Oesophageal intubation can be undetected by auscultation of the chest

DEFF Research Database (Denmark)

Andersen, K H; Schultz-Lebahn, T

1994-01-01

Prompt detection of oesophageal intubation is a primary concern in anaesthetic practice. This blind, randomised study evaluates three widely used tests of intubation. Forty patients had both their trachea and oesophagus intubated, each patient was studied twice. Auscultation of the epigastrium......, right and left axilla is more reliable than auscultation of the chest, and the anaesthetist's feeling when he squeezes the bag. P = 0.001 and P = 0.048, respectively. The tests were carried out after gastric distension with gas had occurred. We conclude that auscultation of epigastrium, right and left...

Source Separation of Heartbeat Sounds for Effective E-Auscultation

Science.gov (United States)

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

2016-03-01

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

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

Science.gov (United States)

Pfeiffer, P; Rudolph, S S; Børglum, J; Isbye, D L

2011-11-01

This study compared the time consumption of bilateral lung ultrasound with auscultation and capnography for verifying endotracheal intubation. A prospective, paired, and investigator-blinded study carried out in the operating theatre. Twenty-five adult patients requiring endotracheal intubation were included. During intubation, transtracheal ultrasound was performed to visualize passage of the endotracheal tube. During bag ventilation, bilateral lung ultrasound was performed for the detection of lung sliding as a sign of ventilation simultaneous with capnography and auscultation of the epigastrium and chest. Primary outcome measure was time difference to confirmed endotracheal intubation between ultrasound and auscultation alone. Secondary outcome measure was time difference between ultrasound and auscultation combined with capnography. Both methods verified endotracheal tube placement in all patients. In 68% of patients, endotracheal tube placement was visualized by real-time transtracheal ultrasound. Comparing ultrasound with the combination of auscultation and capnography, there was a significant difference between the two methods. Median time for ultrasound was 40 s [interquartile range (IQR) 35-48 s] vs. 48 s (IQR 45-53 s), P auscultation alone. Median time for auscultation alone was 42 s (IQR 37-47 s), P = 0.6, with a mean difference of -0.88 s in favour of ultrasound (95% CI -4.2-2.5 s). Verification of endotracheal tube placement with ultrasound is as fast as auscultation alone and faster than the standard method of auscultation and capnography. © 2011 The Authors. Acta Anaesthesiologica Scandinavica © 2011 The Acta Anaesthesiologica Scandinavica Foundation.

Abdominal auscultation does not provide clear clinical diagnoses.

Science.gov (United States)

Durup-Dickenson, Maja; Christensen, Marie Kirk; Gade, John

2013-05-01

Abdominal auscultation is a part of the clinical examination of patients, but the determining factors in bowel sound evaluation are poorly described. The aim of this study was to assess inter- and intra-observer agreement in physicians' evaluation of pitch, intensity and quantity in abdominal auscultation. A total of 100 physicians were presented with 20 bowel sound recordings in a blinded set-up. Recordings had been made in a mix of healthy volunteers and emergency patients. They evaluated pitch, intensity and quantity of bowel sounds in a questionnaire with three, three and four categories of answers, respectively. Fleiss' multi-rater kappa (κ) coefficients were calculated for inter-observer agreement; for intra-observer agreement, calculation of probability was performed. Inter-observer agreement regarding pitch, intensity and quantity yielded κ-values of 0.19 (p auscultation increases with addition of history and clinics, and may be further improved by systematic training, it should still be used in the examination of patients with acute abdominal pain. not relevant. not relevant.

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…

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

Science.gov (United States)

Pfeiffer, P; Bache, S; Isbye, D L; Rudolph, S S; Rovsing, L; Børglum, J

2012-05-01

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 capnography for verifying endotracheal intubation in obese patients. A prospective, paired and investigator-blinded study performed in the operating theatre. Twenty-four adult patients requiring endotracheal intubation for bariatric surgery were included. During post-intubation bag ventilation, bilateral lung US was performed for detection of lungsliding indicating lung ventilation simultaneous with capnography and auscultation of epigastrium and chest. Primary outcome measure was the time difference to confirmed endotracheal intubation between US and auscultation alone. The secondary outcome measure was time difference between US and auscultation combined with capnography. Both methods verified endotracheal tube placement in all patients. No significant difference was found between US compared with auscultation alone. Median time for verification by auscultation alone was 47.5 s [interquartile (IQR) 40-51 s], with a mean difference of -0.3 s in favor of US (95% confidence interval -3.5-2.9 s) P = 0.87. Comparing US with the combination of auscultation and capnography, there was a significant difference between the two methods. Median time for verification by US was 43 s (IQR 40-51 s) vs. 55 s (IQR 46-65 s), P auscultation alone and faster than the standard method of auscultation and capnography. © 2012 The Authors. Acta Anaesthesiologica Scandinavica © 2012 The Acta Anaesthesiologica Scandinavica Foundation.

Cardiac Auscultation Using Smartphones: Pilot Study.

Science.gov (United States)

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

2018-02-28

Cardiac auscultation is a cost-effective, noninvasive screening tool that can provide information about cardiovascular hemodynamics and disease. However, with advances in imaging and laboratory tests, the importance of cardiac auscultation is less appreciated in clinical practice. The widespread use of smartphones provides opportunities for nonmedical expert users to perform self-examination before hospital visits. The objective of our study was to assess the feasibility of cardiac auscultation using smartphones with no add-on devices for use at the prehospital stage. We performed a pilot study of patients with normal and pathologic heart sounds. Heart sounds were recorded on the skin of the chest wall using 3 smartphones: the Samsung Galaxy S5 and Galaxy S6, and the LG G3. Recorded heart sounds were processed and classified by a diagnostic algorithm using convolutional neural networks. We assessed diagnostic accuracy, as well as sensitivity, specificity, and predictive values. A total of 46 participants underwent heart sound recording. After audio file processing, 30 of 46 (65%) heart sounds were proven interpretable. Atrial fibrillation and diastolic murmur were significantly associated with failure to acquire interpretable heart sounds. The diagnostic algorithm classified the heart sounds into the correct category with high accuracy: Galaxy S5, 90% (95% CI 73%-98%); Galaxy S6, 87% (95% CI 69%-96%); and LG G3, 90% (95% CI 73%-98%). Sensitivity, specificity, positive predictive value, and negative predictive value were also acceptable for the 3 devices. Cardiac auscultation using smartphones was feasible. Discrimination using convolutional neural networks yielded high diagnostic accuracy. However, using the built-in microphones alone, the acquisition of reproducible and interpretable heart sounds was still a major challenge. ClinicalTrials.gov NCT03273803; https://clinicaltrials.gov/ct2/show/NCT03273803 (Archived by WebCite at http://www.webcitation.org/6x6g1f

Digital stethoscopes compared to standard auscultation for detecting abnormal paediatric breath sounds.

Science.gov (United States)

Kevat, Ajay C; Kalirajah, Anaath; Roseby, Robert

2017-07-01

Our study aimed to objectively describe the audiological characteristics of wheeze and crackles in children by using digital stethoscope (DS) auscultation, as well as assess concordance between standard auscultation and two different DS devices in their ability to detect pathological breath sounds. Twenty children were auscultated by a paediatric consultant doctor and digitally recorded using the Littman™ 3200 Digital Electronic Stethoscope and a Clinicloud™ DS with smart device. Using spectrographic analysis, we found those with clinically described wheeze had prominent periodic waveform segments spanning expiration for a period of 0.03-1.2 s at frequencies of 100-1050 Hz, and occasionally spanning shorter inspiratory segments; paediatric crackles were brief discontinuous sounds with a distinguishing waveform. There was moderate concordance with respect to wheeze detection between digital and standard binaural stethoscopes, and 100% concordance for crackle detection. Importantly, DS devices were more sensitive than clinician auscultation in detecting wheeze in our study. Objective definition of audio characteristics of abnormal paediatric breath sounds was achieved using DS technology. We demonstrated superiority of our DS method compared to traditional auscultation for detection of wheeze. What is Known: • The audiological characteristics of abnormal breath sounds have been well-described in adult populations but not in children. • Inter-observer agreement for detection of pathological breath sounds using standard auscultation has been shown to be poor, but the clinical value of now easily available digital stethoscopes has not been sufficiently examined. What is New: • Digital stethoscopes can objectively define the nature of pathological breath sounds such as wheeze and crackles in children. • Paediatric wheeze was better detected by digital stethoscopes than by standard auscultation performed by an expert paediatric clinician.

Pulse Oximetry and Auscultation for Congenital Heart Disease Detection.

Science.gov (United States)

Hu, Xiao-Jing; Ma, Xiao-Jing; Zhao, Qu-Ming; Yan, Wei-Li; Ge, Xiao-Ling; Jia, Bing; Liu, Fang; Wu, Lin; Ye, Ming; Liang, Xue-Cun; Zhang, Jing; Gao, Yan; Zhai, Xiao-Wen; Huang, Guo-Ying

2017-10-01

Pulse oximetry (POX) has been confirmed as a specific screening modality for critical congenital heart disease (CCHD), with moderate sensitivity. However, POX is not able to detect most serious and critical cardiac lesions (major congenital heart disease [CHD]) without hypoxemia. In this study, we investigated the accuracy and feasibility of the addition of cardiac auscultation to POX as a screening method for asymptomatic major CHD. A multicenter prospective observational screening study was conducted at 15 hospitals in Shanghai between July 1, 2012, and December 31, 2014. Newborns with either an abnormal POX or cardiac auscultation were defined as screen positive. All screen-positive newborns underwent further echocardiography. False-negative results were identified by clinical follow-up, parents' feedback, and telephone review. We assessed the accuracy of POX plus cardiac auscultation for the detection of major CHD. CHD screening was completed in all 15 hospitals, with a screening rate of 94.0% to 99.8%. In total, 167 190 consecutive asymptomatic newborn infants were screened, of which 203 had major CHD (44 critical and 159 serious). The sensitivity of POX plus cardiac auscultation was 95.5% (95% confidence interval 84.9%-98.7%) for CCHD and 92.1% (95% confidence interval 87.7%-95.1%) for major CHD. The false-positive rate was 1.2% for detecting CCHD and 1.1% for detecting major CHD. In our current study, we show that using POX plus cardiac auscultation significantly improved the detection rate of major CHD in the early neonatal stage, with high sensitivity and a reasonable false-positive rate. It provides strong evidence and a reliable method for neonatal CHD screening. Copyright © 2017 by the American Academy of Pediatrics.

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.

Point-of-care ultrasound versus auscultation in determining the position of double-lumen tube.

Science.gov (United States)

Hu, Wei-Cai; Xu, Lei; Zhang, Quan; Wei, Li; Zhang, Wei

2018-03-01

This study was designed to assess the accuracy of point-of-care ultrasound in determining the position of double-lumen tubes (DLTs).A total of 103 patients who required DLT intubation were enrolled into the study. After DLTs were tracheal intubated in the supine position, an auscultation researcher and ultrasound researcher were sequentially invited in the operating room to conduct their evaluation of the DLT. After the end of their evaluation, fiberscope researchers (FRs) were invited in the operating room to evaluate the position of DLT using a fiberscope. After the patients were changed to the lateral position, the same evaluation process was repeated. These 3 researchers were blind to each other when they made their conclusions. Sensitivity, specificity, positive predictive value, negative predictive value, and accuracy were obtained by statistical analysis.When left DLTs (LDLTs) were used, the accuracy of ultrasound (84.2% [72.1%, 92.5%]) was higher than the accuracy of auscultation (59.7% [45.8%, 72.4%]) (P auscultation (67.4% [52.0%, 80.5%]) (P auscultation (54.4% [40.7%, 67.6%]) (P auscultation (47.8% [32.9%, 63.1%]) (P auscultation in determining the position of DLTs.

CompuLung: a multimedia CBL on pulmonary auscultation.

Science.gov (United States)

Mangione, S.; Dennis, S.

1992-01-01

Cardio-pulmonary auscultation, a time honored art, is suffering a declining interest caused by competing diagnostic technology and inadequate training of physicians. Overreliance on diagnostic technology is expensive, not cost-effective and bound to lead to loss of our clinical heritage. We need novel methods to teach and revive this art. Computer-Based Learning (CBL), particularly multimedia supporting graphics plus sound-and-motion pictures, appears to be ideally suited for teaching and sharpening this skill. We present in this paper a multimedia CBL ("CompuLung"), that provides the user with a comprehensive and interactive tutorial on pulmonary auscultation. PMID:1482999

Objective Auscultation of TCM Based on Wavelet Packet Fractal Dimension and Support Vector Machine

Science.gov (United States)

Yan, Jian-Jun; Wang, Yi-Qin; Liu, Guo-Ping; Yan, Hai-Xia; Xia, Chun-Ming; Shen, Xiaojing

2014-01-01

This study was conducted to illustrate that auscultation features based on the fractal dimension combined with wavelet packet transform (WPT) were conducive to the identification the pattern of syndromes of Traditional Chinese Medicine (TCM). The WPT and the fractal dimension were employed to extract features of auscultation signals of 137 patients with lung Qi-deficient pattern, 49 patients with lung Yin-deficient pattern, and 43 healthy subjects. With these features, the classification model was constructed based on multiclass support vector machine (SVM). When all auscultation signals were trained by SVM to decide the patterns of TCM syndromes, the overall recognition rate of model was 79.49%; when male and female auscultation signals were trained, respectively, to decide the patterns, the overall recognition rate of model reached 86.05%. The results showed that the methods proposed in this paper were effective to analyze auscultation signals, and the performance of model can be greatly improved when the distinction of gender was considered. PMID:24883068

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

OpenAIRE

YILDIZ, Oktay; Arslan, Ayşe

2018-01-01

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

Hybrid High-Fidelity Auscultation Scope, Phase I

Data.gov (United States)

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

Intermittent Auscultation for Intrapartum Fetal Heart Rate Surveillance: American College of Nurse-Midwives.

Science.gov (United States)

2015-01-01

Fetal heart rate surveillance is a standard component of intrapartum care. The fetal heart rate can be evaluated using intermittent auscultation or electronic fetal monitoring. Research that has compared these 2 strategies found them to be equivalent with respect to long-term neonatal outcomes. The purpose of this clinical bulletin by the American College of Nurse-Midwives is to review the evidence for use of intermittent auscultation and provide recommendations for intermittent auscultation technique, interpretation, and documentation. © 2015 by the American College of Nurse-Midwives.

In defence of auscultation: a glorious future?

Science.gov (United States)

Thompson, W Reid

2017-01-01

Auscultation of the heart using a simple stethoscope continues to be a central aspect of the cardiovascular examination despite declining proficiency and availability of competing technologies such as hand-held ultrasound. In the ears and mind of a trained cardiologist, heart sounds can provide important information to help screen for certain diseases such as valvar lesions and many congenital defects. Using emerging technology, auscultation is poised to undergo a transformation that will simultaneously improve the teaching and evaluation of this important clinical skill and create a new generation of smart stethoscopes, capable of assisting the clinician in quickly and confidently screening for heart disease. These developments have important implications for global health, screening of athletes and recognition of congenital heart disease. PMID:28243316

Technology for enhancing chest auscultation in clinical simulation.

Science.gov (United States)

Ward, Jeffrey J; Wattier, Bryan A

2011-06-01

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

Auscultation of Velcro Crackles is Associated With Usual Interstitial Pneumonia.

Science.gov (United States)

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

2016-02-01

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

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....

Brief report: pulmonary auscultation in the operating room: a prospective randomized blinded trial comparing electronic and conventional stethoscopes.

