positive end-expiratory pressure on inspiratory expiratory tidal volume difference during mechanical ventilation. We describe mainstream time-capnograph as an aid to recognize leak around the endotracheal tube and its utility to determine appropriate endotracheal tube size in small children. PMID:19083104

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

    Science.gov (United States)

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

    2012-01-01

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

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

    Directory of Open Access Journals (Sweden)

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

    Science.gov (United States)

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

    2015-05-01

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

  3. Spontaneous pneumomediastinum with a rare presentation.

    Science.gov (United States)

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

    2014-01-01

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

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

    Science.gov (United States)

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

    2016-04-01

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

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

    Directory of Open Access Journals (Sweden)

    Anitha Kumari Abbina

    2013-04-01

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

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

    Science.gov (United States)

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

    2015-01-01

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

  7. 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.

  8. 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. PMID:25027011

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

    Directory of Open Access Journals (Sweden)

    Meenakshisundaram C

    2015-07-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

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    Somya Girish Goyal

    2014-08-01

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

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

    Institute of Scientific and Technical Information of China (English)

    董梦青; 李福凤

    2013-01-01

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

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

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    A Tanasan

    2013-02-01

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

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

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    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.

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

    Science.gov (United States)

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

    2015-01-01

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

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

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    Sureyya Talay

    2014-08-01

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

  17. Clinical study of urokinase-bound fibrocollagenous tubes.

    Science.gov (United States)

    Senatore, F; Bernath, F; Meisner, K

    1986-02-01

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

  18. [Intraoperative risk management during thoracic procedures].

    Science.gov (United States)

    Tsuzaki, Koichi

    2009-05-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2004-01-01

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

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Institute of Scientific and Technical Information of China (English)

    鲜红

    2014-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

    朱亮; 骆文斌; 吴承玉

    2011-01-01

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

  3. 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

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

  4. Temporomandibular joint examination reviewed

    Directory of Open Access Journals (Sweden)

    L. Guarda Nardini

    2011-09-01

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

  5. 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)

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

    Science.gov (United States)

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

    2015-03-01

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

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

    International Nuclear Information System (INIS)

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

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

    International Nuclear Information System (INIS)

    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

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

    Directory of Open Access Journals (Sweden)

    Cleverson Gonçalves dos Santos

    2015-12-01

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

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

    Directory of Open Access Journals (Sweden)

    Aya Nakamura

    2013-01-01

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

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

    Science.gov (United States)

    Dietz, U; Belz, G G

    1991-05-01

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

  12. 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.

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

    International Nuclear Information System (INIS)

    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)

  14. 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.

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

    Science.gov (United States)

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

    2016-10-01

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

  16. Elemental Study on Auscultaiting Diagnosis Support System of Hemodialysis Shunt Stenosis by ANN

    Science.gov (United States)

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

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

  17. An Auscultaiting Diagnosis Support System for Assessing Hemodialysis Shunt Stenosis by Using Self-organizing Map

    Science.gov (United States)

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

    Vascular access for hemodialysis is a lifeline for over 280,000 chronic renal failure patients in Japan. Early detection of stenosis may facilitate long-term use of hemodialysis shunts. Stethoscope auscultation of vascular murmurs has some utility in the assessment of access patency; however, the sensitivity of this diagnostic approach is skill dependent. This study proposes a novel diagnosis support system to detect stenosis by using vascular murmurs. The system is based on a self-organizing map (SOM) and short-time maximum entropy method (STMEM) for data analysis. SOM is an artificial neural network, which is trained using unsupervised learning to produce a feature map that is useful for visualizing the analogous relationship between input data. The author recorded vascular murmurs before and after percutaneous transluminal angioplasty (PTA). The SOM-based classification was consistent with to the classification based on MEM spectral and spectrogram characteristics. The ratio of pre-PTA murmurs in the stenosis category was much higher than the post-PTA murmurs. The results suggest that the proposed method may be an effective tool in the determination of shunt stenosis.

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

    International Nuclear Information System (INIS)

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

  19. 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.

  20. 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.

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

    Directory of Open Access Journals (Sweden)

    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.

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

    Science.gov (United States)

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

    2016-03-01

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

  3. 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 ...

  4. 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.

  5. Auditory display of knee-joint vibration signals

    Science.gov (United States)

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

    2001-12-01

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

  6. Pulmonary hantavirus syndrome: case report and brief review

    Directory of Open Access Journals (Sweden)

    VanHook CJ

    2015-09-01

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

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

    Directory of Open Access Journals (Sweden)

    Bachmann Lucas M

    2001-12-01

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

  8. SUBCLINICAL INTERSTITIAL PULMONARY INJURY IN RHEUMATOID ARTHRITIS

    Directory of Open Access Journals (Sweden)

    D. V. Bestaev

    2015-01-01

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

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

    Directory of Open Access Journals (Sweden)

    María Victoria Gordis Aguilera.

    2011-04-01

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

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

    Directory of Open Access Journals (Sweden)

    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

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

    Science.gov (United States)

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

    2004-01-01

    Background New technologies like echocardiography, color Doppler, CT, and MRI provide more direct and accurate evidence of heart disease than heart auscultation. However, these modalities are costly, large in size and operationally complex and therefore are not suitable for use in rural areas, in homecare and generally in primary healthcare set-ups. Furthermore the majority of internal medicine and cardiology training programs underestimate the value of cardiac auscultation and junior clinicians are not adequately trained in this field. Therefore efficient decision support systems would be very useful for supporting clinicians to make better heart sound diagnosis. In this study a rule-based method, based on decision trees, has been developed for differential diagnosis between "clear" Aortic Stenosis (AS) and "clear" Mitral Regurgitation (MR) using heart sounds. Methods For the purposes of our experiment we used a collection of 84 heart sound signals including 41 heart sound signals with "clear" AS systolic murmur and 43 with "clear" MR systolic murmur. Signals were initially preprocessed to detect 1st and 2nd heart sounds. Next a total of 100 features were determined for every heart sound signal and relevance to the differentiation between AS and MR was estimated. The performance of fully expanded decision tree classifiers and Pruned decision tree classifiers were studied based on various training and test datasets. Similarly, pruned decision tree classifiers were used to examine their differentiation capabilities. In order to build a generalized decision support system for heart sound diagnosis, we have divided the problem into sub problems, dealing with either one morphological characteristic of the heart-sound waveform or with difficult to distinguish cases. Results Relevance analysis on the different heart sound features demonstrated that the most relevant features are the frequency features and the morphological features that describe S1, S2 and the systolic

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

    Directory of Open Access Journals (Sweden)

    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

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

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    Andrea de Melo Alexandre Fraga

    2008-02-01

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

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

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    Iván Caviedes S

    2005-01-01

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

  15. Clinical and Laboratory Findings in Patients With Acute Respiratory Symptoms That Suggest the Necessity of Chest X-ray for Community-Acquired Pneumonia

    International Nuclear Information System (INIS)

    Pneumonia is a common illness in all parts of the world and is considered as a major cause of death among all age groups. Nevertheless, only about 5% of patients referring to their primary care physicians with acute respiratory symptoms will develop pneumonia. This study was performed to derive practical criteria for performing chest radiographs for the evaluation of community-acquired pneumonia (CAP). A total of 420 patients with acute respiratory symptoms and positive findings on chest radiograph were evaluated from December 2008 to December 2009. The subjects were referred to outpatient clinics or emergency departments of Birjand's medical university hospitals, Iran, and were enrolled as positive cases. A checklist was completed for each patient including their demographic information, clinical signs and symptoms (cough, sputum production, dyspnea, chest pain, fever, tachycardia, and tachypnea), abnormal findings in pulmonary auscultation and laboratory findings (erythrocyte sedimentation rate, C-reactive protein levels, and white blood cell count). An equal number of age-matched individuals with acute respiratory symptoms, but insignificant findings on chest radiography, were included as the control group. Finally, the diagnostic values of different findings were compared. The data showed that vital signs and physical examination findings are useful screening parameters for predicting chest radiograph findings in outpatient settings. Therefore, by implementing a prediction rule, we would be able to determine which patients would benefit from a chest X-Ray (sensitivity, 94% and specificity, 57%). This study's findings suggest that requesting chest radiographs might not be necessary in patients with acute respiratory symptoms unless the vital signs and/or physical examination findings are abnormal. Considering the 94% sensitivity of this rule for predicting CAP, a chest radiograph is required for patients with unreliable follow-ups or moderate to high

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

    Science.gov (United States)

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

    2013-01-01

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

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

    Science.gov (United States)

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

    2016-06-01

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

  18. 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.