Science.gov (United States)

Hoffmann, Clement; Falzone, Elisabeth; Verret, Catherine; Pasquier, Pierre; Leclerc, Thomas; Donat, Nicolas; Jost, Daniel; Mérat, Stephane; Maurice, Guillaume de Saint; Lenoir, Bernard; Auroy, Yves; Tourtier, Jean-Pierre

2013-09-01

We compared the subjective quality of pulmonary auscultation between 2 acoustic stethoscopes (Holtex Ideal® and Littmann Cardiology III®) and an electronic stethoscope (Littmann 3200®) in the operating room. A prospective double-blind randomized study with an evaluation during mechanical ventilation was performed in 100 patients. After each examination, the listeners using a numeric scale (0-10) rated the quality of auscultation. Auscultation quality was compared in patients among stethoscopes with a multilevel mixed-effects linear regression with random intercept (operator effect), adjusted on significant factors in univariate analysis. A significant difference was defined as P auscultation were performed. The quality of auscultation was rated 8.2 ± 1.6 for the electronic stethoscope, 7.4 ± 1.8 for the Littmann Cardiology III, and 4.6 ± 1.8 for the Holtex Ideal. Compared with Holtex Ideal, auscultation quality was significantly higher with other stethoscopes (P auscultation quality was significantly higher with Littmann 3200 electronic stethoscope (β = 0.9 [95% confidence interval, 0.5-1.3]). An electronic stethoscope can provide a better quality of pulmonary auscultation than acoustic stethoscopes in the operating room, yet with a magnitude of improvement marginally higher than that provided with a high performance acoustic stethoscope. Whether this can translate into a clinically relevant benefit requires further studies.

A simulator-based study of in-flight auscultation.

Science.gov (United States)

Tourtier, Jean-Pierre; Libert, Nicolas; Clapson, Patrick; Dubourdieu, Stéphane; Jost, Daniel; Tazarourte, Karim; Astaud, Cécil-Emmanuel; Debien, Bruno; Auroy, Yves

2014-04-01

The use of a stethoscope is essential to the delivery of continuous, supportive en route care during aeromedical evacuations. We compared the capability of 2 stethoscopes (electronic, Litmann 3000; conventional, Litmann Cardiology III) at detecting pathologic heart and lung sounds, aboard a C135, a medical transport aircraft. Sounds were mimicked using a mannequin-based simulator SimMan. Five practitioners examined the mannequin during a fly, with a variety of abnormalities as follows: crackles, wheezing, right and left lung silence, as well as systolic, diastolic, and Austin-Flint murmur. The comparison for diagnosis assessed (correct or wrong) between using the electronic and conventional stethoscopes were performed as a McNemar test. A total of 70 evaluations were performed. For cardiac sounds, diagnosis was right in 0/15 and 4/15 auscultations, respectively, with conventional and electronic stethoscopes (McNemar test, P = 0.13). For lung sounds, right diagnosis was found with conventional stethoscope in 10/20 auscultations versus 18/20 with electronic stethoscope (P = 0.013). Flight practitioners involved in aeromedical evacuation on C135 plane are more able to practice lung auscultation on a mannequin with this amplified stethoscope than with the traditional one. No benefit was found for heart sounds.

A statistical analysis of cervical auscultation signals from adults with unsafe airway protection.

Science.gov (United States)

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

2016-01-22

Aspiration, where food or liquid is allowed to enter the larynx during a swallow, is recognized as the most clinically salient feature of oropharyngeal dysphagia. This event can lead to short-term harm via airway obstruction or more long-term effects such as pneumonia. In order to non-invasively identify this event using high resolution cervical auscultation there is a need to characterize cervical auscultation signals from subjects with dysphagia who aspirate. In this study, we collected swallowing sound and vibration data from 76 adults (50 men, 26 women, mean age 62) who underwent a routine videofluoroscopy swallowing examination. The analysis was limited to swallows of liquid with either thin (auscultation.

A comparative study of electronic stethoscopes for cardiac auscultation.

Science.gov (United States)

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

2017-07-01

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

Auscultation of the lung: past lessons, future possibilities.

Science.gov (United States)

Murphy, R L

1981-01-01

Review of the history of auscultation of the lung reveals few scientific investigations. The majority of these have led to inconclusive results. The mechanism of production of normal breath sounds remains uncertain. Hypotheses for the generation of adventitious sounds are unproven. Advances in instrumentation for lung sound recording and analysis have provided little of clinical value. There has been a recent resurgence of interest in lung sounds. Space-age technology has improved methodology for sonic analysis significantly. Lung sounds are complex signals that probably reflect regional lung pathophysiology. If they were understood more clearly important non-invasive diagnostic tools could be devised and the value of clinical auscultation could be improved. A multidisciplinary effort will be required to achieve this. PMID:7268687

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

International Nuclear Information System (INIS)

1994-09-01

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

An automated computerized auscultation and diagnostic system for pulmonary diseases.

Science.gov (United States)

Abbas, Ali; Fahim, Atef

2010-12-01

Respiratory sounds are of significance as they provide valuable information on the health of the respiratory system. Sounds emanating from the respiratory system are uneven, and vary significantly from one individual to another and for the same individual over time. In and of themselves they are not a direct proof of an ailment, but rather an inference that one exists. Auscultation diagnosis is an art/skill that is acquired and honed by practice; hence it is common to seek confirmation using invasive and potentially harmful imaging diagnosis techniques like X-rays. This research focuses on developing an automated auscultation diagnostic system that overcomes the limitations inherent in traditional auscultation techniques. The system uses a front end sound signal filtering module that uses adaptive Neural Networks (NN) noise cancellation to eliminate spurious sound signals like those from the heart, intestine, and ambient noise. To date, the core diagnosis module is capable of identifying lung sounds from non-lung sounds, normal lung sounds from abnormal ones, and identifying wheezes from crackles as indicators of different ailments.

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

Science.gov (United States)

Lagarde, Marloes L J; Kamalski, Digna M A; van den Engel-Hoek, Lenie

2016-02-01

To systematically review the available evidence for the reliability and validity of cervical auscultation in diagnosing the several aspects of dysphagia in adults and children suffering from dysphagia. Medline (PubMed), Embase and the Cochrane Library databases. The systematic review was carried out applying the steps of the PRISMA-statement. The methodological quality of the included studies were evaluated using the Dutch 'Cochrane checklist for diagnostic accuracy studies'. A total of 90 articles were identified through the search strategy, and after applying the inclusion and exclusion criteria, six articles were included in this review. In the six studies, 197 patients were assessed with cervical auscultation. Two of the six articles were considered to be of 'good' quality and three studies were of 'moderate' quality. One article was excluded because of a 'poor' methodological quality. Sensitivity ranges from 23%-94% and specificity ranges from 50%-74%. Inter-rater reliability was 'poor' or 'fair' in all studies. The intra-rater reliability shows a wide variance among speech language therapists. In this systematic review, conflicting evidence is found for the validity of cervical auscultation. The reliability of cervical auscultation is insufficient when used as a stand-alone tool in the diagnosis of dysphagia in adults. There is no available evidence for the validity and reliability of cervical auscultation in children. Cervical auscultation should not be used as a stand-alone instrument to diagnose dysphagia. © The Author(s) 2015.

Computer-aided auscultation of murmurs in children: evaluation of commercially available software.

Science.gov (United States)

Lee, Cecilia; Rankin, Kathryn N; Zuo, Kevin J; Mackie, Andrew S

2016-10-01

Heart murmurs are common in children and may represent congenital or acquired cardiac pathology. Auscultation is challenging and many primary-care physicians lack the skill to differentiate innocent from pathologic murmurs. We sought to determine whether computer-aided auscultation (CardioscanTM) identifies which children require referral to a cardiologist. We consecutively enrolled children aged between 0 and 17 years with a murmur, innocent or pathologic, being evaluated in a tertiary-care cardiology clinic. Children being evaluated for the first time and patients with known cardiac pathology were eligible. We excluded children who had undergone cardiac surgery previously or were unable to sit still for auscultation. CardioscanTM auscultation was performed in a quiet room with the subject in the supine position. The sensitivity and specificity of a potentially pathologic murmur designation by CardioscanTM - that is, requiring referral - was determined using echocardiography as the reference standard. We enrolled 126 subjects (44% female) with a median age of 1.7 years, with 93 (74%) having cardiac pathology. The sensitivity and specificity of a potentially pathologic murmur determination by CardioscanTM for identification of cardiac pathology were 83.9 and 30.3%, respectively, versus 75.0 and 71.4%, respectively, when limited to subjects with a heart rate of 50-120 beats per minute. The combination of a CardioscanTM potentially pathologic murmur designation or an abnormal electrocardiogram improved sensitivity to 93.5%, with no haemodynamically significant lesions missed. Sensitivity of CardioscanTM when interpreted in conjunction with an abnormal electrocardiogram was high, although specificity was poor. Re-evaluation of computer-aided auscultation will remain necessary as advances in this technology become available.

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

Science.gov (United States)

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

2011-01-01

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

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

DEFF Research Database (Denmark)

Nielsen, Tommy; Mølgaard, Henning; Ringsted, Charlotte

2010-01-01

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

The paediatrician and cardiac auscultation

OpenAIRE

Roy, Douglas L

2003-01-01

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

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

Science.gov (United States)

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

2014-01-01

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

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.

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

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

2017-06-07

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

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

Science.gov (United States)

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

2017-01-01

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

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

Directory of Open Access Journals (Sweden)

Jang-Zern Tsai

2017-06-01

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

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

Science.gov (United States)

Høyte, Henning; Jensen, Torstein; Gjesdal, Knut

2005-01-01

Background To determine whether the use of an electronic, sensor based stethoscope affects the cardiac auscultation skills of undergraduate medical students. Methods Forty eight third year medical students were randomized to use either an electronic stethoscope, or a conventional acoustic stethoscope during clinical auscultation training. After a training period of four months, cardiac auscultation skills were evaluated using four patients with different cardiac murmurs. Two experienced cardiologists determined correct answers. The students completed a questionnaire for each patient. The thirteen questions were weighted according to their relative importance, and a correct answer was credited from one to six points. Results No difference in mean score was found between the two groups (p = 0.65). Grading and characterisation of murmurs and, if present, report of non existing murmurs were also rated. None of these yielded any significant differences between the groups. Conclusion Whether an electronic or a conventional stethoscope was used during training and testing did not affect the students' performance on a cardiac auscultation test. PMID:15882458

Diagnostic value of chest ultrasound after cardiac surgery: a comparison with chest X-ray and auscultation.

Science.gov (United States)

Vezzani, Antonella; Manca, Tullio; Brusasco, Claudia; Santori, Gregorio; Valentino, Massimo; Nicolini, Francesco; Molardi, Alberto; Gherli, Tiziano; Corradi, Francesco

2014-12-01

Chest auscultation and chest x-ray commonly are used to detect postoperative abnormalities and complications in patients admitted to intensive care after cardiac surgery. The aim of the study was to evaluate whether chest ultrasound represents an effective alternative to bedside chest x-ray to identify early postoperative abnormalities. Diagnostic accuracy of chest auscultation and chest ultrasound were compared in identifying individual abnormalities detected by chest x-ray, considered the reference method. Cardiac surgery intensive care unit. One hundred fifty-one consecutive adult patients undergoing cardiac surgery. All patients included were studied by chest auscultation, ultrasound, and x-ray upon admission to intensive care after cardiac surgery. Six lung pathologic changes and endotracheal tube malposition were found. There was a highly significant correlation between abnormalities detected by chest ultrasound and x-ray (k = 0.90), but a poor correlation between chest auscultation and x-ray abnormalities (k = 0.15). Chest auscultation may help identify endotracheal tube misplacement and tension pneumothorax but it may miss most major abnormalities. Chest ultrasound represents a valid alternative to chest x-ray to detect most postoperative abnormalities and misplacements. Copyright © 2014 Elsevier Inc. All rights reserved.

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

Directory of Open Access Journals (Sweden)

Prasertsak Charoen

2017-04-01

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

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

Science.gov (United States)

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

2014-12-01

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

Cardiac auscultation poorly predicts the presence of valvular heart disease in asymptomatic primary care patients.

Science.gov (United States)

Gardezi, Syed K M; Myerson, Saul G; Chambers, John; Coffey, Sean; d'Arcy, Joanna; Hobbs, F D Richard; Holt, Jonathan; Kennedy, Andrew; Loudon, Margaret; Prendergast, Anne; Prothero, Anthony; Wilson, Joanna; Prendergast, Bernard D

2018-05-24

Cardiac auscultation is a key clinical skill, particularly for the diagnosis of valvular heart disease (VHD). However, its utility has declined due to the widespread availability of echocardiography and diminishing emphasis on the importance of clinical examination. We aim to determine the contemporary accuracy of auscultation for diagnosing VHD in primary care. Cardiac auscultation was undertaken by one of two experienced general practitioners (primary care/family doctors) in a subset of 251 asymptomatic participants aged >65 years undergoing echocardiography within a large community-based screening study of subjects with no known VHD. Investigators were blinded to the echocardiographic findings. Newly detected VHD was classified as mild (mild regurgitation of any valve or aortic sclerosis) or significant (at least moderate regurgitation or mild stenosis of any valve). Newly identified VHD was common, with mild disease in 170/251 participants (68%) and significant disease in 36/251 (14%). The sensitivity of auscultation was low for the diagnosis of mild VHD (32%) but slightly higher for significant VHD (44%), with specificities of 67% and 69%, respectively. Likelihood ratios were not statistically significant for the diagnosis of either mild or significant VHD in the overall cohort, but showed possible value for auscultation in non-overweight subjects (body mass index auscultation has limited accuracy for the detection of VHD in asymptomatic patients and is a poor diagnostic screening tool in primary care, particularly for overweight subjects. Ensuring easy access to echocardiography in patients with symptoms suggesting VHD is likely to represent a better diagnostic strategy. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

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

Directory of Open Access Journals (Sweden)

Jensen Torstein

2005-05-01

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

Digital stethoscope system: the feasibility of cardiac auscultation

Science.gov (United States)

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

2013-10-01

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

Portable system for auscultation and lung sound analysis.

Science.gov (United States)

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

2014-01-01

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

In-flight auscultation during medical air evacuation: comparison between traditional and amplified stethoscopes.

Science.gov (United States)

Fontaine, Emmanuelle; Coste, Sébastien; Poyat, Chrystelle; Klein, Céline; Lefort, Hugues; Leclerc, Thomas; Dubourdieu, Stéphane; Briche, Frédérique; Jost, Daniel; Maurin, Olga; Domanski, Laurent; Tourtier, Jean-Pierre

2014-01-01

The aim of this study was to evaluate the capacity of a traditional stethoscope versus an electronically amplified one (expected to reduce background and ambient noise) to assess heart and respiratory sounds during medical transport. It was a prospective, double-blinded, randomized performed study. One traditional stethoscope (Littmann Cardiology III; 3M, St Paul, MN) and 1 electronically amplified stethoscope (Littmann 3200, 3M) were used for our tests. Heart and lung auscultation during real medical evacuations aboard a medically configured Falcon 50 aircrafts were studied. The quality of auscultation was ranged using a numeric rating scale from 0 to 10 (0 corresponding to "I hear nothing" and 10 to "I hear perfectly"). Data collected were compared using a t-test for paired values. A total of 40 comparative evaluations were performed. For cardiac auscultation, the value of the rating scale was 4.53 ± 1.91 and 7.18 ± 1.88 for the traditional and amplified stethoscope, respectively (paired t-test: P auscultation was estimated at 3.1 ± 1.95 for a traditional stethoscope and 5.10 ± 2.13 for the amplified one (paired t-test: P < .0001). This study showed that practitioners would be better helped in hearing cardiac and respiratory sounds with an electronically amplified stethoscope than with a traditional one during air medical transport in a medically configured Falcon 50 aircraft. Copyright © 2014 Air Medical Journal Associates. Published by Elsevier Inc. All rights reserved.

Verification of intravenous catheter placement by auscultation--a simple, noninvasive technique.

Science.gov (United States)

Lehavi, Amit; Rudich, Utay; Schechtman, Moshe; Katz, Yeshayahu Shai

2014-01-01

Verification of proper placement of an intravenous catheter may not always be simple. We evaluated the auscultation technique for this purpose. Twenty healthy volunteers were randomized for 18G catheter inserted intravenously either in the right (12) or left arm (8), and subcutaneously in the opposite arm. A standard stethoscope was placed over an area approximately 3 cm proximal to the tip of the catheter in the presumed direction of the vein to grade on a 0-6 scale the murmur heard by rapidly injecting 2 mL of NaCl 0.9% solution. The auscultation was evaluated by a blinded staff anesthesiologist. All 20 intravenous injection were evaluated as flow murmurs, and were graded an average 5.65 (±0.98), whereas all 20 subcutaneous injections were evaluated as either crackles or no sound, and were graded an average 2.00 (±1.38), without negative results. Sensitivity was calculated as 95%. Specificity and Kappa could not be calculated due to an empty false-positive group. Being simple, handy and noninvasive, we recommend to use the auscultation technique for verification of the proper placement of an intravenous catheter when uncertain of its position. Data obtained in our limited sample of healthy subjects need to be confirmed in the clinical setting.

Small Steps in Impacting Clinical Auscultation of Medical Students

Directory of Open Access Journals (Sweden)

Edem K. Binka MD

2016-09-01

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

Radiostethoscopes: an innovative solution for auscultation while wearing protective gear.

Science.gov (United States)

Candiotti, Keith A; Rodriguez, Yiliam; Curia, Luciana; Saltzman, Bruce; Shekhter, Ilya; Rosen, Lisa; Birnbach, David J

2011-01-01

To demonstrate a radiostethoscope that could be modified and successfully used while wearing protective gear to solve the problem of auscultation in a hazardous material or infectious disease setting. This study was a randomized, prospective, and blinded investigation. The study was conducted at the University of Miami-Jackson Memorial Hospital Center for Patient Safety. Two blinded anesthesiologists using a radiostethoscope performed a total of 100 assessments (50 each) to evaluate endotracheal tube position on a human patient simulator (HPS). Each lung of the HPS was ventilated separately using a double lumen tube. Four ventilation patterns (ie, right lung ventilation only; left lung ventilation only; ventilation of both lungs; and an esophageal intubation or no breath sounds) were simulated. The ventilation pattern was determined randomly and participants were blinded. An Ambu-Bag was used for ventilation. An assistant moved the radiostethoscope to the right and left lung fields and then to the abdomen of the HPS while ventilating. Subjects had to identify the ventilation pattern after listening to all three locations. A third member of the research team collected responses. Each subject, who wore both types of respirator (positive and negative), performed a total of 25 trials. Participants later compared the two types of respirators and their ability to auscultate for breath sounds. Subjects were able to verify the correct ventilation pattern in all attempts (100 percent). Radiostethoscopes appear to provide a viable solution for the problem of patient auscultation while wearing protective gear.

Auscultation versus Point-of-care Ultrasound to Determine Endotracheal versus Bronchial Intubation: A Diagnostic Accuracy Study.

Science.gov (United States)

Ramsingh, Davinder; Frank, Ethan; Haughton, Robert; Schilling, John; Gimenez, Kimberly M; Banh, Esther; Rinehart, Joseph; Cannesson, Maxime

2016-05-01

Unrecognized malposition of the endotracheal tube (ETT) can lead to severe complications in patients under general anesthesia. The focus of this double-blinded randomized study was to assess the accuracy of point-of-care ultrasound in verifying the correct position of the ETT and to compare it with the accuracy of auscultation. Forty-two adult patients requiring general anesthesia with ETT were consented. Patients were randomized to right main bronchus, left main bronchus, or tracheal intubation. After randomization, the ETT was placed via fiber-optic visualization. Next, the location of the ETT was assessed using auscultation by a separate blinded anesthesiologist, followed by an ultrasound performed by a third blinded anesthesiologist. Ultrasound examination included assessment of tracheal dilation via cuff inflation with air and evaluation of pleural lung sliding. Statistical analysis included sensitivity, specificity, positive predictive value, negative predictive value, and interobserver agreement for the ultrasound examination (95% CI). In differentiating tracheal versus bronchial intubations, auscultation showed a sensitivity of 66% (0.39 to 0.87) and a specificity of 59% (0.39 to 0.77), whereas ultrasound showed a sensitivity of 93% (0.66 to 0.99) and specificity of 96% (0.79 to 1). Identification of tracheal versus bronchial intubation was 62% (26 of 42) in the auscultation group and 95% (40 of 42) in the ultrasound group (P = 0.0005) (CI for difference, 0.15 to 0.52), and the McNemar comparison showed statistically significant improvement with ultrasound (P auscultation in determining the location of ETT.

Accuracy of pulmonary auscultation to detect abnormal respiratory mechanics: a cross-sectional diagnostic study.

Science.gov (United States)

Xavier, Glaciele Nascimento; Duarte, Antonio Carlos Magalhães; Melo-Silva, César Augusto; dos Santos, Carlos Eduardo Ventura Gaio; Amado, Veronica Moreira

2014-12-01

Pulmonary auscultation is a method used in clinical practice for the evaluation and detection of abnormalities relating to the respiratory system. This method has limitations, as it depends on the experience and hearing acuity of the examiner to determine adventitious sounds. In this context, it's important to analyze whether there is a correlation between auscultation of lung sounds and the behavior of the respiratory mechanical properties of the respiratory system in patients with immediate postoperative cardiac surgery. Copyright © 2014 Elsevier Ltd. All rights reserved.

Relationship between thoracic auscultation and lung pathology detected by ultrasonography in sheep.

Science.gov (United States)

Scott, Phil; Collie, Dave; McGorum, Bruce; Sargison, Neil

2010-10-01

The utility of routine auscultation to detect and characterise the nature of a range of superficial lung and pleural pathologies in domestic sheep was assessed using ultrasonographic examination to indicate and localise pathologies pre-mortem. Necropsy examination was then used to fully characterise the nature and extent of the lesions. Auscultation recordings were made from 10 normal sheep with no clinical evidence of respiratory disease and with absence of significant superficial lung pathology, which was confirmed initially by ultrasound examination and subsequently at necropsy examination. A further two sheep with endotoxaemia and 30 sheep with well-defined lung lesions were also examined. Increased audibility of normal lung sounds in 4/10 normal sheep was associated with tachypnoea as a consequence of handling and transport during hot weather and was also observed in the two sheep with endotoxaemia. Moderate to severe coarse crackles detected in all advanced cases of ovine pulmonary adenocarcinoma (n=16) were audible over an area larger than the lesion distribution identified during ultrasound examination, and confirmed later at necropsy. Auscultation did not detect abnormal sounds in any of the five sheep with focal pleural abscesses (up to 10 cm diameter). Unilateral pyothorax caused attenuation of sounds relative to the contra-lateral normal lung in all three sheep with this condition. Marked fibrinous pleurisy caused attenuation of sounds relative to normal areas of lung in six sheep. No sounds resembling the description of pleural frictions rubs were heard in the sheep with marked fibrinous pleurisy (n=6) or associated with focal pleural abscesses (n=5). Routine interpretation of auscultated sound did not allow the presence of superficial lung pathology or its distribution to be accurately defined in the respiratory diseases represented in this study. Copyright © 2009 Elsevier Ltd. All rights reserved.

A quality assessment of cardiac auscultation material on YouTube.

Science.gov (United States)

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

2013-02-01

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

Diagnosis of asbestosis by a time expanded wave form analysis, auscultation and high resolution computed tomography: a comparative study.

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al Jarad, N; Strickland, B; Bothamley, G; Lock, S; Logan-Sinclair, R; Rudd, R M

1993-01-01

BACKGROUND--Crackles are a prominent clinical feature of asbestosis and may be an early sign of the condition. Auscultation, however, is subjective and interexaminer disagreement is a problem. Computerised lung sound analysis can visualise, store, and analyse lung sounds and disagreement on the presence of crackles is minimal. High resolution computed tomography (HRCT) is superior to chest radiography in detecting early signs of asbestosis. The aim of this study was to compare clinical auscultation, time expanded wave form analysis (TEW), chest radiography, and HRCT in detecting signs of asbestosis in asbestos workers. METHODS--Fifty three asbestos workers (51 men and two women) were investigated. Chest radiography and HRCT were assessed by two independent readers for detection of interstitial opacities. HRCT was performed in the supine position with additional sections at the bases in the prone position. Auscultation for persistent fine inspiratory crackles was performed by two independent examiners unacquainted with the diagnosis. TEW analysis was obtained from a 33 second recording of lung sounds over the lung bases. TEW and auscultation were performed in a control group of 13 subjects who had a normal chest radiograph. There were 10 current smokers and three previous smokers. In asbestos workers the extent of pulmonary opacities on the chest radiograph was scored according to the International Labour Office (ILO) scale. Patients were divided into two groups: 21 patients in whom the chest radiograph was > 1/0 (group 1) and 32 patients in whom the chest radiograph was scored auscultation in seven (22%) patients and by TEW in 14 (44%). HRCT detected definite interstitial opacities in 11 (34%) and gravity dependent subpleural lines in two (6%) patients. All but two patients with evidence of interstitial disease or gravity dependent subpleural lines on HRCT had crackles detected by TEW. In patients with an ILO score of > 1/0 auscultation and TEW revealed mid to late

Auscultation d'ouvrages avec un capteur géotextile à fibres optiques

Directory of Open Access Journals (Sweden)

ARTIERES, Olivier

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.

Variation in family physicians' recording of auscultation abnormalities in patients with acute cough is not explained by case mix. A study from 12 European networks.

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Francis, Nick A; Melbye, Hasse; Kelly, Mark J; Cals, Jochen W L; Hopstaken, Rogier M; Coenen, Samuel; Butler, Christopher C

2013-06-01

Conflicting data on the diagnostic and prognostic value of auscultation abnormalities may be partly explained by inconsistent use of terminology. To describe general practitioners use of chest auscultation abnormality terms for patients presenting with acute cough across Europe, and to explore the influence of geographic location and case mix on use of these terms. Clinicians recorded whether 'diminished vesicular breathing', 'wheezes', 'crackles' and 'rhonchi' were present in an observational study of adults with acute cough in 13 networks in 12 European countries. We describe the use of these terms overall and by network, and used multilevel logistic regression to explore variation by network, controlling for patients' gender, age, comorbidities, smoking status and symptoms. 2345 patients were included. Wheeze was the auscultation abnormality most frequently recorded (20.6% overall) with wide variation by network (range: 8.3-30.8%). There was similar variation for other auscultation abnormalities. After controlling for patient characteristics, network was a significant predictor of auscultation abnormalities with odds ratios for location effects ranging from 0.37 to 4.46 for any recorded auscultation abnormality, and from 0.25 to 3.14 for rhonchi. There is important variation in recording chest auscultation abnormalities by general practitioners across Europe, which cannot be explained by differences in patient characteristics. There is a need and opportunity for standardization in the detection and classification of lung sounds.

Endobronchial intubation detected by insertion depth of endotracheal tube, bilateral auscultation, or observation of chest movements: randomised trial.

Science.gov (United States)

Sitzwohl, Christian; Langheinrich, Angelika; Schober, Andreas; Krafft, Peter; Sessler, Daniel I; Herkner, Harald; Gonano, Christopher; Weinstabl, Christian; Kettner, Stephan C

2010-11-09

To determine which bedside method of detecting inadvertent endobronchial intubation in adults has the highest sensitivity and specificity. Prospective randomised blinded study. Department of anaesthesia in tertiary academic hospital. 160 consecutive patients (American Society of Anesthesiologists category I or II) aged 19-75 scheduled for elective gynaecological or urological surgery. Patients were randomly assigned to eight study groups. In four groups, an endotracheal tube was fibreoptically positioned 2.5-4.0 cm above the carina, whereas in the other four groups the tube was positioned in the right mainstem bronchus. The four groups differed in the bedside test used to verify the position of the endotracheal tube. To determine whether the tube was properly positioned in the trachea, in each patient first year residents and experienced anaesthetists were randomly assigned to independently perform bilateral auscultation of the chest (auscultation); observation and palpation of symmetrical chest movements (observation); estimation of the position of the tube by the insertion depth (tube depth); or a combination of all three (all three). Correct and incorrect judgments of endotracheal tube position. 160 patients underwent 320 observations by experienced and inexperienced anaesthetists. First year residents missed endobronchial intubation by auscultation in 55% of cases and performed significantly worse than experienced anaesthetists with this bedside test (odds ratio 10.0, 95% confidence interval 1.4 to 434). With a sensitivity of 88% (95% confidence interval 75% to 100%) and 100%, respectively, tube depth and the three tests combined were significantly more sensitive for detecting endobronchial intubation than auscultation (65%, 49% to 81%) or observation(43%, 25% to 60%) (Pauscultation to detect inadvertent endobronchial intubation. But even experienced physicians will benefit from inserting tubes to 20-21 cm in women and 22-23 cm in men, especially when high

Usefulness of bowel sound auscultation: a prospective evaluation.

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Felder, Seth; Margel, David; Murrell, Zuri; Fleshner, Phillip

2014-01-01

Although the auscultation of bowel sounds is considered an essential component of an adequate physical examination, its clinical value remains largely unstudied and subjective. The aim of this study was to determine whether an accurate diagnosis of normal controls, mechanical small bowel obstruction (SBO), or postoperative ileus (POI) is possible based on bowel sound characteristics. Prospectively collected recordings of bowel sounds from patients with normal gastrointestinal motility, SBO diagnosed by computed tomography and confirmed at surgery, and POI diagnosed by clinical symptoms and a computed tomography without a transition point. Study clinicians were instructed to categorize the patient recording as normal, obstructed, ileus, or not sure. Using an electronic stethoscope, bowel sounds of healthy volunteers (n = 177), patients with SBO (n = 19), and patients with POI (n = 15) were recorded. A total of 10 recordings randomly selected from each category were replayed through speakers, with 15 of the recordings duplicated to surgical and internal medicine clinicians (n = 41) blinded to the clinical scenario. The sensitivity, positive predictive value, and intra-rater variability were determined based on the clinician's ability to properly categorize the bowel sound recording when blinded to additional clinical information. Secondary outcomes were the clinician's perceived level of expertise in interpreting bowel sounds. The overall sensitivity for normal, SBO, and POI recordings was 32%, 22%, and 22%, respectively. The positive predictive value of normal, SBO, and POI recordings was 23%, 28%, and 44%, respectively. Intra-rater reliability of duplicated recordings was 59%, 52%, and 53% for normal, SBO, and POI, respectively. No statistically significant differences were found between the surgical and internal medicine clinicians for sensitivity, positive predictive value, or intra-rater variability. Overall, 44% of clinicians reported that they rarely listened

Evaluation of a Computer-aided Lung Auscultation System for Diagnosis of Bovine Respiratory Disease in Feedlot Cattle.