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

    Science.gov (United States)

    Morinière, Sylvain; Beutter, Patrice; Boiron, Michèle

    2006-07-01

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

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

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    V. Sheikh

    2012-07-01

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

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

    Science.gov (United States)

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

    2016-03-30

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

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

    Directory of Open Access Journals (Sweden)

    Maria de Fátima Bazhuni Pombo March

    2005-04-01

    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.

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

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    Jiandong Zheng

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

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

    Institute of Scientific and Technical Information of China (English)

    Chen Cibin; Lu Xiong; Huang Peilan

    2005-01-01

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

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

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    Léonard A. Koussouhon

    2015-09-01

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

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

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    Singhi S

    2003-01-01

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

  7. 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?

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

    Institute of Scientific and Technical Information of China (English)

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

    2006-01-01

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

  9. Signs and symptoms in children with a serious infection: a qualitative study

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    Aerssens Peter

    2005-08-01

    Full Text Available Abstract Background Early diagnosis of serious infections in children is difficult in general practice, as incidence is low, patients present themselves at an early stage of the disease and diagnostic tools are limited to signs and symptoms from observation, clinical history and physical examination. Little is known which signs and symptoms are important in general practice. With this qualitative study, we aimed to identify possible new important diagnostic variables. Methods Semi-structured interviews with parents and physicians of children with a serious infection. We investigated all signs and symptoms that were related to or preceded the diagnosis. The analysis was done according to the grounded theory approach. Participants were recruited in general practice and at the hospital. Results 18 children who were hospitalised because of a serious infection were included. On average, parents and paediatricians were interviewed 3 days after admittance of the child to hospital, general practitioners between 5 and 8 days after the initial contact. The most prominent diagnostic signs in seriously ill children were changed behaviour, crying characteristics and the parents' opinion. Children either behaved drowsy or irritable and cried differently, either moaning or an inconsolable, loud crying. The parents found this illness different from previous illnesses, because of the seriousness or duration of the symptoms, or the occurrence of a critical incident. Classical signs, like high fever, petechiae or abnormalities at auscultation were helpful for the diagnosis when they were present, but not helpful when they were absent. Conclusion behavioural signs and symptoms were very prominent in children with a serious infection. They will be further assessed for diagnostic accuracy in a subsequent, quantitative diagnostic study.

  10. THE TREATMENT WITH WATER SEAL CHEST DRAIN (PDU IN TYPE 2 DIABETES MELLITUS PATIENT WITH RIGHT HYDROPNEUMOTHORAX OF TUBERCULAR AETIOLOGY WITH PERSISTENT RIGHT PNEUMOTHORAX WITH BPF AFTER FAILURE OF DECORTICATION

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    Sudeena

    2016-01-01

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

  11. [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

  12. Making Room at the Table for Obstetrics, Midwifery, and a Culture of Normalcy Within Maternity Care.

    Science.gov (United States)

    Akileswaran, Chitra P; Hutchison, Margaret S

    2016-07-01

    The principle of avoiding the worst possible outcomes guided the enormous successes of modern obstetrics in reducing the morbidity and mortality of childbirth. The challenges of improving the quality of childbirth today has prompted health care providers, policymakers, and patients to ask whether this principle is in fact preventing us from supporting the normal processes of childbirth, resulting in undue intervention and potentially causing harm. In this commentary, we suggest that recognizing the strengths of the medical model of childbirth does not preclude looking outside of it to meet the maternity care needs of the majority of healthy, low-risk women. Obstetricians have the good fortune to have a partner in their work among midwives, who hail from a long tradition of incorporating a perspective of "normalcy" in the care of childbearing women. Given the many evidence-based practices demonstrating the strengths of midwifery to actualize patient-centered, low-intervention birth, we advocate for the explicit establishment of professional standards for team-based physician-midwife care. More than merely introducing midwives into a physician-dominated setting, this means elevating the contributions of midwives and meaningfully incorporating a culture of normalcy to standardize practices such as intermittent auscultation, continuous birth support, nonpharmacologic pain management, and positional flexibility in labor. The literature suggests that a woman's health care provider is the most powerful determinant of her birth outcomes; striking the balance between averting poor outcomes and normalcy compels us to make room at the table for both obstetricians and midwives. PMID:27275807

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

    Directory of Open Access Journals (Sweden)

    Pereira J.C.R.

    2004-01-01

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

  14. 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. PMID:27172344

  15. Embedded Stethoscope for Heart Sounds

    Directory of Open Access Journals (Sweden)

    Mr.Ashish Harsola

    2012-12-01

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

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Nayana Amin

    2016-01-01

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

  18. 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

    1998-04-01

    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 skin temperatures and time to reach the limit of thermal tolerance. A lower stroke volume (99 +/- 7 and 68 +/- 4 ml/beat in Y and O, respectively, P heating, was the primary factor for the lower Qc observed in the older men. Increases in HR were similar in the young and older men; however, when expressed as a percentage of maximal HR, the older men relied on a greater proportion of their chronotropic reserve to obtain the same HR response (62 +/- 3 and 75 +/- 4% maximal HR in Y and O, respectively, P skin. PMID:9516200

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

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    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. 

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

    Institute of Scientific and Technical Information of China (English)

    李明月; 徐一兰; 陈波; 郭义; 王卫

    2015-01-01

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

  1. 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.

  2. 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

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

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    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.

  4. Methacholine bronchial provocation measured by spirometry versus wheeze detection in preschool children

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    Yahav Yaacov

    2005-06-01

    Full Text Available Abstract Background Determination of PC20-FEV1 during Methacholine bronchial provocation test (MCT is considered to be impossible in preschool children, as it requires repetitive spirometry sets. The aim of this study was to assess the feasibility of determining PC20-FEV1 in preschool age children and compares the results to the wheeze detection (PCW method. Methods 55 preschool children (ages 2.8–6.4 years with recurrent respiratory symptoms were recruited. Baseline spirometry and MCT were performed according to ATS/ERS guidelines and the following parameters were determined at baseline and after each inhalation: spirometry-indices, lung auscultation at tidal breathing, oxygen saturation, respiratory and heart rate. Comparison between PCW and PC20-FEV1 and clinical parameters at these end-points was done by paired Student's t-tests. Results and discussion Thirty-six of 55 children (65.4% successfully performed spirometry-sets up to the point of PCW. PC20-FEV1 occurred at a mean concentration of 1.70+/-2.01 while PCW occurred at a mean concentration of 4.37+/-3.40 mg/ml (p 1 by 44.7+/-14.5%; PEFR by 40.5+/-14.5 and FEF25–75 by 54.7+/-14.4% (P Conclusion Determination of PC20-FEV1 by spirometry is feasible in many preschool children. PC20-FEV1 often appears at lower provocation dose than PCW. The lower dose may shorten the test and encourage participation. Significant decrease in spirometry indices at PCW suggests that PC20-FEV1 determination may be safer.

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

    International Nuclear Information System (INIS)

    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

  6. [Very rare and life-threatening complications of bocavirus bronchiolitis: pneumomediastinum and bilateral pneumothorax].

    Science.gov (United States)

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

    2016-01-01

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

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

    Science.gov (United States)

    Nath, Ranjit Kumar; Soni, Dheeraj Kumar

    2016-08-01

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

  8. Left ventricular diastolic filling in patients with systemic hypertension

    International Nuclear Information System (INIS)

    To study the prevalence and significance of left ventricular (LV) diastolic dysfunction in mild to moderate systemic hypertension (HT), cardiac blood pool imagings with Tc-99 m were obtained in 10 normal subjects and 27 patients with HT. The patients with HT did not show any evidence of coronary heart disease, renal insufficiency, cerebrovascular accident or diabetes mellitus. They were divided into 3 groups; (1) HT-1 (n=10): without evidence of echocardiographic (UCG) and electrocardiographic (ECG) left ventricular hypertrophy (LVH), (2) HT-2 (n=8): with evidence of ECG-LVH without UCG-LVH, (3) HT-3 (n=9): with evidence of UCG-LVH. UCG-LVH was defined when posterior or interventricular septal tall thickness exceeded 13 mm at end-diastole. From UCG findings LV mass was calculated and from UCG findings and auscultating brachial systolic pressure LV peak-systolic wall stress (WS) was obtained. Cardiac blood pool imagings were performed at modified LAO at rest and during exercise stress. Indices of LV systolic function (rest ejection fraction, mean ejection rate during the first third of ejection and exercise ejection fraction response) were essentially similar in normal subjects and all HT groups. In contrast, LV diastolic filling rate during the first third of diastole (1/3 FR mean) decreased significantly in any group of HT, and it was prominent in HT-3. In patients with HT, 1/3 FR mean did not correlate with blood pressure, LV peak-systolic WS, LV systolic functions and LV end-diastolic volume. But it correlated inversely with LV mass (r=-0.84). These results suggest that impairment of early diastolic LV filling can be detected before systolic cardiac impairment and LVH develop, and it is, at least in part, relate to the LV mass. (author)