Science.gov (United States)

Mang, A V; Buczinski, S; Booker, C W; Timsit, E

2015-01-01

A computer-aided lung auscultation (CALA) system was recently developed to diagnose bovine respiratory disease (BRD) in feedlot cattle. To determine, in a case-control study, the level of agreement between CALA and veterinary lung auscultation and to evaluate the sensitivity (Se) and specificity (Sp) of CALA to diagnose BRD in feedlot cattle. A total of 561 Angus cross-steers (initial body weight = 246 ± 45 kg) were observed during the first 50 day after entry to a feedlot. Case-control study. Steers with visual signs of BRD identified by pen checkers were examined by a veterinarian, including lung auscultation using a conventional stethoscope and CALA that produced a lung score from 1 (normal) to 5 (chronic). For each steer examined for BRD, 1 apparently healthy steer was selected as control and similarly examined. Agreement between CALA and veterinary auscultation was assessed by kappa statistic. CALA's Se and Sp were estimated using Bayesian latent class analysis. Of the 561 steers, 35 were identified with visual signs of BRD and 35 were selected as controls. Comparison of veterinary auscultation and CALA (using a CALA score ≥2 as a cut off) revealed a substantial agreement (kappa = 0.77). Using latent class analysis, CALA had a relatively high Se (92.9%; 95% credible interval [CI] = 0.71-0.99) and Sp (89.6%; 95% CI = 0.64-0.99) for diagnosing BRD compared with pen checking. CALA had good diagnostic accuracy (albeit with a relatively wide CI). Its use in feedlots could increase the proportion of cattle accurately diagnosed with BRD. Copyright © 2015 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

A randomised, simulated study assessing auscultation of heart rate at birth

NARCIS (Netherlands)

Voogdt, Kevin G. J. A.; Morrison, Allison C.; Wood, Fiona E.; van Elburg, Ruurd M.; Wyllie, Jonathan P.

2010-01-01

Heart rate is a primary clinical indicator directing newborn resuscitation. The time taken to assess the heart rate by auscultation in relation to accuracy during newborn resuscitation is not known. To assess both the accuracy and time taken to assess heart rate by stethoscope in simulated

Comparison of thoracic auscultation, clinical score, and ultrasonography as indicators of bovine respiratory disease in preweaned dairy calves.

Science.gov (United States)

Buczinski, S; Forté, G; Francoz, D; Bélanger, A-M

2014-01-01

The diagnostic tools for bovine respiratory disease diagnosis include clinical inspection, thoracic auscultation, and ultrasonography. Thoracic auscultation and clinical examination have limitations in the detection of lung consolidation in dairy calves. Prospective cohort of 106 preweaned calves from 13 different dairy herds (10 with a history of active bovine respiratory disease (BRD) in calves and 3 without suspected BRD problems). Each preweaned calf was clinically inspected using the Wisconsin calf respiratory scoring chart (CRSC) and treatment history was noted. Systematic thoracic auscultation and ultrasonography then were performed, the latter focusing on lung consolidation. Mortality was recorded over a 30-day period. A total of 56 of 106 calves had ultrasonographic evidence of lung consolidation. The sensitivity of thoracic auscultation to detect consolidation was 5.9% (range, 0-16.7%). Only 41.1% (23/33) of calves with consolidated lungs had been treated previously by the producers. When adding CRSC and previous BRD treatment by the producer, sensitivity of detection increased to 71.4% (40/56). The area under the receiver operating characteristics curve was 0.809 (95% CI, 0.721-0.879) for the number of areas within the lungs with consolidation and 0.743 (95% CI, 0.648-0.823) for the maximal depth of consolidation as predictors of death within 1 month after examination. These were not significantly different (P = .06). This study shows that thoracic auscultation is of limited value in diagnosing lung consolidation in calves. Ultrasonographic assessment of the thorax could be a useful tool to assess BRD detection efficiency on dairy farms. Copyright © 2013 by the American College of Veterinary Internal Medicine.

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

International Nuclear Information System (INIS)

Cordero Calderon, C.F.

1996-02-01

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

Simulation-guided cardiac auscultation improves medical students' clinical skills: the Pavia pilot experience.

Science.gov (United States)

Perlini, Stefano; Salinaro, Francesco; Santalucia, Paola; Musca, Francesco

2014-03-01

Clinical evaluation is the cornerstone of any cardiac diagnosis, although excessive over-specialisation often leads students to disregard the value of clinical skills, and to overemphasize the approach to instrumental cardiac diagnosis. Time restraints, low availability of "typical" cardiac patients on whom to perform effective bedside teaching, patients' respect and the underscoring of the value of clinical skills all lead to a progressive decay in teaching. Simulation-guided cardiac auscultation may improve clinical training in medical students and residents. Harvey(©) is a mannequin encompassing more than 50 cardiac diagnoses that was designed and developed at the University of Miami (Florida, USA). One of the advantages of Harvey(©) simulation resides in the possibility of listening, comparing and discussing "real" murmurs. To objectively assess its teaching performance, the capability to identify five different cardiac diagnoses (atrial septal defect, normal young subject, mitral stenosis with tricuspid regurgitation, chronic mitral regurgitation, and pericarditis) out of more than 50 diagnostic possibilities was assessed in 523 III-year medical students (i.e. at the very beginning of their clinical experience), in 92 VI-year students, and in 42 residents before and after a formal 10-h teaching session with Harvey(©). None of them had previously experienced simulation-based cardiac auscultation in addition to formal lecturing (all three groups) and bedside teaching (VI-year students and residents). In order to assess the "persistence" of the acquired knowledge over time, the test was repeated after 3 years in 85 students, who did not repeat the formal 10-h teaching session with Harvey(©) after the III year. As expected, the overall response was poor in the "beginners" who correctly identified 11.0 % of the administered cardiac murmurs. After simulation-guided training, the ability to recognise the correct cardiac diagnoses was much better (72.0 %; p

Nonlinear Analysis of Auscultation Signals in TCM Using the Combination of Wavelet Packet Transform and Sample Entropy

Directory of Open Access Journals (Sweden)

Jian-Jun Yan

2012-01-01

Full Text Available Auscultation signals are nonstationary in nature. Wavelet packet transform (WPT has currently become a very useful tool in analyzing nonstationary signals. Sample entropy (SampEn has recently been proposed to act as a measurement for quantifying regularity and complexity of time series data. WPT and SampEn were combined in this paper to analyze auscultation signals in traditional Chinese medicine (TCM. SampEns for WPT coefficients were computed to quantify the signals from qi- and yin-deficient, as well as healthy, subjects. The complexity of the signal can be evaluated with this scheme in different time-frequency resolutions. First, the voice signals were decomposed into approximated and detailed WPT coefficients. Then, SampEn values for approximated and detailed coefficients were calculated. Finally, SampEn values with significant differences in the three kinds of samples were chosen as the feature parameters for the support vector machine to identify the three types of auscultation signals. The recognition accuracy rates were higher than 90%.

A Novel and Cost-Effective Method for Evaluating Cardiopulmonary Auscultation Skills in Student Physical Therapists.

Science.gov (United States)

Sword, David O; Thomas, K Jackson; Wise, Holly H; Brown, Deborah D

2017-01-01

Sophisticated high-fidelity human simulation (HFHS) manikins allow for practice of both evaluation and treatment techniques in a controlled environment in which real patients are not put at risk. However, due to high demand, access to HFHS by students has been very competitive and limited. In the present study, a basic CPR manikin with a speaker implanted in the chest cavity and internet access to a variety of heart and breath sounds was used. Students were evaluated on their ability to locate and identify auscultation sites and heart/breath sounds. A five-point Likert scale survey was administered to gain insight into student perceptions on the use of this simulation method. Our results demonstrated that 95% of students successfully identified the heart and breath sounds. Furthermore, survey results indicated that 75% of students agreed or strongly agreed that this manner of evaluation was an effective way to assess their auscultation skills. Based on performance and perception, we conclude that a simulation method as described in this paper is a viable and cost-effective means of evaluating auscultation competency in not only student physical therapists but across other health professions as well.

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

NARCIS (Netherlands)

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

2015-01-01

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

Teaching cardiopulmonary auscultation in workshops using a virtual patient simulation technology - A pilot study.

Science.gov (United States)

Pereira, D; Gomes, P; Faria, S; Cruz-Correia, R; Coimbra, M

2016-08-01

Auscultation is currently both a powerful screening tool, providing a cheap and quick initial assessment of a patient's clinical condition, and a hard skill to master. The teaching of auscultation in Universities is today reduced to an unsuitable number of hours. Virtual patient simulators can potentially mitigate this problem, by providing an interesting high-quality alternative to teaching with real patients or patient simulators. In this paper we evaluate the pedagogical impact of using a virtual patient simulation technology in a short workshop format for medical students, training them to detect cardiac pathologies. Results showed a significant improvement (+16%) in the differentiation between normal and pathological cases, although longer duration formats seem to be needed to accurately identify specific pathologies.

Auscultation of concrete hydraulic dams by sonic tomography; Auscultation des structures hydrauliques en beton par tomographie sonique

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Kharrat, Y.; Rhazi, J.; Ballivy, G. [Sherbrooke Univ., PQ (Canada). Dept. de Genie Civil; Cote, P. [Centre de Nantes, Bouguenais (France)

1995-12-31

Sonic tomography, a new nondestructive testing method, was described to document the aging and internal degradation of concrete structures. The method is based on the transmission of sonic waves through concrete structures. New tomographic methodology similar to that used in medical or geophysical imaging was applied to existing sonic auscultation techniques used in civil engineering. In the process the speed of propagation of sonic waves in structures is measured with arrays of detectors. Fissures or zones of degradation can be spatially localized and an internal image of the structure can be constructed. Case studies of two hydraulic dams, one from France, the other in Quebec were presented as illustrations. . The theory and experimental procedures involved were described. 16 refs., 1 tab., 12 figs.

Quantitative Assessment of Blood Pressure Measurement Accuracy and Variability from Visual Auscultation Method by Observers without Receiving Medical Training

Science.gov (United States)

Feng, Yong; Chen, Aiqing

2017-01-01

This study aimed to quantify blood pressure (BP) measurement accuracy and variability with different techniques. Thirty video clips of BP recordings from the BHS training database were converted to Korotkoff sound waveforms. Ten observers without receiving medical training were asked to determine BPs using (a) traditional manual auscultatory method and (b) visual auscultation method by visualizing the Korotkoff sound waveform, which was repeated three times on different days. The measurement error was calculated against the reference answers, and the measurement variability was calculated from the SD of the three repeats. Statistical analysis showed that, in comparison with the auscultatory method, visual method significantly reduced overall variability from 2.2 to 1.1 mmHg for SBP and from 1.9 to 0.9 mmHg for DBP (both p auscultation methods). In conclusion, the visual auscultation method had the ability to achieve an acceptable degree of BP measurement accuracy, with smaller variability in comparison with the traditional auscultatory method. PMID:29423405

Evaluation of a focussed protocol for hand-held echocardiography and computer-assisted auscultation in detecting latent rheumatic heart disease in scholars.

Science.gov (United States)

Zühlke, Liesl J; Engel, Mark E; Nkepu, Simpiwe; Mayosi, Bongani M

2016-08-01

Introduction Echocardiography is the diagnostic test of choice for latent rheumatic heart disease. The utility of echocardiography for large-scale screening is limited by high cost, complex diagnostic protocols, and time to acquire multiple images. We evaluated the performance of a brief hand-held echocardiography protocol and computer-assisted auscultation in detecting latent rheumatic heart disease with or without pathological murmur. A total of 27 asymptomatic patients with latent rheumatic heart disease based on the World Heart Federation criteria and 66 healthy controls were examined by standard cardiac auscultation to detect pathological murmur. Hand-held echocardiography using a focussed protocol that utilises one view - that is, the parasternal long-axis view - and one measurement - that is, mitral regurgitant jet - and a computer-assisted auscultation utilising an automated decision tool were performed on all patients. The sensitivity and specificity of computer-assisted auscultation in latent rheumatic heart disease were 4% (95% CI 1.0-20.4%) and 93.7% (95% CI 84.5-98.3%), respectively. The sensitivity and specificity of the focussed hand-held echocardiography protocol for definite rheumatic heart disease were 92.3% (95% CI 63.9-99.8%) and 100%, respectively. The test reliability of hand-held echocardiography was 98.7% for definite and 94.7% for borderline disease, and the adjusted diagnostic odds ratios were 1041 and 263.9 for definite and borderline disease, respectively. Computer-assisted auscultation has extremely low sensitivity but high specificity for pathological murmur in latent rheumatic heart disease. Focussed hand-held echocardiography has fair sensitivity but high specificity and diagnostic utility for definite or borderline rheumatic heart disease in asymptomatic patients.

Intermittent auscultation of fetal heart rate during labour - a widely accepted technique for low risk pregnancies: but are the current national guidelines robust and practical?

Science.gov (United States)

Sholapurkar, S L

2010-01-01

Intermittent auscultation of fetal heart rate is an accepted practice in low risk labours in many countries. National guidelines on intrapartum fetal monitoring were critically reviewed regarding timing and frequency of intermittent auscultation. Hypothetical but plausible examples are presented to illustrate that it may be possible to miss significant fetal distress with strict adherence to current guidelines. Opinion is forwarded that intermittent auscultation should be performed for 60 seconds before and after three contractions over about 10 min every half an hour in the first stage of labour. Reasons are put forward to show how this could be more practical and patient friendly and at the same time could improve detection of fetal distress. The current recommendation of intermittent auscultation every 15 min in the first stage is associated with poor compliance and leads to unnecessary burden, stress and medicolegal liability for birth attendants. Modification of current national guidelines would be desirable.

Helping Family Physicians Improve Their Cardiac Auscultation Skills with an Interactive CD-ROM.

Science.gov (United States)

Roy, Douglas; Sargeant, Joan; Gray, Jean; Hoyt, Brian; Allen, Michael; Fleming, Michael

2002-01-01

Physicians (n=42) studied cardiac auscultation using a 15-hour CD-ROM program. Nine months later, 21 who completed a posttest showed significant improvement in identifying heart sounds. CDs were valued for opportunities to review material at an individual pace. Lack of computer skills hindered use. (Contains 26 references.) (SK)

Sonography of the chest using linear-array versus sector transducers: Correlation with auscultation, chest radiography, and computed tomography.

Science.gov (United States)

Tasci, Ozlem; Hatipoglu, Osman Nuri; Cagli, Bekir; Ermis, Veli

2016-07-08

The primary purpose of our study was to compare the efficacies of two sonographic (US) probes, a high-frequency linear-array probe and a lower-frequency phased-array sector probe in the diagnosis of basic thoracic pathologies. The secondary purpose was to compare the diagnostic performance of thoracic US with auscultation and chest radiography (CXR) using thoracic CT as a gold standard. In total, 55 consecutive patients scheduled for thoracic CT were enrolled in this prospective study. Four pathologic entities were evaluated: pneumothorax, pleural effusion, consolidation, and interstitial syndrome. A portable US scanner was used with a 5-10-MHz linear-array probe and a 1-5-MHz phased-array sector probe. The first probe used was chosen randomly. US, CXR, and auscultation results were compared with the CT results. The linear-array probe had the highest performance in the identification of pneumothorax (83% sensitivity, 100% specificity, and 99% diagnostic accuracy) and pleural effusion (100% sensitivity, 97% specificity, and 98% diagnostic accuracy); the sector probe had the highest performance in the identification of consolidation (89% sensitivity, 100% specificity, and 95% diagnostic accuracy) and interstitial syndrome (94% sensitivity, 93% specificity, and 94% diagnostic accuracy). For all pathologies, the performance of US was superior to those of CXR and auscultation. The linear probe is superior to the sector probe for identifying pleural pathologies, whereas the sector probe is superior to the linear probe for identifying parenchymal pathologies. Thoracic US has better diagnostic performance than CXR and auscultation for the diagnosis of common pathologic conditions of the chest. © 2016 Wiley Periodicals, Inc. J Clin Ultrasound 44:383-389, 2016. © 2016 Wiley Periodicals, Inc.

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

NARCIS (Netherlands)

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

2016-01-01

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

[A comparison of degree of precision of auscultation, partial pressure of carbon dioxide in end-expiration, and transillumination technique in verifying accurate position of endotracheal tube].