  9. The history of veterinary cardiology.

    Science.gov (United States)

    Buchanan, James W

    2013-03-01

    Throughout civilization, animals have played a pivotal role in the advancement of science and medicine. From as early as 400 BC when Hippocrates recognized that diseases had natural causes, the steadfast advances made by biologists, scientists, physicians and scholars were fueled by timely and important facts and information- much of it gained through animal observations that contributed importantly to understanding anatomy, physiology, and pathology. There have been many breakthroughs and historic developments. For example, William Harvey in the 16th and 17th centuries clarified the importance of the circulatory system, aided by observations in dogs and pigs, which helped to clarify and confirm his concepts. The nineteenth century witnessed advances in physical examination techniques including auscultation and percussion. These helped create the basis for enhanced proficiency in clinical cardiology. An explosion of technologic advances that followed in the 20th century have made possible sophisticated, accurate, and non-invasive diagnostics. This permitted rapid patient assessment, effective monitoring, the development of new cardiotonic drugs, clinical trials to assess efficacy, and multi-therapy strategies. The latter 20th century has marshaled a dizzying array of advances in medical genetics and molecular science, expanding the frontiers of etiologies and disease mechanisms in man, with important implications for animal health. Veterinary medicine has evolved during the last half century, from a trade designed to serve agrarian cultures, to a diverse profession supporting an array of career opportunities ranging from private, specialty practice, to highly organized, specialized medicine and subspecialty academic training programs in cardiology and allied disciplines. PMID:23453139

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

    Science.gov (United States)

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

    2016-01-01

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

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

    Directory of Open Access Journals (Sweden)

    CECILIA ALVAREZ G.

    2002-04-01

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

  12. Severe Brochostenosis by Oral Propafenone Immediately After Commencing Treatment.

    Science.gov (United States)

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

    2011-01-18

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

  13. 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

  14. Research on TCM identification technology%关于中药鉴定技术的相关研究

    Institute of Scientific and Technical Information of China (English)

    杜战国

    2015-01-01

    As the development and progress of The Times, the modern medical technology is also in constant development and biological research. The initial diagnosis way of traditional Chinese medicine " touch inspection, auscultation inspection, olfaction inspection, view inspection" and so on, now has developed into to meet the needs of times development of new technologies and methods, such as: DNA molecular genetic marker techniques, cluster analysis, etc. A variety of high-tech research way in traditional Chinese medicine identification of standardization, standardization, and scientific aspects and so on, has the very vital significance, also has a long-term development prospects. In constant introduction of new technology application and promotion of development at the same time, can't waste the most traditional and classical technology, need to be present and organic combination of traditional, promote the rational development of traditional Chinese medicine identification. This article through to the researches of the TCM identification technology, reviews the development prospects and application of this technology.%随着时代的发展和进步,现代医学和生物研究技术也在不断的发展。传统中医中的望、闻、观、触等初步诊断方式毅然发展成为现在DNA分子遗传标记技术、聚类分析等适应时代发展需求的新技术和方法。类似多种高科技研究方式在中药鉴定的规范化,标准化和科学化方面都存在十分重要的意义,也有很客观以及长远的发展前景。在不断地引进新技术进行发展应用和推广的同时,不能废弃最为传统和经典的技术,需要将现在和传统进行有机的结合,促进中药鉴定的合理高效发展。本文通过对有关中药鉴定技术的相关研究,综述此技术的发展前景以及应用。

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

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    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

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

    Institute of Scientific and Technical Information of China (English)

    薛瑞璐

    2012-01-01

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

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

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    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

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

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    López Sáiz, José Manuel

    1984-05-01

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

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

    International Nuclear Information System (INIS)

    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

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

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    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

  1. Idiopathic pulmonary fibrosis

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    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

  2. Accurate blood pressure recording: Is it difficult?

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    Bhalla A

    2005-11-01

    Full Text Available BACKGROUND: Blood pressure (BP measurement is a routine procedure but errors are frequently committed during BP recording. AIMS AND SETTINGS: The aim of the study was to look at the prevalent practices in the institute regarding BP recording. The study was conducted in the Medicine Department at Government Medical College, Chandigarh, a teaching institute for MBBS students. METHODS: A prospective, observational study was performed amongst the 80 doctors in a tertiary care hospital. All of them were observed by a single observer during the act of BP recording. The observer was well versed with the guidelines issued by British Hypertension Society (BHS and the deviations from the standard set of guidelines issued by BHS were noted. The errors were defined as deviations from these guidelines. STATISTICAL METHODS: The results were recorded as percentage of doctors committing these errors. RESULTS: In our study, 90% used mercury type sphygmomanometer. Zero error of the apparatus, hand dominance was not noted by any one. Every one used the standard BP cuff for recording BP. 70% of them did not let the patient rest before recording BP. 80% did not remove the clothing from the arm. None of them recorded BP in both arms. In out patient setting, 80% recorded blood pressure in sitting position and 14% in supine position. In all the patients where BP was recorded in sitting position BP apparatus was below the level of heart and 20% did not have their arm supported. 60% did not use palpatory method for noticing systolic BP and 70% did not raise pressure 30-40 mm Hg above the systolic level before checking the BP by auscultation. 80% lowered the BP at a rate of more than 2 mm/s and 60% rounded off the BP to nearest 5-10 mm Hg. 70% recorded BP only once and 90% of the rest re inflated the cuff without completely deflating and allowing rest before a second reading was obtained. CONCLUSION: The practice of recording BP in our hospital varies from the standard

  3. 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

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

    Institute of Scientific and Technical Information of China (English)

    闫伯强

    2011-01-01

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

  5. Tibetan Sheep Infectious Pleuropneumonia Treatment Experience%藏羊传染性胸膜肺炎的诊治体会

    Institute of Scientific and Technical Information of China (English)

    折尕才措

    2012-01-01

      In October 2011 to one MuHu home in October 2011, the animal husbandry and veterinary station received from a MuHu home more than 200 Tibetan sheep only have 40 sheep communicable pleura pneumonia, mortality is higher, the diagnosis and treatment. Has the following experience:a sheep increased body temperature to 41℃~42℃, mental depressed, shortness of breath, cough, nostril outflow purulent mucus, present rust red. Lung auscultation breath sounds to weaken or disappear, sheep only pain, percussion lung has dullness or real sound. Visual mucosal hyperemia, cyanosis, photophobia tears, canthus have mucus. Late disease sheep can't stand up, breathing extremely difficult, and ultimately asphyxia and death. Autopsy see lungs have obvious lesions, color shallow, the surface is not smooth, section is marble sample, 2~5 d death. Early use of ciprofloxacin's grace and tylosin effect is good, late basic no therapeutic value.%  2011年10月对某牧户家2011年10月,玉树州畜牧兽医工作站接到某牧户家200多只藏羊中有40只羊发生传染性胸膜肺炎,死亡率较高,进行了诊治。有如下体会:患羊体温升高至41℃~42℃,精神沉郁,呼吸急促,咳嗽,鼻孔流出脓性黏膜,呈现铁锈红色。肺部听诊呼吸音减弱或消失,羊只有痛感,叩诊肺部有浊音或实音。可视黏膜充血、发绀、羞明流泪,眼角有黏膜。后期病羊无法站立,呼吸极度困难,最终窒息而亡。剖检见肺脏有明显病变,颜色变浅,表面不光滑,切面呈大理石样,2~5 d死亡。早期用恩诺沙星和泰乐菌素效果较好,后期基本无治疗价值。

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

    Directory of Open Access Journals (Sweden)

    Ping Ling Yeoh

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

  7. Temporal behavior of a ventilated claystone at the Tournemire URL: Cross-spectral analyses focused on daily harmonics

    Science.gov (United States)