Science.gov (United States)

Qi, Le; Liu, Rong; Tang, Enhui; Li, Shouchun; Jin, Jun; He, Xihuan; Lyu, Shaojun; Weng, Hao

2015-10-01

To evaluate the effect of auscultation, partial pressure of carbon dioxide in end-expiration (P(ET)CO2), transillumination technique to judge whether the endotracheal tube is misplaced into the esophagus. A blinded randomized controlled trial was conducted. Sixty patients with American Society of Anesthesiology (ASA) grade I - II undergoing endotracheal intubation in Fengxian Central Hospital admitted from September 2014 to February 2015 were enrolled. Two endotracheal tubes with the same size were respectively inserted into the trachea and esophagus for the same depth after general anesthesia by the same person. Two blinded anesthetists with different experience checked the tube position using three methods including auscultation, P(ET)CO2, and transillumination technique, respectively. The order of the tubes tested (trachea or esophagus) and the method used were randomized according to randomise numbers table. The experienced anesthetists conducted the test first, followed by an inexperienced anesthetist conducting the same methods. The numbers of right and wrong determinations with different methods by different anesthetists were recorded. Sixty patients underwent the procedures for 180 times, with intratracheal intubation for 90 times, and esophageal intubation for 90 times. It was shown that the results were not different in two groups [96.7% (174/180) vs. 92.2% (166/180), χ2 = 3.500, P = 0.057]. By using auscultation, the correct rate of experienced anesthetist was higher than that of inexperienced (95.0% vs. 78.3%, χ2 = 5.786, P = 0.013). Using P(ET)CO2, both anesthetists were correct in all cases, and the accuracy was 100%. Using transillumination, the experienced anesthetist was mistaken in 3 cases (accuracy was 95.0%), while the inexperienced mistook in 1 case (accuracy was 98.3%), and no significant difference was found between two groups χ2 = 0.500, P = 0.250). The correct rate of using transillumination was significantly higher than that of using

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...

Adaptive Noise Suppression of Pediatric Lung Auscultations With Real Applications to Noisy Clinical Settings in Developing Countries

Science.gov (United States)

Emmanouilidou, Dimitra; McCollum, Eric D.; Park, Daniel E.

2015-01-01

Goal Chest auscultation constitutes a portable low-cost tool widely used for respiratory disease detection. Though it offers a powerful means of pulmonary examination, it remains riddled with a number of issues that limit its diagnostic capability. Particularly, patient agitation (especially in children), background chatter, and other environmental noises often contaminate the auscultation, hence affecting the clarity of the lung sound itself. This paper proposes an automated multiband denoising scheme for improving the quality of auscultation signals against heavy background contaminations. Methods The algorithm works on a simple two-microphone setup, dynamically adapts to the background noise and suppresses contaminations while successfully preserving the lung sound content. The proposed scheme is refined to offset maximal noise suppression against maintaining the integrity of the lung signal, particularly its unknown adventitious components that provide the most informative diagnostic value during lung pathology. Results The algorithm is applied to digital recordings obtained in the field in a busy clinic in West Africa and evaluated using objective signal fidelity measures and perceptual listening tests performed by a panel of licensed physicians. A strong preference of the enhanced sounds is revealed. Significance The strengths and benefits of the proposed method lie in the simple automated setup and its adaptive nature, both fundamental conditions for everyday clinical applicability. It can be simply extended to a real-time implementation, and integrated with lung sound acquisition protocols. PMID:25879837

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

Science.gov (United States)

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

2016-11-07

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

Hemodynamics of Aortic Stenosis and Implications for Non-invasive Diagnosis via Auscultation

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

2017-11-01

Aortic stenosis refers to the abnormal narrowing of the aortic valve and it is one of the most common valvular diseases. It is also known to generate ejection murmurs, which contain valuable disease-related information. However, an incomplete understanding of the flow mechanism(s) responsible for the murmur generation, as well as the effect of intervening tissue on murmur propagation has limited the diagnostic information can be extracted through cardiac auscultation. In this study, a canonical model of the aorta with stenosis is used, and a multiphysics computational modeling approach is employed to investigate the generation and propagation of the murmurs. First, direct numerical simulation (DNS) is used to explore the hemodynamics of the post-stenotic flow. Then, a high-order, linear viscoelastic wave solver is used to investigate the wave propagation in a modeled thorax. The results show that both the aortic jet and the secondary flow contribute significantly to the murmur generation. The murmur signals on the epidermal surface are measured and analyzed. The break frequencies obtained from the spectra of cases with different degrees of stenosis are found to follow a universal scaling. The implications of these results for cardiac auscultation are discussed. The authors would like to acknowledge support from NSF Grants IIS-1344772, CBET-1511200, and NSF XSEDE Grant TG-CTS100002.

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

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Dudik, Joshua M.; Coyle, James L.

2015-01-01

Cervical auscultation is the recording of sounds and vibrations caused by the human body from the throat during swallowing. While traditionally done by a trained clinician with a stethoscope, much work has been put towards developing more sensitive and clinically useful methods to characterize the data obtained with this technique. The eventual goal of the field is to improve the effectiveness of screening algorithms designed to predict the risk that swallowing disorders pose to individual patients’ health and safety. This paper provides an overview of these signal processing techniques and summarizes recent advances made with digital transducers in hopes of organizing the highly varied research on cervical auscultation. It investigates where on the body these transducers are placed in order to record a signal as well as the collection of analog and digital filtering techniques used to further improve the signal quality. It also presents the wide array of methods and features used to characterize these signals, ranging from simply counting the number of swallows that occur over a period of time to calculating various descriptive features in the time, frequency, and phase space domains. Finally, this paper presents the algorithms that have been used to classify this data into ‘normal’ and ‘abnormal’ categories. Both linear as well as non-linear techniques are presented in this regard. PMID:26213659

Aortic Root Aneurism Found in a 42-Year-Old Epitomizes the Importance of Auscultation in Routine Exams.

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Fredricks, Todd R; Benseler, Jeffrey S

2016-05-01

Bicuspid aortic valve disease (BAV) is the most common cardiac valve pathology. BAV is associated with aortic root disorders. The literature has few case reports identifying this condition during routine physical exam. A 42-yr-old military reservist flight medic presented for his annual military flight physical. He was found to have a faint cardiac murmur. His past family and medical history were remarkable for familial essential hypertension and being told at age 9 that he had a "murmur." He was referred for cardiology consultation, echocardiography, stress testing, and a computerized tomography angiogram (CTa), which identified BAV with a 4.3-cm aortic root aneurysm. A follow-up at 1 yr was recommended. In the interim he developed severe aortic valve insufficiency, a 4.6-cm aortic root aneurysm. The valve and aortic root were repaired and a single left anterior descending coronary artery lesion was bypassed during surgery. The flight medic made a full recovery but was not returned to flight status. This case emphasizes the importance of periodic reassessment by thorough history and careful cardiac auscultation during flight physicals. BAV aortopathy is an uncommon condition seen in the military aviation community. Most flight surgeons will not have the opportunity to identify it specifically via auscultation. This patient had over nine annual flight physicals prior to the one reported and no pathology was ever identified through routine auscultation. The potential role of point-of-care ultrasound (POCUS) for survey of vascular and valve status of aviation personnel merits further research.

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

OpenAIRE

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 b...

Angle transducer based on fiber Bragg gratings able for tunnel auscultation

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Quintela, A.; Lázaro, J. M.; Quintela, M. A.; Mirapeix, J.; Muñoz-Berti, V.; López-Higuera, J. M.

2010-09-01

In this paper an angle transducer based on Fiber Bragg Grating (FBG) is presented. Two gratings are glued to a metallic platen, one in each side. It is insensitive to temperature changes, given that the temperature shifts affect equally to both FBG. When the platen is uniformly bent an uniform strain appears in both sides of the platen. It depends on the bend angle and the platen length and thickness. The transducer has been designed to be used in the auscultation of tunnels during their construction process and during their live time. The transducer design and its characterization are presented.

Purring in cats during auscultation: how common is it, and can we stop it?

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Little, C J L; Ferasin, L; Ferasin, H; Holmes, M A

2014-01-01

When cats purr during examination it is difficult to perform auscultation. The objective of this study was to determine the prevalence of purring in cats during examination, and identify interventions that could be used to stop purring. Cats seen at a first opinion clinic were enrolled in the study and their purring status recorded. Thirty of the purring cats were exposed to up to three different interventions in an attempt to stop purring in a randomised controlled trial including blowing at the ear, use of an ethanol-based aerosol near the cat and proximity to a running tap. The 30 cats in the trial were subjected to a total of 54 attempts to stop purring, proximity to a running tap caused 17 of 21 (81%) cats to stop purring, blowing at the cat's ears worked in 2 of 15 (13%) cats, spraying an aerosol close to the cat was effective in 9 of 18 (50%) cases. In 2 cats (7%), none of the interventions interrupted purring. This study provides evidence that placing a purring cat near a running tap and in proximity to the discharge of an ethanol-based aerosol are effective measures to stop purring in order to allow auscultation. © 2013 British Small Animal Veterinary Association.

The paediatrician and cardiac auscultation.

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Roy, Douglas L

2003-11-01

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

Heart sound segmentation of pediatric auscultations using wavelet analysis.

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

2013-01-01

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

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

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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 decision-making framework called Intelligent Structured Intermittent Auscultation (ISIA) introduced through an education session. Results Following the intervention, medical records review revealed an increase in the use of IA during labour represented by a relative change of 12%, with improved documentation of clinical findings from assessments, and a significant reduction in the risk of receiving an admission CTG (RR 0.75, 95% CI, 0.60 – 0.95, p = 0.016). Conclusion The ISIA informed decision-making framework transformed the practice of IA and provided a mechanism for knowledge translation that enabled midwives to implement evidence-based fetal heart monitoring for low risk women. PMID:24884597

Cervical auscultation in the diagnosis of oropharyngeal aspiration in children: a study protocol for a randomised controlled trial.

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Frakking, Thuy T; Chang, Anne B; O'Grady, Kerry-Ann F; Walker-Smith, Katie; Weir, Kelly A

2013-11-07

Oropharyngeal aspiration (OPA) can lead to recurrent respiratory illnesses and chronic lung disease in children. Current clinical feeding evaluations performed by speech pathologists have poor reliability in detecting OPA when compared to radiological procedures such as the modified barium swallow (MBS). Improved ability to diagnose OPA accurately via clinical evaluation potentially reduces reliance on expensive, less readily available radiological procedures. Our study investigates the utility of adding cervical auscultation (CA), a technique of listening to swallowing sounds, in improving the diagnostic accuracy of a clinical evaluation for the detection of OPA. We plan an open, unblinded, randomised controlled trial at a paediatric tertiary teaching hospital. Two hundred and sixteen children fulfilling the inclusion criteria will be randomised to one of the two clinical assessment techniques for the clinical detection of OPA: (1) clinical feeding evaluation only (CFE) group or (2) clinical feeding evaluation with cervical auscultation (CFE + CA) group. All children will then undergo an MBS to determine radiologically assessed OPA. The primary outcome is the presence or absence of OPA, as determined on MBS using the Penetration-Aspiration Scale. Our main objective is to determine the sensitivity, specificity, negative and positive predictive values of 'CFE + CA' versus 'CFE' only compared to MBS-identified OPA. Early detection and appropriate management of OPA is important to prevent chronic pulmonary disease and poor growth in children. As the reliability of CFE to detect OPA is low, a technique that can improve the diagnostic accuracy of the CFE will help minimise consequences to the paediatric respiratory system. Cervical auscultation is a technique that has previously been documented as a clinical adjunct to the CFE; however, no published RCTs addressing the reliability of this technique in children exist. Our study will be the first to establish the utility

Carotid artery ultrasonographic assessment in patients from the Fremantle Diabetes Study Phase II with carotid bruits detected by electronic auscultation.

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

2014-09-01

Electronic auscultation appears superior to acoustic auscultation for identifying hemodynamic abnormalities. The aim of this study was to determine whether carotid bruits detected by electronic stethoscope in patients with diabetes are associated with stenoses and increased carotid intima-medial thickness (CIMT). Fifty Fremantle Diabetes Study patients (mean±SD age, 73.7±10.0 years; 38.0% males) with a bruit found by electronic auscultation and 50 age- and sex-matched patients with normal carotid sounds were studied. The degree of stenosis and CIMT were assessed from duplex ultrasonography. Patients with a bruit were more likely to have stenosis of ≥50% and CIMT of >1.0 mm than those without (odds ratios [95% confidence intervals]=14.0 [1.8-106.5] and 5.3 [1.8-15.3], respectively; both P=0.001). For the six patients with stenosis of ≥70%, five had a bruit, and one (with a known total occlusion) did not (odds ratio=5.0 [0.6-42.8]; P=0.22). The sensitivity and specificity of carotid bruit for stenoses of ≥50% were 88% and 58%, respectively; respective values for stenoses of ≥70% were 83% and 52%. The equivalent negative predictive values were 96% and 98%, and positive predictive values were 30% and 10%, respectively. Electronic recording of carotid sounds for later interpretation is convenient and reliable. Most patients with stenoses had an overlying bruit. Most bruits were false positives, but ultrasonography is justified to document extent of disease; CIMT measurement will identify increased vascular risk in most of these patients. The absence of a bruit was rarely a false-negative finding, suggesting that these patients can usually be reassured that they do not have hemodynamically important stenosis.

Crackle pitch and rate do not vary significantly during a single automated-auscultation session in patients with pneumonia, congestive heart failure, or interstitial pulmonary fibrosis.

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Vyshedskiy, Andrey; Ishikawa, Sadamu; Murphy, Raymond L H

2011-06-01

To determine the variability of crackle pitch and crackle rate during a single automated-auscultation session with a computerized 16-channel lung-sound analyzer. Forty-nine patients with pneumonia, 52 with congestive heart failure (CHF), and 18 with interstitial pulmonary fibrosis (IPF) performed breathing maneuvers in the following sequence: normal breathing, deep breathing, cough several times; deep breathing, vital-capacity maneuver, and deep breathing. From the auscultation recordings we measured the crackle pitch and crackle rate. Crackle pitch variability, expressed as a percentage of the average crackle pitch, was small in all patients and in all maneuvers: pneumonia 11%, CHF 11%, pulmonary fibrosis 7%. Crackle rate variability was also small: pneumonia 31%, CHF 32%, IPF 24%. Compared to the first deep-breathing maneuver (100%), the average crackle pitch did not significantly change following coughing (pneumonia 100%, CHF 103%, IPF 100%), the vital-capacity maneuver (pneumonia 100%, CHF 92%, IPF 104%), or during quiet breathing (pneumonia 97%, CHF 100%, IPF 104%). Similarly, the average crackle rate did not change significantly following coughing (pneumonia 105%, CHF 110%, IPF 90%) or the vital-capacity maneuver (pneumonia 102%, CHF 101%, IPF 99%). However, during normal breathing the crackle rate was significantly lower in the patients with pneumonia (74%, P auscultation session suggests that crackle rate can be used to follow the course of cardiopulmonary illnesses such as pneumonia, IPF, and CHF.

A study of new pulse auscultation system.

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Chen, Ying-Yun; Chang, Rong-Seng

2015-04-14

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

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

Science.gov (United States)

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

2017-08-01

Effectiveness of simulation-based education in cardiac auscultation training is controversial, and may vary among a variety of heart sounds and murmurs. We investigated whether a single auscultation training class using a cardiology patient simulator for medical students provides competence required for clinical clerkship, and whether students' proficiency after the training differs among heart sounds and murmurs. A total of 324 fourth-year medical students (93-117/year for 3 years) were divided into groups of 6-8 students; each group participated in a three-hour training session using a cardiology patient simulator. After a mini-lecture and facilitated training, each student took two different tests. In the first test, they tried to identify three sounds of Category A (non-split, respiratory split, and abnormally wide split S2s) in random order, after being informed that they were from Category A. They then did the same with sounds of Category B (S3, S4, and S3+S4) and Category C (four heart murmurs). In the second test, they tried to identify only one from each of the three categories in random order without any category information. The overall accuracy rate declined from 80.4% in the first test to 62.0% in the second test (pauscultation training. Copyright © 2016 The Author(s). Published by Elsevier Ltd.. All rights reserved.