    Bailly, David; Matray, Jean-Michel; Ababou, Rachid

    2014-12-01

    The main topic of this communication is the presentation of study, auscultation and supervision procedures of deep geological radioactive waste storage repositories using natural harmonic forcings. In this paper, the effects of natural ventilation on the macroscopic behavior of a clayrock are investigated by means of time series recorded underground over a period of two years in the eastern part of Gallery 1996 at the Tournemire Underground Research Laboratory (URL). This study is based on time series acquired in theatmosphere, at the gallery wall surface, and inside the rock mass. It includes measured signals from 6 thermo-hygrometers, 5 crack-meters (measuring the displacement of 2 shrinkage cracks and 3 tectonic fractures), and a 1 meter-FDR (Frequency Domain Reflectometry) profile probe equipped with 6 sensors for measuring the volumetric pore-water content into the rock mass. Auto-spectral and cross-spectral analyses using the concept of Singular Spectrum Harmonics (SSHs and cross-SSHs) are developed. Our analyses and interpretations focus here mainly on the solar diurnal atmospheric tide (denoted S1 ). This tide corresponds to the insolation cycle of the Earth atmosphere during a mean Solar Day (24 h 00 min). This component is tracked throughout the various measured signals ("Spectral Tracking" of tide fluctuations across signals). This is equivalent, in a way, to analyzing the temporal behavior of the URL during a "Mean Solar Day on Earth". Results indicate that the daily natural forcing caused mainly by a combination of barometric and temperature related fluctuations, is the most important effect overall on our various signals. The daily harmonic induces the fluctuations of gallery air temperature, relative and absolute air humidity and it leads to desaturation of the claystone, which in turn leads to the claystone deformation and damage. The effects of the annual harmonic SA may also be significant (it was fully analyzed in the more complete version of

  8. Pulmonary infection caused by Talaromyces purpurogenus in a patient with multiple myeloma.

    Science.gov (United States)

    Atalay, Altay; Koc, Ayse Nedret; Akyol, Gulsah; Cakir, Nuri; Kaynar, Leylagul; Ulu-Kilic, Aysegul

    2016-06-01

    A 66-year-old female patient with multiple myeloma (MM) was admitted to the emergency service on 29.09.2014 with an inability to walk, and urinary and faecal incontinence. She had previously undergone autologous bone marrow transplantation (ABMT) twice. The patient was hospitalized at the Department of Haematology. Further investigations showed findings suggestive of a spinal mass at the T5-T6-T7 level, and a mass lesion in the iliac fossa. The mass lesion was resected and needle biopsy was performed during a colonoscopy. Examination of the specimens revealed plasmacytoma. The patient also had chronic obstructive pulmonary disease (COPD) and was suffering from respiratory distress. After consultation with an infectious diseases specialist the patient was placed on an intravenous antibiotherapy with piperacillin/tazobactam (4.5g x 3) on 17.10.2014. During piperacillin/tazobactam treatment, the patient suffered from drowsiness, her general condition deteriorated, and she had rales on auscultation of the lungs. The patient underwent thoracic computerized tomography (CT) which showed areas of focal consolidation in the lower lobes of the two lungs (more prominent on the left), and increased medullary density. The radiology report suggested that fungal infection could not be ruled out based on the CT images. The sputum sample was sent to the mycology laboratory and direct microscopic examination performed with Gram and Giemsa staining showed the presence of septate hyphae; therefore voriconazole was added to the treatment. Slow growing (at day 10), grey-greenish colonies and red pigment formation were observed in all culture media except cycloheximide-containing Sabouraud dextrose agar (SDA) medium. The isolate was initially considered to be Talaromyces marneffei. However, it was subsequently identified by DNA sequencing analysis as Talaromyces purpurogenus. The patient was discharged at her own wish, as she was willing to continue treatment in her hometown

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

    Institute of Scientific and Technical Information of China (English)

    李靖; 郑劲平; 袁锦屏; 曾广翘; 钟南山; 林材元

    2004-01-01

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

  10. Idiopathic pulmonary fibrosis.

    Science.gov (United States)

    Meltzer, Eric B; Noble, Paul W

    2008-01-01

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

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

    Directory of Open Access Journals (Sweden)

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

    2005-12-01

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

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

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    Isha Gutgutia

    2012-12-01

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

  13. 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

  14. 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

  15. Method specificity of non-invasive blood pressure measurement: oscillometry and finger pulse pressure vs acoustic methods.

    Science.gov (United States)

    De Mey, C; Schroeter, V; Butzer, R; Roll, S; Belz, G G

    1995-10-01

    1. The agreement of blood pressure measurements by stethoscope auscultation (SBPa, DBPa-IV and DBPa-V), oscillometry (Dinamap; SBPo, and DBPo) and digital photoplethysmography (Finapres; SBPf, and DBPf) with the graphical analysis of the analogue microphone signals of vascular wall motion sound (SBPg and DBPg) was evaluated in eight healthy subjects in the presence of responses to the intravenous infusion of 1 microgram min-1 isoprenaline. 2. In general, there was good agreement between the SBP/DBP-measurements based on auscultatory Korotkoff-I- and IV-criteria and the reference method; the average method difference in estimating the isoprenaline responses for SBPa-SBPg was: -1.1, 95% CI: -5.4 to 3.1 mm Hg with a within-subject between-method repeatability coefficient (REP) of 11.6 mm Hg and for DBPa-IV-DBPg: 3.5, 95% CI: -0.5 to 6.5 mm Hg, REP: 11.5 mm Hg. The ausculatation of Korotkoff-V substantially overestimated the isoprenaline induced reduction of DBP: method difference DBPa-V-DBPg: -11.3, 95% CI: -17.8 to -4.7 mm Hg, REP: 31.8 mm Hg. 3. Oscillometry yielded good approximations for the SBP response to isoprenaline (average method difference SBPo-SBPg: -2.9, 95% CI: -9.0 to 3.3 mm Hg, REP: 17.6 mm Hg) but was poorly sensitive with regard to the DBP responses: method difference DBPo-DBPg: 6.5, 95% CI: -1.3 to 14.3 mm Hg, REP: 25.7 mm Hg. 4. Whilst the finger pulse pressure agreed well with regard to DBP (method difference for the DBP responses to isoprenaline: DBPf-DBPg: 1.8, 95% CI: -5.1 to 8.6 mm Hg, REP: 18.5 mm Hg) it was rather unsatisfactory with regard to SBP (method difference SBPf-SBPg: -14.1, 95% CI: -28.2 to -0.1 mm Hg, REP: 49.9 mm Hg).(ABSTRACT TRUNCATED AT 250 WORDS) PMID:8554929

  16. L’ELLIPSE ET LA COHÉRENCE SÉMANTIQUE: ÉTUDE DE LE JUJUBIER DU PATRIARCHE D’AMINATA SOW FALL.

    Directory of Open Access Journals (Sweden)

    Dr. Irene Udousoro

    2014-04-01

    Full Text Available La norme linguistique courante admet de plus en plus le concept d’ellipse dans la communication soit orale ou écrite si bien qu’on ne le conçoit plus comme un écart mais comme un style d’écriture. La presse, surtout les journalistes, s’en servent, particulièrement, pour donner les grandes lignes dans leurs informations ou pour des annonces dans les journaux, à la radio ou à la télévision. Les romanciers exploitent, eux aussi, ce procédé stylistique dans leurs œuvres malgré les exigences de l’écriture classique quant au respect de la norme en matière de la langue. L’emploi de l’ellipse présuppose le non-dit, l’absence de certains éléments linguistiques ou textuels, (s’il s’agit de l’ellipse de certaines parties de la narration que l’auteur voudrait ausculter, une absence signifiante qui ne gêne cependant pas la signification du texte ou de l’énoncé elliptique. L’ellipse dans un texte littéraire permet de caractériser le style d’un auteur, reflétant ainsi le tempérament littéraire, le style personnel de cet auteur. Cette recherche est destinée à étudier Le Jujubier du Patriarche d’Aminata Sow Fall, récit fictionnel imprégné de phrases elliptiques à tel point que l’on pourrait le qualifier d’écriture elliptique. Notre tâche consiste, dans un premier temps, à étudier la notion de phrase pour fournir une base contre laquelle l’on peut déterminer ce que l’on considère comme des énoncés elliptiques. Ensuite, nous comptons faire sortir quelques exemples d’énoncés elliptiques et en décrire la nature. Cela nous permettra, en dernier lieu, de tirer des conclusions quant aux effets de ce style communicatif sur la compréhension des phrases isolées ou du texte intégral en question.

  17. Detection des fuites d'eau dans les barrages en terre par polarisation spontanee: Determination experimentale du potentiel zeta et du coefficient de couplage

    Science.gov (United States)

    Ould Hamoni, Mohamed Abderrahmane

    In Quebec, hydraulic represents an undeniable source for energy production and therefore needed an engine for economic development. Therefore, proper design and ongoing inspections are necessary to ensure the stability and safety of these structures. Thus, abnormalities in embankment dams should be located in the shortest time. The internal erosion is the main cause of the failure of embankment dams. Consequently, the infiltration of water in dams, which generates the internal erosion, should be detected. Several non-destructive methods have been developed to auscultate these structures and determine the groundwater level in the embankment works. In this project, the self-potential (SP) method was adopted. This method consists in measuring a passive electric field at the surface of the sail. The phenomenon is defined by the electrofiltration circulation water into the porous matrix of a material which generates a measurable electric current to the ground surface. Laboratory tests at the Universite de Sherbrooke were performed to determine the effect of water flow on the electrical properties for different materials. Plexiglas pipe was used for testing and the theoretical model is the Helmholtz-Smoluchowski. During the tests, the influence of hydraulic loading and temperature on the electrical properties of the materials has been checked. The experiments aim at determining the primary relationship between the coupling coefficient and zeta potential using the self-potential (SP) method. The experimental results were compared with values from the literature to confirm the model and protocol used. Thus since that the experimental data are consequent with those theoretical, experimental model adopted can be considered as reliable. This project is a prerequisite for future research that will develop an inversion algorithm to identify and locate anomalies in the embankment dams. Experimental studies have demonstrated that the hydraulic load had a significant effect on the

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

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    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

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

    Directory of Open Access Journals (Sweden)

    Giselle de Castro

    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

  20. 胸腔镜辅助下小切口二尖瓣置换及成形手术后呼吸的护理干预%Thoracoscope assisted small incision after mitral valve replacement surgery and forming respiratory nursing intervention

    Institute of Scientific and Technical Information of China (English)

    欧阳晶; 付玉珠

    2013-01-01

    Objective :to study the thoracoscope assisted small incision after mitral valve coffret change or the management of respiratory tract . Methods :from July 2012 to August 2013 in thoracoscope assisted small incision mitral valve coffret or keratoplasty ,a total of 24 bits ,through to the effective management of patients with respiratory tract management ,such as preoperative patients effective breathing and coughing ;Postoperative res-pirator use note heating ,humidification .Postoperative early endotracheal intubation ;Patients with postoperative encourage effective cough ;Strengthe-ning exercises ,take back ;Encourage patients early ambulation .On the first day after operation ,turn into the second or third day after wards review bedside chest radiographs and double lung auscultation breath sounds .The pulse oxygen saturation ,oxygenation index were observed ,the color of phlegm ,quantity ,character ,blood transfusion amount ,incision .Results :the thoracoscope assisted small incision mitral valve coffret ,occurred in the postoperative patient right pleural effusion puncture extraction light hemorrhagic effusions 200 ml ,the rest of the patients with pleural effusion .Post-operative day and returned to the ward when auscultate breath sounds on the right is a bit low ,3 to 4 days after normal breath sounds .Postoperatively , refers to the pulse oxygen maintained at 92% ~ 99% .Oxygenation index > 300 .Patient care in 5 -10 ml ,sputum volume for white viscous sputum . Shorter postoperative hospital stay compared with the conventional mitral valve surgery ,patients recover faster ,less blood transfusion ,aesthetics ,etc . Conclusion :to strengthen the thoracoscope assisted small incision after mitral valve coffret or change of respiratory tract management can effectively reduce respiratory complications ,effective shorten hospitalization time ,is very important to promote patients recover .%目的:探讨胸腔镜辅助下小切口二尖瓣罝换或成形术后呼

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

    Institute of Scientific and Technical Information of China (English)

    付金英; 章微微; 李学军; 王元姣

    2014-01-01

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

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

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    Edson N. Morais

    1998-03-01

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

  3. 表现为反复双下肢肿胀(淋巴水肿)的特发性嗜酸性粒细胞增多综合征一例%Recurrent swelling of lower limbs (lymphedema) as manifestations of idiopathic hypereosinophilic syndrome: a case report

    Institute of Scientific and Technical Information of China (English)

    王飞; 胡莉芳; 宋国新; 李可栋; 卢新政; 侯麦花

    2015-01-01

    A 21-year-old male was hospitalized for recurrent swelling of lower limbs (lymphedema) for 1 year and worsening of it for 1 week.Physical examination revealed several smooth,firm enlarged lymph nodes of the neck,groin without apparent tenderness measuring about 1 cm in diameter.Cardiac and pulmonary auscultation showed no obvious abnormality.The abdomen was soft on palpation without tenderness or rebound tenderness.Skin examination revealed swelling of both lower limbs,especially the left lower limb,as well as scattered irregularly sized,dark erythematous patches with a wood-like consistency on the swollen lower limbs,with high temperature but no tenderness.Elevated peripheral eosinophil count was observed before and after admission,with the eosinophil percentage higher than 70%.Vascular ultrasonography showed thrombosis in the right anterior tibial artery,left dorsal artery of foot and lower portion of the left great saphenous vein.Multiple enlarged lymph nodes were found by computed tomography in the mediastinal,bilateral axillary,retroperitoneal regions and around the abdominal aorta.Lymph node and bone marrow biopsies showed eosinophilia.Histopathology of lesions on the extensor aspect of the left medial thigh and left lateral malleolus showed massive eosinophilic infiltration and lymphatic dilation in the dermis,as well as eosinophil emboli in some lumens.The FIP1L1-PDGFRA fusion gene was undetected.A diagnosis of idiopathic hypereosinophilic syndrome was finally made.The symptoms rapidly regressed after glucocorticoid treatment.%患者男,21岁,因双下肢反复红肿1年,再发加重1周入院.体检:颈部、腹股沟可及数枚肿大淋巴结,直径约1 cm,光滑、质韧,无明显压痛;心、肺听诊无明显异常;腹软,无压痛及反跳痛.皮肤科检查:双下肢明显肿胀,呈木质样硬度,以左下肢为著,其上散在大小不等暗红斑,皮温高,无明显压痛.入院前后2次查血中嗜酸性粒细胞均明显升高,

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

    Institute of Scientific and Technical Information of China (English)

    胡彬; 吴仲烨; 任斐; 薛鹏; 高慧; 陈彬; 刘磊; 张兆伟

    2014-01-01

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

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

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

    2014-01-01

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

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

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    Marisa Dias Von Atzingen

    2008-01-01

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

  7. 婴幼儿肺炎支原体肺炎79例临床分析%Clinical analysis of Mycoplasma pneumoniae pneumonia in 79 infants and young children

    Institute of Scientific and Technical Information of China (English)

    张莹; 赵顺英

    2011-01-01

    目的 探讨婴幼儿肺炎支原体肺炎(MPP)的临床及影像学特点和预后.方法 分析79例MPP患儿的临床表现、影像学及实验室检查结果、治疗及预后.结果 婴幼儿MPP 1岁以上者多见,临床表现以发热、有痰咳嗽为主,70%有喘息,半数可闻及肺部湿啰音和(或)喘鸣音,95%伴有肺外损害,其中心肌酶升高最为常见.双肺均可受累,局部病变部位以右、中下肺受累最常见,多见斑片影、片状密度增高影.病程10 d之后MP-IgM检测100%阳性.多数血细胞计数和C反应蛋白在正常范围.50%以上患儿出现CD4+细胞比值降低,73%总IgE升高.绝大多数患儿存在小气道通气功能损害.19%的患儿表现为重症/难治性肺炎,2例遗留支气管扩张和闭塞性细支气管炎(bronchiolitis obliterans,BO)改变,多数病程中出现喘息者随访1年不再发生喘息.结论 除一般表现外,婴幼儿也可出现重症/难治性MPP(SMPP/RMPP).MPP可继发免疫紊乱、小气道功能障碍,个别病例可出现BO和局限性支气管扩张.%Objective To in vestigate clinical manifestations and radiological findings and prognosis of Mycoplasma pneumoniae pneumonia(MPP) in younger children.Methods Clinical manifestations,radiographic findings,laboratory examinations,treatment effect,and sequelae of 79 children under 3 years old with MPP were analyzed.Results MPP was seen more in young children older than 1 year old. The common clinical manifestations were cough,fever and wheezing. Some patients developed shortness of breath or dyspnea. Scattered tales and expiratory wheezes were beard on chest auscultation. Most cases had at least one extrapulmonary lesion and cardiovascular complications were the most common. Unilateral disease was as common as bilateral. The radiographic findings were predominant with patchy infiltration and consolidation with right middle and lower lung zone. Serum MP-IgM was positive in all patients after 10 days. WBC and CRP were in