A Study of New Pulse Auscultation System

Directory of Open Access Journals (Sweden)

Ying-Yun Chen

2015-04-01

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

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

Directory of Open Access Journals (Sweden)

Erik Strauss

2016-01-01

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

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

Science.gov (United States)

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

2017-01-26

The admission cardiotocograph (CTG) is a commonly used screening test consisting of a short (usually 20 minutes) recording of the fetal heart rate (FHR) and uterine activity performed on the mother's admission to the labour ward. This is an update of a review published in 2012. To compare the effects of admission cardiotocography with intermittent auscultation of the FHR on maternal and infant outcomes for pregnant women without risk factors on their admission to the labour ward. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register to 30 November 2016 and we planned to review the reference list of retrieved papers All randomised and quasi-randomised trials comparing admission CTG with intermittent auscultation of the FHR for pregnant women between 37 and 42 completed weeks of pregnancy and considered to be at low risk of intrapartum fetal hypoxia and of developing complications during labour. Two authors independently assessed trial eligibility and quality, and extracted data. Data were checked for accuracy. We included no new trials in this update. We included four trials involving more than 13,000 women which were conducted in the UK and Ireland and included women in labour. Three trials were funded by the hospitals where the trials took place and one trial was funded by the Scottish government. No declarations of interest were made in two trials; the remaining two trials did not mention declarations of interest. Overall, the studies were assessed as low risk of bias. Results reported in the 2012 review remain unchanged.Although not statistically significant using a strict P auscultation (risk ratio (RR) 1.20, 95% confidence interval (CI) 1.00 to 1.44, 4 trials, 11,338 women, I² = 0%, moderate quality evidence). There was no clear difference in the average treatment effect across included trials between women allocated to admission CTG and women allocated to intermittent auscultation in instrumental vaginal birth (RR 1.10, 95% CI 0.95 to 1

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

Science.gov (United States)

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

2014-08-01

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

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.

2015-01-01

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

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

Cuff depth and continuous chest auscultation method for determination of tracheal tube insertion depth in nasal intubation: observational study.

Science.gov (United States)

Ouchi, Kentaro; Sugiyama, Kazuna

2016-04-01

Incorrect endobronchial placement of the tracheal tube can lead to serious complications. Hence, it is necessary to determine the accuracy of tracheal tube positioning. Markers are included on tracheal tubes, in the process of their manufacture, as indicators of approximate intubation depth. In addition, continuous chest auscultation has been used for determining the proper position of the tube. We examined insertion depth using the cuff depth and continuous chest auscultation method (CC method), compared with insertion depth determined by the marker method, to assess the accuracy of these methods. After induction of anesthesia, tracheal intubation was performed in each patient. In the CC method, the depth of tube insertion was measured when the cuff had passed through the glottis, and again when breath sounds changed in quality; the depth of tube insertion was determined from these values. In the marker method, the depth of tube insertion was measured and determined when the marker of the tube had reached the glottis, using insertion depth according to the marker as an index. Insertion depth by the marker method was 26.6 ± 1.2 cm and by the CC method was 28.0 ± 1.2 cm (P < 0.0001). The CC method indicated a significantly greater depth than the marker method. This study determined the safe range of tracheal tube placement. Tube positions determined by the CC method were about 1 cm deeper than those determined by the marker. This information is important to prevent accidental one-lung ventilation and accidental extubation. UMIN No. UMIN000011375.

Initial Field Test of a Cloud-Based Cardiac Auscultation System to Determine Murmur Etiology in Rural China.

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Pyles, Lee; Hemmati, Pouya; Pan, J; Yu, Xiaoju; Liu, Ke; Wang, Jing; Tsakistos, Andreas; Zheleva, Bistra; Shao, Weiguang; Ni, Quan

2017-04-01

A system for collection, distribution, and long distant, asynchronous interpretation of cardiac auscultation has been developed and field-tested in rural China. We initiated a proof-of-concept test as a critical component of design of a system to allow rural physicians with little experience in evaluation of congenital heart disease (CHD) to obtain assistance in diagnosis and management of children with significant heart disease. The project tested the hypothesis that acceptable screening of heart murmurs could be accomplished using a digital stethoscope and internet cloud transmittal to deliver phonocardiograms to an experienced observer. Of the 7993 children who underwent school-based screening in the Menghai District of Yunnan Province, Peoples Republic of China, 149 had a murmur noted by a screener. They had digital heart sounds and phonocardiograms collected with the HeartLink tele auscultation system, and underwent echocardiography by a cardiology resident from the First Affiliated Hospital of Kunming Medical University. The digital phonocardiograms, stored on a cloud server, were later remotely reviewed by a board-certified American pediatric cardiologist. Fourteen of these subjects were found to have CHD confirmed by echocardiogram. Using the HeartLink system, the pediatric cardiologist identified 11 of the 14 subjects with pathological murmurs, and missed three subjects with atrial septal defects, which were incorrectly identified as venous hum or Still's murmur. In addition, ten subjects were recorded as having pathological murmurs, when no CHD was confirmed by echocardiography during the field study. The overall test accuracy was 91% with 78.5% sensitivity and 92.6% specificity. This proof-of-concept study demonstrated the feasibility of differentiating pathologic murmurs due to CHD from normal functional heart murmurs with the HeartLink system. This field study is an initial step to develop a cost-effective CHD screening strategy in low

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

Energy Technology Data Exchange (ETDEWEB)

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

2009-10-15

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

Cardiac Auscultation for Noncardiologists: Application in Cardiac Rehabilitation Programs: PART I: PATIENTS AFTER ACUTE CORONARY SYNDROMES AND HEART FAILURE.

Science.gov (United States)

Compostella, Leonida; Compostella, Caterina; Russo, Nicola; Setzu, Tiziana; Iliceto, Sabino; Bellotto, Fabio

2017-09-01

During outpatient cardiac rehabilitation after an acute coronary syndrome or after an episode of congestive heart failure, a careful, periodic evaluation of patients' clinical and hemodynamic status is essential. Simple and traditional cardiac auscultation could play a role in providing useful prognostic information.Reduced intensity of the first heart sound (S1), especially when associated with prolonged apical impulse and the appearance of added sounds, may help identify left ventricular (LV) dysfunction or conduction disturbances, sometimes associated with transient myocardial ischemia. If both S1 and second heart sound (S2) are reduced in intensity, a pericardial effusion may be suspected, whereas an increased intensity of S2 may indicate increased pulmonary artery pressure. The persistence of a protodiastolic sound (S3) after an acute coronary syndrome is an indicator of severe LV dysfunction and a poor prognosis. In patients with congestive heart failure, the association of an S3 and elevated heart rate may indicate impending decompensation. A presystolic sound (S4) is often associated with S3 in patients with LV failure, although it could also be present in hypertensive patients and in patients with an LV aneurysm. Careful evaluation of apical systolic murmurs could help identifying possible LV dysfunction or mitral valve pathology, and differentiate them from a ruptured papillary muscle or ventricular septal rupture. Friction rubs after an acute myocardial infarction, due to reactive pericarditis or Dressler syndrome, are often associated with a complicated clinical course.During cardiac rehabilitation, periodic cardiac auscultation may provide useful information about the clinical-hemodynamic status of patients and allow timely detection of signs, heralding possible complications in an efficient and low-cost manner.

Conception et exploitation d'une sonde électronique d'auscultation des réseaux d'assainissement urbains non visitables

OpenAIRE

Bedrani , Mourad

1983-01-01

Partant de l'hypothèse que, d'une part, aucun rejet ne peut se trouver à une température rigoureusement identique à celle des eaux drainées dans le réseau, et que, d'autre part, la température de la nappe phréatique est systématiquement plus basse que celle de différents rejets domestiques ou industriels, nous avons conçu une sonde autonome à double paramètre : température et conductivité, baptisée Ichtyotherme, pour l'auscultation des réseaux. L'appareil développé est couplé à un microordina...

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

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

2016-07-01

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

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

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S. I. Fedorova

2015-01-01

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

Improved auscultation skills in paramedic students using a modified stethoscope.

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Simon, Erin L; Lecat, Paul J; Haller, Nairmeen A; Williams, Carolyn J; Martin, Scott W; Carney, John A; Pakiela, John A

2012-12-01

The Ventriloscope® (Lecat's SimplySim, Tallmadge, OH) is a modified stethoscope used as a simulation training device for auscultation. To test the effectiveness of the Ventriloscope as a training device in teaching heart and lung auscultatory findings to paramedic students. A prospective, single-hospital study conducted in a paramedic-teaching program. The standard teaching group learned heart and lung sounds via audiocassette recordings and lecture, whereas the intervention group utilized the modified stethoscope in conjunction with patient volunteers. Study subjects took a pre-test, post-test, and a follow-up test to measure recognition of heart and lung sounds. The intervention group included 22 paramedic students and the standard group included 18 paramedic students. Pre-test scores did not differ using two-sample t-tests (standard group: t [16]=-1.63, p=0.12) and (intervention group: t [20]=-1.17, p=0.26). Improvement in pre-test to post-test scores was noted within each group (standard: t [17]=2.43, p=0.03; intervention: t [21]=4.81, p<0.0001). Follow-up scores for the standard group were not different from pre-test scores of 16.06 (t [17]=0.94, p=0.36). However, follow-up scores for the intervention group significantly improved from their respective pre-test score of 16.05 (t [21]=2.63, p=0.02). Simulation training using a modified stethoscope in conjunction with standardized patients allows for realistic learning of heart and lung sounds. This technique of simulation training achieved proficiency and better retention of heart and lung sounds in a safe teaching environment. Copyright © 2012 Elsevier Inc. All rights reserved.

Thoracic auscultation in captive bottlenose dolphins (Tursiops truncatus), California sea lions (Zalophus californianus), and South African fur seals (Arctocephalus pusillus) with an electronic stethoscope.

Science.gov (United States)

Scharpegge, Julia; Hartmann, Manuel García; Eulenberger, Klaus

2012-06-01

Thoracic auscultation is an important diagnostic method used in cases of suspected pulmonary disease in many species, as respiratory sounds contain significant information on the physiology and pathology of the lungs and upper airways. Respiratory diseases are frequent in marine mammals and are often listed as one of their main causes of death. The aim of this study was to investigate and report baseline parameters for the electronic-mediated thoracic auscultation of one cetacean species and two pinniped species in captivity. Respiratory sounds from 20 captive bottlenose dolphins (Tursiops truncatus), 6 California sea lions (Zalophus californianus), and 5 South African fur seals (Arctocephalus pusillus) were recorded with an electronic stethoscope. The sounds were analyzed for duration of the respiratory cycle, adventitious sounds, and peak frequencies of recorded sounds during expiration and inspiration as well as for sound intensity as reflected by waveform amplitude during the respiratory cycle. In respiratory cycles of the bottlenose dolphins' expiring "on command," the duration of the expiration was significantly shorter than the duration of the inspiration. In the examined pinnipeds of this study, there was no clear pattern concerning the duration of one breathing phase: Adventitious sounds were detected most often in bottlenose dolphins that were expiring on command and could be compared with "forced expiratory wheezes" in humans. This is the first report of forced expiratory wheezes in bottlenose dolphins; they can easily be misinterpreted as pathologic respiratory sounds. The peak frequencies of the respiratory sounds reached over 2,000 Hz in bottlenose dolphins and over 1,000 Hz in California sea lions and South African fur seals, but the variation of the frequency spectra was very high in all animals. To the authors' knowledge, this is the first systematic analysis of respiratory sounds of bottlenose dolphins and two species of pinnipeds.

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

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Narula, Jagat; Chandrashekhar, Y; Braunwald, Eugene

2018-04-01

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

Detection of Respiratory Adverse Events in Pediatric Dental Patients Sedated With 0.75mg/Kg of Midazolam and Oxygen by Continuous Pretracheal Auscultation: A Prospective Randomized Controlled Trial.

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Somri, Mostafa; Matter, Ibrahim; Hadjittofi, Christopher; Hoash, Naser; Moaddi, Bian; Kharouba, Johnny; Parisinos, Constantinos A; Peretz, Benjamin

Sedation is becoming more commonplace for pediatric patients undergoing minor procedures. Fortunately, electronic monitors have contributed to a reduction in the associated respiratory adverse events (RAEs). To test the hypothesis that adding the pretracheal stethoscope (PTS) to standard monitoring methods (SMMs) may improve RAE detection in sedated pediatric dental patients, the frequency of RAEs detected by SMMs (i.e. visual observation, capnography, and pulse oximetry) was compared to that detected by SMMs alongside continuous PTS auscultation. A prospective, randomised, controlled trial was performed with 100 pediatric patient participants of ASA≤2, who were scheduled to receive dental treatment under 0.75 mg/kg and oxygen. Patients were randomised into Groups A (n=50; SMMs) and B (n=50; SMMs+PTS). Inclusion criteria were behavioral management problems and intolerance to dental treatment despite behavioral management techniques or nitrous oxide administration. Exclusion criteria were high-risk conditions for RAEs, altered mental status, gastrointestinal disorders, parental refusal of conscious sedation and failure of previous conscious sedation. An anesthesist was present throughout the dental treatments. RAEs were detected in 10 (20%) and 22(44%) Group A and B patients respectively (p=0.01). The majority of RAEs within Group B were detected by PTS auscultation (n=19). Capnography produced 13 and 15 false-positive results in Groups A and B respectively, whereas the PTS produced 4(8%) false-positive results in Group B (p=0.009). PTS was found to be useful for detecting RAEs during pediatric dental sedation with 0.75mg/kg midazolam and oxygen, in the presence of an anesthesist.

COLIBRI 2 (Matériel d'auscultation de pistes cyclables) : Faisabilité, proposition de solution mécanique : phse3.1/A du MAQ 5.3 LCPC

OpenAIRE

DARGENTON, Jean Christophe; SWITSERS, Estève; CENTRE D'ETUDES TECHNIQUES DE L'EQUIPEMENT DE L'OUEST - CETE OUEST; CENTRE D'ETUDES ET DE CONSTRUCTION DE PROTOTYPES D'ANGERS - CETE OUEST - CECP ANGERS

2008-01-01

Document s'intégrant dans la faisabilité de réalisation d'un prototype d'auscultation opérationnelle non destructive permettant la détection et caractérisation de défaut d'interface à l'intérieur d'un corps de chaussée (21N07461). Ce document décrit une solution technique permettant de répondre au CDCF du projet COLIBRI-2 réalisée à partir d'une remorque à avance continu et d'un module de mesure que l'on dépose à chaque pas de mesure (principe des Flash).

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

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Sprikkelman, A. B.; Grol, M. H.; Lourens, M. S.; Gerritsen, J.; Heymans, H. S.; van Aalderen, W. M.

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 (FEV1). A study was undertaken to determine whether a change in lung sounds corresponded with a 20% fall in FEV1 after methacholine challenge, and whether the occurrence of wheeze was the most important change. METHODS: Fifteen children with asthma (eight boys) of mean age 10.8 years (range 8-15) were studied. All had normal chest auscultation before the methacholine challenge test. Lung sounds were recorded over the trachea for one minute and stored on tape. They were analysed directly and also scored blindly from the tape recording by a second investigator. Wheeze, cough, increase in respiratory rate, and prolonged expiration were assessed. RESULTS: The total cumulative methacholine dose causing a fall in FEV1 of 20% or more (PD20) was detected in 12 children by a change in lung sounds - in four by wheeze and in eight by cough, increased respiratory rate, and/or prolonged expiration. In two subjects altered lung sounds were detectable one dose step before PD20 was reached. In three cases in whom no fall in FEV1 occurred, no change in lung sounds could be detected at the highest methacholine dose. CONCLUSION: Changes in lung sounds correspond well with a 20% fall in FEV1 after methacholine challenge. Wheeze is an insensitive indicator for assessing bronchial responsiveness. Cough, increase in respiratory rate, and prolonged expiration occurs more frequently. PMID:8779140

Real-time detection of gastric insufflation related to facemask pressure-controlled ventilation using ultrasonography of the antrum and epigastric auscultation in nonparalyzed patients: a prospective, randomized, double-blind study.