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

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    Paulo V. Peixoto

    2000-12-01

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

  9. 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

  10. 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

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

    Institute of Scientific and Technical Information of China (English)

    李建东; 郝淑玲

    2015-01-01

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

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

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

    2013-01-01

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

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

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    陆雅萍; 方向明; 胡奕; 黄冰; 孙建良; 施谷平

    2011-01-01

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

  14. Effect of penehyclidine in emergency neonate ileus surgery%盐酸戊乙奎醚用于新生儿肠梗阻急诊手术的临床观察

    Institute of Scientific and Technical Information of China (English)

    姜丽华; 马琪; 魏晓永

    2011-01-01

    目的 观察盐酸戊乙奎醚在新生儿肠梗阻急诊手术中对误吸所致肺部症状的影响.方法 急诊肠梗阻手术新生儿40例,术前均因误吸导致肺部炎症,随机均分为盐酸戊乙奎醚组(A组)和阿托品组(B组).麻醉诱导前A组静注盐酸戊乙奎醚0.3 mg,B组静注阿托品0.1 mg.听诊患儿给药前及给药后10 min的呼吸音;记录给药前、给药后10、30 min鼓膜温度、HR,SpO;现察给药前、给药后30 min及术毕患儿面色和口腔分泌物情况;记录拔管时间及ICU停留时间结果给药后10 min,A组肺部干湿啰音消失或减轻,B组无明显改变.给药后10、30 min,A组HR慢于、鼓膜温度低于、SpO2高于B组(P<0.05),A组在ICU停留时间明显短于B组(P<0.05).结论 盐酸戊乙奎醚用于新生儿肠梗阻急诊手术可减轻患儿误吸所致的肺部症状,改善患儿末梢循环,缩短患儿在ICU停留时间.%Objective To observe the effect of penehyclidine hydrochloride in emergency neonate ileus surgery with aspiration-induced sympotom of lung. Methods Forty neonates suffered from ileus were equally randomized into penehyclidine group(A group)and atropine group (B group).Neonates intravenously received pnehyclidine hydrochloride 0. 3 mg in A group and atropine 0. 1 mg in B group before anesthesia induction. Breath sound was auscultated before and 10 min after administration; temperature of eardrum, HR and SpO2 were recorded before and 10 min, 30 min after administration; complexion and oropharyngeal secretion were observed before administration, 30 min after administration and at the end of operation; and time of extubation and duration in intensive care unit (ICU) were also recorded. Results Ten minutes after administration, rhonchus and moist rales disappared or reduced in A group while no significant change in B group. Ten minutes and 30 min after administration, A group had slower HR, lower temperature of eardrum and higher SpO2 than B group ( P < 0. 05 ). The

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

    Institute of Scientific and Technical Information of China (English)

    梁锦泉; 冯子泽

    2013-01-01

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

  16. 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

  17. Effect of refined respiratory intervention management on preventing pulmonary infection of post-thoracotomy%精细化呼吸干预管理预防开胸术后肺部感染的效果

    Institute of Scientific and Technical Information of China (English)

    朱力; 刘建芬; 景静

    2015-01-01

    Objective Compare the effect of reducing patients′ pulmonary infection by different post-thoracotomy breathing intervention management modes. Methods A total of 88 sampled patients, who had done thoracotomy, were divided chronologically 44 each into control group (February to March 2013) and test group ( April to May 2013 ) . Regular respiratory intervention management were conducted on the control groups and refined respiratory intervention management were given to the test groups, compare the effect of two groups. Results The temperatures (36. 27 ± 0. 30)℃ of the patients from the test group at 6 pm in the 4th day after surgery were lower than ( 36. 78 ± 0. 36 )℃ of the control group; difference between the two groups were statistically significant (t=7. 35,P<0. 05). The white blood cell analysis (6. 07 ± 1. 43) × 109/L in the 4th after surgery of experimental group tend to be more normal than the white blood cell analysis (7. 61 ± 1. 94) × 109/L of the control group with statistical significance (t=4. 27,P<0. 05). There were all normal for chest X ray in the test group, but 4 cases with lung patchy infiltrate shadows in the control group with incidence rate 9. 09%. Conclusions Refined breathing intervention management can make the body temperature, white blood cell, neutrophils ratio of post-operative patients recover to normal range quick without lung auscultation wet rales, and prevent post-thoracotomy pulmonary infection.%目的:比较开胸术后不同呼吸干预管理模式对降低患者肺部感染的效果。方法采用便利抽样的方法,选择2013年2—3月手术患者44例设为对照组,2013年4—5月手术患者44例为试验组。对照组给予常规呼吸干预管理模式,试验组给予精细化呼吸干预管理模式,比较两组干预效果。结果术后第4天,试验组患者18:00体温为(36.27±0.30)℃,对照组为(36.78±0.36)℃,差异有统计学意义(t=7.35,P<0.05);试验组白细胞计数为(6.07±1.43)

  18. 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.

  19. 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.

  20. Exercício físico controla pressão arterial e melhora qualidade de vida Exercise control blood pressure and improvement quality of life

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    Daiana Cristine Bündchen

    2013-04-01

    Full Text Available INTRODUÇÃO: Para o tratamento correto da hipertensão arterial, é plausível a hipótese de que diante da prática regular de exercícios físicos estes pacientes não necessitariam de fármacos anti-hipertensivos. OBJETIVO: Avaliar o efeito do tratamento exclusivo com exercício físico na pressão arterial (PA e qualidade de vida (QV de hipertensos. MÉTODO: Ensaio clínico com 32 hipertensos sedentários, 55±9 anos, que estavam sob tratamento farmacológico (TF aleatoriamente alocados em Grupo Exercício (GE e Grupo Controle (GC. No GE, 18 indivíduos (50% mulheres após pelo menos dez dias de interrupção do TF iniciaram programa de exercício de dez semanas, 3x/semana, 30 minutos de exercício aeróbio seguidos por exercícios resistidos, enquanto 14 do GC (57% mulheres se mantiveram sob TF. Foi verificada PA sistólica (PAS e diastólica (PAD no início e final do estudo pelo método auscultatório clássico e QV pelo questionário MINICHAL. Os dados foram expressos por M±DP, usou-se teste t de Student, U de Mann-Whitney e Wilcoxon, considerando-se p BACKGROUND: Hypertension can be correctly treated when exercise is regularly practiced and hence, patients would not need anti-hypertensive drugs. PURPOSE: To evaluate the effect of treatment exclusively with exercise on blood pressure (BP and quality of life (QL of hypertensive subjects. METHODS: Clinical trial with 32 sedentary hypertensive subjects, aged 55 ± 9 years, under pharmacological treatment (PT randomly allocated to Exercise Group (EG and Control Group (CG. At EG, 18 subjects (50% women at least 10 days after the cessation of PT started the exercise program of 10 weeks, 3x/week, 30 minutes of aerobic exercise followed by resistance exercises, while 14 CG (57% women remained under PT. Systolic blood pressure (SBP and diastolic blood pressure (DBP was evaluated by auscultation at the beginning and end and QL was evaluated using the questionnaire MINICHAL. Data were expressed

  1. Applying the seismic interferometry method to vertical seismic profile data using tunnel excavation noise as source

    Science.gov (United States)

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

    2013-04-01

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

  2. Risk factors of rheumatic heart disease in Bangladesh: a case-control study.

    Science.gov (United States)

    Riaz, Baizid Khoorshid; Selim, Shahjada; Karim, Md Nazmul; Chowdhury, Kamrun Nahar; Chowdhury, Shahabul Huda; Rahman, Md Ridwanur

    2013-03-01

    Not all cases of rheumatic fever (RF) end up as rheumatic heart disease (RHD). The fact raises the possibility of existence of a subgroup with characteristics that prevent RF patients from developing the RHD. The present study aimed at exploring the risk factors among patients with RHD. The study assessed the risk of RHD among people both with and without RF. In total, 103 consecutive RHD patients were recruited as cases who reported to the National Centre for Control of Rheumatic Fever and Heart Disease, Dhaka, Bangladesh. Of 309 controls, 103 were RF patients selected from the same centre, and the remaining 206 controls were selected from Shaheed Suhrawardy Medical College Hospital, who got admitted for other non-cardiac ailments. RHD was confirmed by auscultation and colour Doppler echocardiography. RF was diagnosed based on the modified Jones criteria. An unadjusted odds ratio was generated for each variable, with 95% confidence interval (CI), and only significant factors were considered candidate for multivariate analysis. Three separate binary logistic regression models were generated to assess the risk factors of RF, risk factors of RHD compared to non-rheumatic control patients, and risk factors of RHD compared to control with RF. RF and RHD shared almost a similar set of risk factors in the population. In general, age over 19 years was found to be protective of RF; however, age of the majority (62.1%) of the RHD cases was over 19 years. Women [odds ratio (OR) = 2.2, 95% CI 1.1-4.3], urban resident (OR = 3.1, 95% CI 1.2-8.4), dwellers in brick-built house (OR = 3.6, 95% CI 1.6-8.1), having > 2 siblings (OR = 3.1, 95% CI 1.5- 6.3), offspring of working mothers (OR = 7.6, 95% CI 2.0-24.2), illiterate mother (OR = 2.6, 95% CI 1.2-5.8), and those who did not brush after taking meals (OR = 2.5, 95% CI 1.0-6.3) were more likely to develop RF. However, more than 5 members in a family showed a reduced risk of RF. RHD shared almost a similar set of factors in

  3. 集束化护理在重症肺炎患儿病情改善中的应用效果研究%Effects of bundle nursing on the improvement of illness state in severe pneumonia children

    Institute of Scientific and Technical Information of China (English)

    王晓霞; 葛延瑱

    2014-01-01

    目的:探讨集束化护理在重症肺炎中的应用效果。方法选取80例重症肺炎患者为研究对象,随机分为观察组和对照组各40例,对照组采用常规护理,观察组采用集束化护理,比较两组的护理效果。结果观察组的SaO2、PaO2高于对照组, PaCO2低于对照组,退热时间、肺部听诊改善时间、胸部X线片改善时间、并发症、住院时间少于对照组,疗效高于对照组,差异有统计学意义( P<0.05);观察组的焦虑标分、生活标分、躯体标分等生活质量评分高于对照组,家长护理满意度高于对照组,差异有统计学意义( P<0.05)。结论集束化护理以循证医学为指导,能提高重症肺炎患儿的治疗效果,改善生活质量。%Objective To investigate the effect of bundle nursing in the treatment of severe pneumonia.Methods Eighty children with severe pneumonia were randomly divided into the observation group and the control group , the control group received routine nursing care, the observation group was used bundle nursing , nursing effects were compared between two groups.Results SaO2 , PaO2 in the obser-vation group were higher than those in the control group , PaCO2 was lower than that in the control group , the cooling time, improvment time of lung auscultation and chest X -ray, complications, hospitalization time were less than those in the control group , curative effect was high-er than that in the control group , with statistical significance ( P<0.05 ) .Life quality grading score in anxiety scale , living standard , phys-ical standard in the observation group were higher than those in the control group , the parents nursing satisfaction was higher than that in the control group, with statistical significance (P<0.05) .Conclusions Bundle nursing is directed by nursing evidence -based medicine;it can improve the treatment effects and the quality life of severe pneumonia children .

  4. 婴幼儿肺动脉吊带29例临床特征及诊治分析%Diagnosis and treatment of pulmonary artery sling in 29 infants

    Institute of Scientific and Technical Information of China (English)

    符跃强; 刘成军; 陈应富; 李静; 胡兰; 许峰; 冯川

    2014-01-01

    Objective To explore the clinical features,diagnosis and treatment of pulmonary artery sling in infants. Methods From September 2009 to July 2014,patients who were diagnosed as pulmonary artery sling at Childrenˊs Hospital of Chongqing Medical University were recruited and analyzed. The clinical data,imaging examination( X-ray,echocardiography and multi-detector computed tomography scan),bronchoscopy,treatment and surgery were retrospectively reviewed. Results Twenty-nine cases were diagnosed as pulmonary artery sling,including sixteen males and thirteen females with the age at diagnosis ranging from two to forty-two months( median age was seven months). Twenty-six cases manifested with recurrent wheezing and stridor. The chest auscultation of twenty-six patients had wheeze sound. Fifteen cases of children were with simple pulmonary artery sling and the diagnosis of pulmonary artery sling median age was 6 months,the other fourteen cases were accompanied by other cardiovascular diseases,with median age of 8 months with no statistical difference between the two groups( P > 0. 05 ). Twenty-six patients underwent multi-detector CT vascular and airway reconstruction which indentified the diagnosis of pulmonary artery sling and the combinating malformation of heart,another three patients only underwent multi-detector CT airway reconstruction. The CT results showed tracheal stenosis in all patients and found seven bridging bronchus. Twenty-five patients received echocardiography,3 of them were performed before CT scan,but only five patients were indentified with pulmonary artery sling. Thirteen patients received bronchoscopy and were found with tracheal stenosis, six of which were combined with cartilaginous rings. Sixteen patients underwent surgery,but four of them died. After operation,the respiratory symptom of twelve patients was improved. The duration of mechanical ventilation >72 hours,operation age ≤ 5 months or cardiopulmonary bypass time >100 minutes

  5. 中国10省(市)2009-2014年15岁以下儿童流感确诊住院病例严重急性呼吸道感染临床特征及其危险因素分析%Clinical characteristics of hospitalized cases of severe acute respiratory infection with laboratory-confirmed influenza and the risk factors analysis of influenza infection for children under 15 years old in ten provinces in China during 2009-2014

    Institute of Scientific and Technical Information of China (English)

    彭质斌; 许军; 余昭; 孙倩莱; 李鲁生; 杨鹏; 姜中毅; 康敏; 熊辛

    2015-01-01

    Objective To identify clinical characteristics of hospitalized laboratoryconfirmed influenza cases of children under 15 years old,and their risk factors of influenza infection.Methods Analyzing the reports of hospitalized laboratory-confirmed influenza cases of children under 15 years old who were detected by the sentinel surveillance systems in 10 provinces from December 2009 to June 2014.Such data as their demographic,medical history,clinical symptoms and signs,treatment and outcome were collected using questionnaires,with their clinical characteristics and their risk factors of influenza infection described.Results Of the 2 937 severe acute respiratory infection inpatients,190 (6.5%) were laboratory-confirmed influenza cases.123 (64.7%) of such confirmed cases were male,and 139 (73.2%) were children under 5 years old,with age median of 3.0 years (IQR:1.0-5.0 years).20 (10.5%) of them had at least one chronic medical condition,mostly chronic cardiovascular disease (3.2%),immunosuppressive disease (3.2%),and cancer/tumor (2.6%).Most common clinical symptoms of the cases were fever (92.6%) and cough (88.8%),of which abnormal pulmonary auscultation (51.1%) and abnormal chest X-ray performance (36.1%) were the most common clinical signs.29 cases (15.8%) had complications,of which pneumonia (15.3%) was most common.16 cases (8.6%) used antiviral drugs,and 4 cases (2.2%) were admitted into ICU.Risk factor analysis suggested that age <6 months (OR=0.406,95%CI:0.203-0.815) was a protective factor against influenza infection; and age 5-9 years old (OR=2.535,95% CI:1.059-6.066) was a risk factor for influenza infection.Conclusion Hospitalized laboratoryconfirmed influenza cases were found mostly in children under 5 years old.Risk exposure for influenza infection varied among age groups.%目的 探讨我国<15岁儿童流感确诊病例严重急性呼吸道感染(SARI)临床特征及感染危险因素.方法 分析10省市2009年12

  6. 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.

  7. 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.