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Bouvet, Lionel; Albert, Marie-Laure; Augris, Caroline; Boselli, Emmanuel; Ecochard, René; Rabilloud, Muriel; Chassard, Dominique; Allaouchiche, Bernard

2014-02-01

The authors sought to determine the level of inspiratory pressure minimizing the risk of gastric insufflation while providing adequate pulmonary ventilation. The primary endpoint was the increase in incidence of gastric insufflation detected by ultrasonography of the antrum while inspiratory pressure for facemask pressure-controlled ventilation increased from 10 to 25 cm H2O. In this prospective, randomized, double-blind study, patients were allocated to one of the four groups (P10, P15, P20, and P25) defined by the inspiratory pressure applied during controlled-pressure ventilation: 10, 15, 20, and 25 cm H2O. Anesthesia was induced using propofol and remifentanil; no neuromuscular-blocking agent was administered. Once loss of eyelash reflex occurred, facemask ventilation was started for a 2-min period while gastric insufflation was detected by auscultation and by real-time ultrasonography of the antrum. The cross-sectional antral area was measured using ultrasonography before and after facemask ventilation. Respiratory parameters were recorded. Sixty-seven patients were analyzed. The authors registered statistically significant increases in incidences of gastric insufflation with inspiratory pressure, from 0% (group P10) to 41% (group P25) according to auscultation, and from 19 to 59% according to ultrasonography. In groups P20 and P25, detection of gastric insufflation by ultrasonography was associated with a statistically significant increase in the antral area. Lung ventilation was insufficient for group P10. Inspiratory pressure of 15 cm H2O allowed for reduced occurrence of gastric insufflation with proper lung ventilation during induction of anesthesia with remifentanil and propofol in nonparalyzed and nonobese patients. (Anesthesiology 2014; 120:326-34).

Validation of Omron HBP-1300 professional blood pressure monitor based on auscultation in children and adults.

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Meng, Linghui; Zhao, Di; Pan, Yan; Ding, Wenqing; Wei, Qing; Li, Hua; Gao, Pingjin; Mi, Jie

2016-01-13

BACKGROUnD: To determine whether the professional Omron HBP-1300 blood pressure (BP) monitor meets American Association for the Advancement of Medical Instrumentation (AAMI) accuracy standards in Chinese children and adults. According to the AAMI protocol, simultaneous auscultatory measurements by two observers using a mercury manometer were obtained in participants using the Omron HBP-1300. Triple measurements were obtained after a minimum 5-min rest with a 1-min interval between adjacent measurements. A total of 85 participants submitted to 255 doctor-measured BP and 255 successful professional monitor readings. The initial auscultation systolic BP was 160 mmHg in seven participants (8.2%). All of the simultaneous measurements agreed to within ± 10 mmHg, while 95% agreed to within ± 4 mmHg for both systolic and diastolic BP, and the consistency between two observers was satisfactory. The difference between the devices was -1.3 ± 3.6 mmHg for systolic BP and 0.7 ± 3.8 mmHg for diastolic BP and by AAMI method 1, which met this guideline. The average difference between two devices by AAMI method 2 was 1.4 ± 3.2 mmHg for systolic BP and 1.0 ± 3.9 mmHg for diastolic BP, which met this guideline. The professional BP monitor Omron HBP-1300 is desirable for measuring the BP for Chinese children and adults.

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

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

Intermittent auscultation (IA) of fetal heart rate in labour for fetal well-being.

Science.gov (United States)

Martis, Ruth; Emilia, Ova; Nurdiati, Detty S; Brown, Julie

2017-02-13

The goal of fetal monitoring in labour is the early detection of a hypoxic baby. There are a variety of tools and methods available for intermittent auscultation (IA) of the fetal heart rate (FHR). Low- and middle-income countries usually have only access to a Pinard/Laënnec or the use of a hand-held Doppler device. Currently, there is no robust evidence to guide clinical practice on the most effective IA tool to use, timing intervals and length of listening to the fetal heart for women during established labour. To evaluate the effectiveness of different tools for IA of the fetal heart rate during labour including frequency and duration of auscultation. We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (19 September 2016), contacted experts and searched reference lists of retrieved articles. All published and unpublished randomised controlled trials (RCTs) or cluster-RCTs comparing different tools and methods used for intermittent fetal auscultation during labour for fetal and maternal well-being. Quasi-RCTs, and cross-over designs were not eligible for inclusion. All review authors independently assessed eligibility, extracted data and assessed risk of bias for each trial. Data were checked for accuracy. We included three studies (6241 women and 6241 babies), but only two studies are included in the meta-analyses (3242 women and 3242 babies). Both were judged as high risk for performance bias due to the inability to blind the participants and healthcare providers to the interventions. Evidence was graded as moderate to very low quality; the main reasons for downgrading were study design limitations and imprecision of effect estimates. Intermittent Electronic Fetal Monitoring (EFM) using Cardiotocography (CTG) with routine Pinard (one trial)There was no clear difference between groups in low Apgar scores at five minutes (reported as < six at five minutes after birth) (risk ratio (RR) 0.66, 95% confidence interval (CI) 0.24 to 1.83, 633

Inter-Rater Agreement of Auscultation, Palpable Fremitus, and Ventilator Waveform Sawtooth Patterns Between Clinicians.

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Berry, Marc P; Martí, Joan-Daniel; Ntoumenopoulos, George

2016-10-01

Clinicians often use numerous bedside assessments for secretion retention in participants who are receiving invasive mechanical ventilation. This study aimed to evaluate inter-rater agreement between clinicians when using standard clinical assessments of secretion retention and whether differences in clinician experience influenced inter-rater agreement. Seventy-one mechanically ventilated participants were assessed by a research clinician and by one of 13 ICU clinicians. Each clinician conducted a standardized assessment of lung auscultation, palpation for chest-wall (rhonchal) fremitus, and ventilator inspiratory/expiratory flow-time waveforms for the sawtooth pattern. On the presence of breath sounds, agreement ranged from absolute to moderate in the upper zones and the lower zones, respectively. Kappa values for abnormal and adventitious lung sounds achieved moderate agreement in the upper zones, less than chance agreement to substantial agreement in the middle zones, and moderate agreement to almost perfect agreement in the lower zones. Moderate to almost perfect agreement was established for palpable fremitus in the upper zones, moderate to substantial agreement in the middle zones, and less than chance to moderate agreement in the lower zones. Inter-rater agreement on the presence of expiratory sawtooth pattern identification showed moderate agreement. The level of percentage agreement between the research and ICU clinicians for each respiratory assessment studied did not relate directly to level of clinical experience. Inter-rater agreement for all assessments showed variability between lung regions but maintained reasonable percentage agreement in mechanically ventilated participants. The level of percentage agreement achieved between clinicians did not directly relate to clinical experience for all respiratory assessments. Therefore, these respiratory assessments should not necessarily be viewed in isolation but interpreted within the context of a full

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

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Favrat, B; Pécoud, A; Jaussi, A

2004-01-01

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

Cervical auscultation as an adjunct to the clinical swallow examination: a comparison with fibre-optic endoscopic evaluation of swallowing.

Science.gov (United States)

Bergström, Liza; Svensson, Per; Hartelius, Lena

2014-10-01

This prospective, single-blinded study investigated the validity and reliability of cervical auscultation (CA) under two conditions; (1) CA-only, using isolated swallow-sound clips, and (2) CSE + CA, using extra clinical swallow examination (CSE) information such as patient case history, oromotor assessment, and the same swallow-sound clips as condition one. The two CA conditions were compared against a fibre-optic endoscopic evaluation of swallowing (FEES) reference test. Each CA condition consisted of 18 swallows samples compiled from 12 adult patients consecutively referred to the FEES clinic. Patients' swallow sounds were simultaneously recorded during FEES via a Littmann E3200 electronic stethoscope. These 18 swallow samples were sent to 13 experienced dysphagia clinicians recruited from the UK and Australia who were blinded to the FEES results. Samples were rated in terms of (1) if dysphagic, (2) if the patient was safe on consistency trialled, and (3) dysphagia severity. Sensitivity measures ranged from 83-95%, specificity measures from 50-92% across the conditions. Intra-rater agreement ranged from 69-97% total agreement. Inter-rater reliability for dysphagia severity showed substantial agreement (rs = 0.68 and 0.74). Results show good rater reliability for CA-trained speech-language pathologists. Sensitivity and specificity for both CA conditions in this study are comparable to and often better than other well-established CSE components.

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

Science.gov (United States)

2010-01-01

Background The present study compares the value of additional use of computer simulated heart sounds, to conventional bedside auscultation training, on the cardiac auscultation skills of 3rd year medical students at Oslo University Medical School. Methods In addition to their usual curriculum courses, groups of seven students each were randomized to receive four hours of additional auscultation training either employing a computer simulator system or adding on more conventional bedside training. Cardiac auscultation skills were afterwards tested using live patients. Each student gave a written description of the auscultation findings in four selected patients, and was rewarded from 0-10 points for each patient. Differences between the two study groups were evaluated using student's t-test. Results At the auscultation test no significant difference in mean score was found between the students who had used additional computer based sound simulation compared to additional bedside training. Conclusions Students at an early stage of their cardiology training demonstrated equal performance of cardiac auscultation whether they had received an additional short auscultation course based on computer simulated training, or had had additional bedside training. PMID:20082701

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

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

2016-12-01

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

The Use of Cervical Auscultation to Predict Oropharyngeal Aspiration in Children: A Randomized Controlled Trial.

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Frakking, Thuy T; Chang, Anne B; O'Grady, Kerry-Ann F; David, Michael; Walker-Smith, Katie; Weir, Kelly A

2016-12-01

In this study, we aimed to determine if the use of cervical auscultation (CA) as an adjunct to the clinical feeding evaluation (CFE + CA) improves the reliability of predicting oropharyngeal aspiration (abbreviated to aspiration) in children. The design of the study is based on open label, randomized controlled trial with concealed allocation. Results from children (<18 years) randomized to either CFE or CFE + CA were compared to videofluoroscopic swallow study (VFSS), the reference standard data. Aspiration was defined using the Penetration-Aspiration Scale. All assessments were undertaken at a single tertiary pediatric hospital. 155 children referred for a feeding/swallowing assessment were randomized into the CFE n = 83 [38 males; mean age = 34.9 months (SD 34.4)] or CFE + CA n = 72 [43 males; mean age = 39.6 months (SD 39.3)] group. kappa statistic, sensitivity, and specificity values, area under receiver operating curve (aROC). No significant differences between groups were found, although CFE + CA (kappa = 0.41, 95 % CI 0.2-0.62) had higher agreement for aspiration detection by VFSS, compared to the clinical feeding exam alone (kappa = 0.31, 95 % CI 0.10-0.52). Sensitivity was 85 % (95 % CI 62.1-96.8) for CFE + CA and 63.6 % (95 % CI 45.1-79.6) for CFE. aROC was not significantly greater for CFE + CA (0.75, 95 % CI 0.65-0.86) than CFE (0.66, 95 % CI 0.55-0.76) across all age groups. Although using CA as an adjunct to the clinical feeding evaluation improves the sensitivity of predicting aspiration in children, it is not sensitive enough as a diagnostic tool in isolation. Given the serious implications of missing the diagnosis of aspiration, instrumental assessments (e.g., VFSS), remain the preferred standard.

Self-directed study using MP3 players to improve auscultation proficiency of physicians: a randomized, controlled trial.

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Donato, Anthony A; Kaliyadan, Antony G; Wasser, Thomas

2014-01-01

Studies of physicians at all levels of training demonstrate significant deficiencies in cardiac auscultation skills. The best instructional methods to augment these skills are not known. This study was a randomized, controlled trial of 83 noncardiologist volunteers exposed to a 12-week lower cognitive load self-study group using MP3 players containing heart sound audio files compared to a group receiving a 1-time 1-hour higher cognitive load multimedia lecture using the same audio files. The primary outcome measure was change in 15-question posttest score at 4 and 12 weeks as compared to pretest on recognition of identical audio files introduced during training. In the self-study group, the association of total exposure and deliberate practice effort (estimated by standard deviation of files played/mean) to improvement in test score was measured as a secondary end point. Self-study group participants improved as compared to pretest by 4.42 ± 3.41 answers correct at 12 weeks (5.09-9.51 correct, p < .001), while those exposed to the multimedia lecture improved by an average of 1.13 ± 3.2 answers correct (4.48-5.61 correct, p = .03). In the self-study arm, improvement in the posttest was positively associated with both total exposure (β = 0.55, p < .001) and deliberate practice score (β = 0.31, p = .02). A lower cognitive load self-study of audio files improved recognition of cardiac sounds, as compared to multimedia lecture, and deliberate practice strategies improved study efficiency. More investigation is needed to assess transfer of learning to a wider range of cardiac sounds in both simulated and clinical environments. © 2014 The Alliance for Continuing Education in the Health Professions, the Society for Academic Continuing Medical Education, and the Council on Continuing Medical Education, Association for Hospital Medical Education.

A new automatic blood pressure kit auscultates for accurate reading with a smartphone: A diagnostic accuracy study.

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

2016-08-01

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.

[Computer-aided Diagnosis and New Electronic Stethoscope].

Science.gov (United States)

Huang, Mei; Liu, Hongying; Pi, Xitian; Ao, Yilu; Wang, Zi

2017-05-30

Auscultation is an important method in early-diagnosis of cardiovascular disease and respiratory system disease. This paper presents a computer-aided diagnosis of new electronic auscultation system. It has developed an electronic stethoscope based on condenser microphone and the relevant intelligent analysis software. It has implemented many functions that combined with Bluetooth, OLED, SD card storage technologies, such as real-time heart and lung sounds auscultation in three modes, recording and playback, auscultation volume control, wireless transmission. The intelligent analysis software based on PC computer utilizes C# programming language and adopts SQL Server as the background database. It has realized play and waveform display of the auscultation sound. By calculating the heart rate, extracting the characteristic parameters of T1, T2, T12, T11, it can analyze whether the heart sound is normal, and then generate diagnosis report. Finally the auscultation sound and diagnosis report can be sent to mailbox of other doctors, which can carry out remote diagnosis. The whole system has features of fully function, high portability, good user experience, and it is beneficial to promote the use of electronic stethoscope in the hospital, at the same time, the system can also be applied to auscultate teaching and other occasions.

Validation of the RisingSun RS-651 Blood Pressure Monitor Based on Auscultation in Adults According to the ANSI/AAMI/ISO 81060-2:2013 Standard.

Science.gov (United States)

She, Jin; Guan, Xizhou; Liu, Yanyong; Xiang, Haiyan

2016-12-01

This study validated the RisingSun RS-651 blood pressure (BP) monitor based on auscultation in adults according to the American National Standards Institute/Association for the Advancement of Medical Instrumentation/International Organization for Standardization (ANSI/AAMI/ISO) 81060-2:2013 standard. The RS-651 device was evaluated in a study of 97 participants. The same arm simultaneous method, as defined in the ANSI/AAMI/ISO standard, was used. The mean differences±standard deviation for criterion 1 were 0.8±2.3 mm Hg for systolic BP (SBP) and -0.1±2.9 mm Hg for diastolic BP (DBP). Analysis for criterion 2 resulted in values of 0.8±1.5 mm Hg for SBP and -0.1±2.1 mm Hg for DBP. All of the data fulfilled the ANSI/AAMI/ISO 81060-2:2013 standard requirements to pass the validation. The RisingSun RS-651 device can be recommended for both clinical and self/home use in adults according to the ANSI/AAMI/ISO 81060-2:2013 standard. © 2016 The Authors. The Journal of Clinical Hypertension Published by Wiley Periodicals, Inc.