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

    Directory of Open Access Journals (Sweden)

    Ricardo M. Pereira

    2008-04-01

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

  9. Effects of acute normovolemic hemodilution on intrapulmonary shunting and oxygenation during one-lung ventilation in dogs%急性等容血液稀释对犬单肺通气期间肺分流与氧合的影响

    Institute of Scientific and Technical Information of China (English)

    马宁; 李树人; 槐庆元

    2001-01-01

    目的观察犬单肺通气期间,不同程度急性等容血液稀释对肺分流和氧供、氧耗等的影响.方法 12只健康杂种犬,基础麻醉后插入双腔气管导管,股动、静脉置管.稳定30分钟(HD0)后,以血定安等速置换全血,分别达到轻度(HDl)、中度(HD2)、重度(HD3)和极重度(HD4)血液稀释四个阶段.每阶段均分为双肺通气(TLV)和单肺通气(OLV),分别于各阶段TLV、OLVl5分钟后测量分流(Qs/Qt)及氧供(DO2)、氧耗(VO2)等各指标变化.结果随着HD程度的加深,平均动脉压、心输出量、肺血管阻力(PVR)、平均肺动脉压(MPAP)、氧分压、DO2等趋于降低,氧摄取率(ERO2)、血乳酸、Qs/Qt趋于增加,到HD3、HD4时已出现DO2-VO2依赖性降低及无氧酵解征象.与TLV时相比,OLV期间HD0、HD1及HD2组PVR、MPAP增高明显(P<0.01),而HD3、HD4组变化不大(P>0.05);OLV时QS/Qt增加更为明显,HD2、HD3及HD4组分别较基值增加74%、164%及177%(P<0.01).结论缺氧、ANHD均为影响Qs/Qt与氧合的重要因素,OLV时ANHD应以不低于中度为准.%Objective To evaluate the effects of different degrees of acute normovolemic hemodilution (ANH) on intrapulmonary shunting, oxygen delivery and consumption during one-lung ventilation(OLV) in dogs. Methods Twelve healthy mongrel dogs weighing 18-22 kg were anesthetized with Ⅳ pentobarbital sodium 20mg.kg-1, scopolamine 0.3 mg and pancuronium 0.2 mg. kg-1 and intubated with a left-sided Carlen' s tube. Correct positioning of the tube was verified by auscultation and by visual inspection after thoracotomy at the end of the experiment. The dogs were mechanically ventilated with 100% oxygen. PET CO2 was maintained between 4.67-6.00 kPa. ECG and rectal temperature were continuously monitored. An intravenous line was established for infusion of Lacted Ringer solution. SwanGanz catheter was inserted via femoral vein on one side for sampling of mixed venous blood and measurement of cardiac output (CO) by

  10. 381例新生儿心脏彩超结果分析%Analysis of Neonatal Cardiac Ultrasound Results of 381 Cases

    Institute of Scientific and Technical Information of China (English)

    王丽娟; 杨家翔; 赵婧; 白艳; 彭卉; 梁蓉

    2015-01-01

    目的:了解新生儿先天性心脏病( CHD)类型分布,探讨新生儿彩色多普勒超声心动图在新生儿CHD的早期筛查中的重要性。方法对有口唇或甲床发绀、呼吸急促、新生儿肺炎、听诊发现有心脏杂音以及胸片提示心影增大等疑似有新生儿CHD的381例新生儿行彩色多普勒超声心动图检查,并回顾性分析产前胎儿期的彩色多普勒超声心动图检查情况。结果本组疑似新生儿CHD患儿381例中彩色多普勒超声心动图异常患儿324例,检出率为85.04%,其中以卵圆孔未闭、动脉导管未闭最多见,其次分别为室间隔及房间隔缺损,复杂及严重CHD所占比例相对较低。在381例受检者中,行过产前胎儿彩色多普勒超声心动图检查者201例,占总人数的52.76%,CHD发生率8.96%,未行产前胎儿彩色多普勒超声心动图检查者CHD发生率42.78%。结论彩色多普勒超声心动图在产前胎儿中得到了广泛的应用,然并不普及。新生儿彩色多普勒超声心动图检出异常者主要以预后较好的单纯卵圆孔未闭和动脉导管未闭常见,复杂及严重CHD占有一定的比例。采用彩色多普勒超声心动图等检查项目筛查和随访是非常必要的,需认识导致新生儿CHD的原因,尽早发现CHD患儿,为及时进行干预提供保障。%Objective Understanding the type of congenital heart disease distribution, discuss the importance of color doppler echocardiography in screening neonatuses with congenital heartdisease( CHD) . Methods To give color doppler echocar-diography to 381 neonatuses with doubtful CHD who have the lips or nail bed cyanosis,shortness of breath,neonatal pneumonia, auscultation found to have heart murmur and chest X-ray prompt increased heart shadow,etc. and retrospective analysis of prenatal fetal color doppler echocardiography situation. Results To tally 324 neonatuses who color doppler echocardiographic abnormalities in doubtful 381

  11. The Audible Human Project: Modeling Sound Transmission in the Lungs and Torso

    Science.gov (United States)

    Dai, Zoujun

    Auscultation has been used qualitatively by physicians for hundreds of years to aid in the monitoring and diagnosis of pulmonary diseases. Alterations in the structure and function of the pulmonary system that occur in disease or injury often give rise to measurable changes in lung sound production and transmission. Numerous acoustic measurements have revealed the differences of breath sounds and transmitted sounds in the lung under normal and pathological conditions. Compared to the extensive cataloging of lung sound measurements, the mechanism of sound transmission in the pulmonary system and how it changes with alterations of lung structural and material properties has received less attention. A better understanding of sound transmission and how it is altered by injury and disease might improve interpretation of lung sound measurements, including new lung imaging modalities that are based on an array measurement of the acoustic field on the torso surface via contact sensors or are based on a 3-dimensional measurement of the acoustic field throughout the lungs and torso using magnetic resonance elastography. A long-term goal of the Audible Human Project (AHP ) is to develop a computational acoustic model that would accurately simulate generation, transmission and noninvasive measurement of sound and vibration within the pulmonary system and torso caused by both internal (e.g. respiratory function) and external (e.g. palpation) sources. The goals of this dissertation research, fitting within the scope of the AHP, are to develop specific improved theoretical understandings, computational algorithms and experimental methods aimed at transmission and measurement. The research objectives undertaken in this dissertation are as follows. (1) Improve theoretical modeling and experimental identification of viscoelasticity in soft biological tissues. (2) Develop a poroviscoelastic model for lung tissue vibroacoustics. (3) Improve lung airway acoustics modeling and its

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

    Institute of Scientific and Technical Information of China (English)

    王灿; 苗艳艳; 苗明三

    2015-01-01

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

  13. Diagnosis and Treatment in 20 Children with Aerophagia%儿童吞气症20例的诊断与治疗

    Institute of Scientific and Technical Information of China (English)

    郝理华; 刘志峰

    2012-01-01

    Objective To investigate the diagnosis and treatment of childhood aerophagia. Methods Twenty children with aerophagia, aged 2-13 years old,hospitalized in Nanjing Children's Hospital Affiliated to Nanjing Medical University from Jul. 2005 to Mar. 2009 were selected. All the diagnosis were made according to the medical history, physical examination and laboratory tests, parenchymal diseases were excluded. The clinical data of them were reviewed. Results The diagnostic clinical profiles suggested by Rome IE criteria,all the 20 cases of aerophagia were diagnosed. Of the 20 patients,the chief complaints were abdominal distention in 20 cases(100% ) .visible or audible air swallowing in 20 cases(100%),repetitive belching in 18 cases(90%) .reduced appetite in 18 cases(90% ),constipation in 12 cases(60%), psychological stresses in 8 cases(40% ) .recurrent abdominal pain in 6 cases(30% ) .chronic diarrhea in 2 cases(10% ) and acute abdominal pain in 2 cases(10% ). Physical examination:obvious abdominal distention,soft abdomen.no tenderness or mess,percussion for the sound of drums,auscultation for active bowel sounds. X - ray showed excessive gastrointestinal gas, with no liquid plane. The infection disease,electrolytes disturbance and surgical diseases were excluded by normal blood,urine and stool test,stool cultivation,enterovirus and blood biochemistry detection. Fourteen cases(70% ) were cured by psychological counseling management, diet modification, laxatives,propubives and vitamins. Six several cases were also cured after silicone oils(dimethicone or simethicone) treatment. Conclusions Aerophagia is a kind of functional gastrointestinal disorders in children. Part cases of aerophagia are accompanied with psychiatric disorders, a self - limited course were common observed in the patients without psychiatric disorders. Silicone oils can help to alleviate the clinical symptoms and may shorten the duration of illness.%目的 探讨吞气症的诊断和治疗.方法

  14. 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

    Directory of Open Access Journals (Sweden)

    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

  15. 1 ∶ 2 matched case-control study on the risk factors related to congenital heart disease during the peri-conceptional period%围孕期先天性心脏病危险因素的1∶2配比病例对照研究

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Ariel Pérez-Monroy¹

    2010-01-01

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

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

    Institute of Scientific and Technical Information of China (English)

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

    2014-01-01

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

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

    Directory of Open Access Journals (Sweden)

    Marcos Doederlein Polito

    2003-02-01

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

  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

    Directory of Open Access Journals (Sweden)

    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. 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

    Directory of Open Access Journals (Sweden)

    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

  1. 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.

  2. 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.

  3. 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.