Incremental Value (Bayesian Framework) of Thoracic Ultrasonography over Thoracic Auscultation for Diagnosis of Bronchopneumonia in Preweaned Dairy Calves.

Science.gov (United States)

Buczinski, S; Ménard, J; Timsit, E

2016-07-01

Thoracic ultrasonography (TUS) is a specific and relatively sensitive method to diagnose bronchopneumonia (BP) in dairy calves. Unfortunately, as it requires specific training and equipment, veterinarians typically base their diagnosis on thoracic auscultation (AUSC), which is rapid and easy to perform. We hypothesized that the use of TUS, in addition to AUSC, can significantly increase accuracy of BP diagnosis. Therefore, the objectives were to (i) determine the incremental value of TUS over AUSC for diagnosis of BP in preweaned dairy calves and (ii) assess diagnostic accuracy of AUSC. Two hundred and nine dairy calves (<1 month of age) were enrolled in this cross-sectional study. Prospective cross-sectional study. All calves from a veal calves unit were examined (independent operators) using the Wisconsin Calf Respiratory Scoring Criteria (CRSC), AUSC, and TUS. A Bayesian latent class approach was used to estimate the incremental value of AUSC over TUS (integrated discrimination improvement [IDI]) and the diagnostic accuracy of AUSC. Abnormal CRSC, AUSC, and TUS were recorded in 3.3, 53.1, and 23.9% of calves, respectively. AUSC was sensitive (72.9%; 95% Bayesian credible interval [BCI]: 50.1-96.4%), but not specific (53.3%; 95% BCI: 43.3-64.0%) to diagnose BP. Compared to AUSC, TUS was more specific (92.9%; 95% BCI: 86.5-97.1%), but had similar sensitivity (76.5%; 95% BCI: 60.2-88.8%). The incremental value of TUS over AUSC was high (IDI = 43.7%; 5% BCI: 22.0-63.0%) significantly improving proportions of sick and healthy calves appropriately classified. The use of TUS over AUSC significantly improved accuracy of BP diagnosis in dairy calves. Copyright © 2016 The Authors. Journal of Veterinary Internal Medicine published by Wiley Periodicals, Inc. on behalf of the American College of Veterinary Internal Medicine.

Improving auscultatory proficiency using computer simulated heart sounds

Directory of Open Access Journals (Sweden)

Hanan Salah EL-Deen Mohamed EL-Halawany

2016-09-01

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

Diagnostic Tests and Procedures

Science.gov (United States)

... your heart with a stethoscope. This is called auscultation, which means the study of heart sounds. Doctors ... finds that your disease is more serious.) Tags: auscultation , blood pressure , heart valve , x-ray Article Info ...

Fetal Heart Rate Monitoring during Labor

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... What are the types of monitoring? • How is auscultation performed? • How is electronic fetal monitoring performed? • How ... methods of fetal heart rate monitoring in labor. Auscultation is a method of periodically listening to the ...

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

DEFF Research Database (Denmark)

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

2016-01-01

Background: Cavalier King Charles Spaniels (CKCS) are predisposed to myxomatous mitral valve disease (MMVD). Studies have indicated a strong genetic background. Objective: The aim of this study was to evaluate the effect of a breeding scheme involving auscultation and echocardiography. Animals......: In the Danish Kennel Club mandatory breeding scheme, 997 purebred CKCS were examined during the period 2002-2011. Each dog was evaluated 1-4 times with a total of 1,380 examinations. Methods: Auscultation and echocardiography were performed to evaluate mitral regurgitation murmur severity and degree of mitral...... compared with dogs in 2002-2003, reflecting a 73% decreased risk (P auscultation...

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

Science.gov (United States)

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

2017-09-25

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

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

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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.

Bronchial intubation could be detected by the visual stethoscope techniques in pediatric patients.

Science.gov (United States)

Kimura, Tetsuro; Suzuki, Akira; Mimuro, Soichiro; Makino, Hiroshi; Sato, Shigehito

2012-12-01

We created a system that allows the visualization of breath sounds (visual stethoscope). We compared the visual stethoscope technique with auscultation for the detection of bronchial intubation in pediatric patients. In the auscultation group, an anesthesiologist advanced the tracheal tube, while another anesthesiologist auscultated bilateral breath sounds to detect the change and/or disappearance of unilateral breath sounds. In the visualization group, the stethoscope was used to detect changes in breath sounds and/or disappearance of unilateral breath sounds. The distance from the edge of the mouth to the carina was measured using a fiberoptic bronchoscope. Forty pediatric patients were enrolled in the study. At the point at which irregular breath sounds were auscultated, the tracheal tube was located at 0.5 ± 0.8 cm on the bronchial side from the carina. When a detectable change of shape of the visualized breath sound was observed, the tracheal tube was located 0.1 ± 1.2 cm on the bronchial side (not significant). At the point at which unilateral breath sounds were auscultated or a unilateral shape of the visualized breath sound was observed, the tracheal tube was 1.5 ± 0.8 or 1.2 ± 1.0 cm on the bronchial side, respectively (not significant). The visual stethoscope allowed to display the left and the right lung sound simultaneously and detected changes of breath sounds and unilateral breath sound as a tracheal tube was advanced. © 2012 Blackwell Publishing Ltd.

Experimental validation of the tuneable diaphragm effect in modern acoustic stethoscopes.

Science.gov (United States)

Nowak, Karolina M; Nowak, Lukasz J

2017-09-01

The force with which the diaphragm chestpiece of a stethoscope is pressed against the body of a patient during an auscultation examination introduces the initial stress and deformation to the diaphragm and the underlying tissues, thus altering the acoustic parameters of the sound transmission path. If the examination is performed by an experienced physician, he will intuitively adjust the amount of the force in order to achieve the optimal sound quality. However, in case of becoming increasingly popular auto-diagnosis and telemedicine auscultation devices with no such feedback mechanisms, the question arises regarding the influence of the possible force mismatch on the parameters of the recorded signal. The present study describes the results of the experimental investigations on the relation between pressure applied to the chestpiece of a stethoscope and parameters of the transmitted bioacoustic signals. The experiments were carried out using various stethoscopes connected to a force measurement system, which allowed to maintain fixed pressure during auscultation examinations. The signals were recorded during examinations of different volunteers, at various auscultation sites. The obtained results reveal strong individual and auscultation-site variability. It is concluded that the underlying tissue deformation is the primary factor that alters the parameters of the recorded signals. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

The Diagnostic Utility of Computer-Assisted Auscultation for the Early Detection of Cardiac Murmurs of Structural Origin in the Periodic Health Evaluation.

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Viviers, Pierre L; Kirby, Jo-Anne H; Viljoen, Jeandré T; Derman, Wayne

Identification of the nature of cardiac murmurs during the periodic health evaluation (PHE) of athletes is challenging due to the difficulty in distinguishing between murmurs of physiological or structural origin. Previously, computer-assisted auscultation (CAA) has shown promise to support appropriate referrals in the nonathlete pediatric population. CAA has the ability to accurately detect cardiac murmurs of structural origin during a PHE in collegiate athletes. Cross-sectional, descriptive study. Level 3. A total of 131 collegiate athletes (104 men, 28 women; mean age, 20 ± 2 years) completed a sports physician (SP)-driven PHE consisting of a cardiac history questionnaire and a physical examination. An independent CAA assessment was performed by a technician who was blinded to the SP findings. Athletes with suspected structural murmurs or other clinical reasons for concern were referred to a cardiologist for confirmatory echocardiography (EC). Twenty-five athletes were referred for further investigation (17 murmurs, 6 abnormal electrocardiographs, 1 displaced apex, and 1 possible case of Marfan syndrome). EC confirmed 3 structural and 22 physiological murmurs. The SP flagged 5 individuals with possible underlying structural pathology; 2 of these murmurs were confirmed as structural in nature. Fourteen murmurs were referred by CAA; 3 of these were confirmed as structural in origin by EC. One such murmur was not detected by the SP, however, and detected by CAA. The sensitivity of CAA was 100% compared with 66.7% shown by the SP, while specificity was 50% and 66.7%, respectively. CAA shows potential to be a feasible adjunct for improving the identification of structural murmurs in the athlete population. Over-referral by CAA for EC requires further investigation and possible refinements to the current algorithm. Further studies are needed to determine the true sensitivity, specificity, and cost efficacy of the device among the athletic population. CAA may be a

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

Energy Technology Data Exchange (ETDEWEB)

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

2011-07-01

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

Teaching and testing physical examination skills without the use of patients.

Science.gov (United States)

Karnath, Bernard; Thornton, William; Frye, Ann W

2002-07-01

To design a cardiopulmonary physical exam curriculum that does not involve the use of patients. Bedside teaching is becoming a lost art, and the use of alternative methods of instruction such as simulation has become increasingly important. Simulators have been shown to enhance physical examination skills of students and physicians in training.(1) In 1995, a program was started to improve cardiopulmonary physical diagnosis and the teaching of auscultation at the University of Texas Medical Branch at Galveston (UTMB). The teaching manikin "Harvey" played a vital role in the development of the new curriculum. In 1997, UTMB adopted an organ-based approach to the basic science curriculum. The cardiopulmonary module in the basic science curriculum was a ten-week course taught in the second year of medical school. The physical diagnosis section of that course involved six instructional hours; four of the six hours were dedicated to cardiac auscultation and two hours to pulmonary auscultation. Only simulators and CD-ROMs were used for instruction. The 184 second-year medical students at UTMB were formed into small groups for instruction and practice. Although "Harvey" was an effective teaching tool, other simulators had to be developed for testing students' skills after instruction. It would be very difficult to administer a skills OSCE for 184 students without the development of several smaller transportable simulators. A commercially available blood pressure simulator from the Medical Plastics Laboratory, Inc., Gatesville, TX, was used to test the accuracy of students' blood pressure readings. Small auscultation transducers combined with a palpable pulse simulator, developed by one of the authors (WT) in collaboration with Andries Acoustics, Spicewood, TX, were used to efficiently test students' proficiency in cardiopulmonary auscultation. Digital simulated cardiopulmonary sounds were recorded onto a standard CD-ROM mini-disc and transmitted to the small transducers

The 200th anniversary of the stethoscope: Can this low-tech device survive in the high-tech 21st century?

Science.gov (United States)

Bank, Ivan; Vliegen, Hubert W; Bruschke, Albert V G

2016-12-14

In 1816, Laennec discovered that auscultation of the heart and lungs could effectively be performed by placing a hollow cylinder (initially made of a roll of paper) between the chest of the patient and the ear of the examiner. This was the first step in the development of the stethoscope, which was a breakthrough in the diagnosis and management of cardiac and pulmonary patients. Technical improvements of the stethoscope followed and in cardiac patients auscultation soon became a major diagnostic tool. In the second half of the 20th century, new powerful non-invasive diagnostic modalities were developed and the interest in auscultation declined. As a result, the auscultatory skills of students and physicians at all levels of training decreased to a disappointingly low level. We now must decide whether we should stimulate the use of and proficiency in auscultation or if we should accept the further decline and eventual abolishment of this component of the physical examination. Reviewing the literature and taking into consideration the setting in which the patients are presented, including the availability of advanced diagnostic facilities, we conclude that the time-honoured stethoscope, in spite of its limitations, still has potential as a patient-friendly, effective, and economical instrument in medical practice. However, new initiatives are required to train students, physicians and allied health professionals in cardiac auscultation to avoid misinterpretations that may harm the patients and generate extra costs. To be successful such programs will require wide support from the medical community. Published on behalf of the European Society of Cardiology. All rights reserved. © The Author 2016. For permissions please email: journals.permissions@oup.com.

The electronic stethoscope.

Science.gov (United States)

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

2015-07-10

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

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

Science.gov (United States)

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

2011-05-01

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

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

Science.gov (United States)

Roguin, Ariel

2006-01-01

Rene Theophile Hyacinthe Laënnec (1781–1826) was a French physician who, in 1816, invented the stethoscope. Using this new instrument, he investigated the sounds made by the heart and lungs and determined that his diagnoses were supported by the observations made during autopsies. Laënnec later published the first seminal work on the use of listening to body sounds, De L’auscultation Mediate (On Mediate Auscultation). Laënnec is considered the father of clinical auscultation and wrote the first descriptions of bronchiectasis and cirrhosis and also classified pulmonary conditions such as pneumonia, bronchiectasis, pleurisy, emphysema, pneumothorax, phthisis and other lung diseases from the sounds he heard with his invention. Laënnec perfected the art of physical examination of the chest and introduced many clinical terms still used today. PMID:17048358

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

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

Science.gov (United States)

Lovrenski, Jovan; Petrović, Slobodanka; Balj-Barbir, Svetlana; Jokić, Radoica; Vilotijević-Dautović, Gordana

2016-05-01

To compare lung ultrasound (LUS) with auscultation findings in children with clinical suspicion of pneumonia. 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. 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. 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. Copyright © 2016 by Academy of Sciences and Arts of Bosnia and Herzegovina.

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.

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

Science.gov (United States)

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

2011-01-01

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

International perception of lung sounds: a comparison of classification across some European borders

OpenAIRE

Aviles Solis, Juan Carlos; Vanbelle, Sophie; Halvorsen, Peder Andreas; Francis, Nick; Cals, Jochem W L; Andreeva, Elena A; Marques, Alda; Piirila, Paivi; Pasterkamp, Hans; Melbye, Hasse

2017-01-01

Source at http://dx.doi.org/10.1136/bmjresp-2017-000250 Introduction: Lung auscultation is helpful in the diagnosis of lung and heart diseases; however, the diagnostic value of lung sounds may be questioned due to interobserver variation. This situation may also impair clinical research in this area to generate evidence-based knowledge about the role that chest auscultation has in a modern clinical setting. The recording and visual display of lung sounds is a method that is both repeatab...

Maintenance of health care providers clinical proficiency: Transdisciplinary analysis, modeling and intervention

Science.gov (United States)

2015-10-13

Auscultation/Cardio 4.2.3 Auscultation/GI 4.2.4 Shape of face 4.2.5 Skin color (Neck, axillar) 4.2.6 Hip Exam 4.2.7 Weight 4.2.8 Stature 5.0 Treatment... vegetables , spend no more than 2 hours on screen time, include 1 hour of physical activity or active play, and consume little or no sugar-sweetened...learning environments, logistics analysis, and enterprise operational analytics. Ms. Ingraham also works on the application of artificial intelligence

Congenital peritoneopericardial diaphragmatic hernia in a terrier dog

Directory of Open Access Journals (Sweden)

Reza Kheirandish

2014-06-01

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

Sensitivity of bronchial responsiveness measurements in young infants

DEFF Research Database (Denmark)

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

2006-01-01

of 402 infants (median age, 6 weeks). Forced flow-volume measurements were obtained by the raised volume rapid thoracoabdominal compression technique and were compared with indexes of tidal breathing, measurements of transcutaneous oxygen (Ptco(2)), and auscultation during methacholine challenge testing....... RESULTS: Ptco(2) was the most sensitive parameter to detect increasing airway obstruction during methacholine challenge, followed by forced expiratory volume at 0.5 s (FEV(0.5)). Both were superior to other indexes of forced spirometry as well as tidal breathing indexes and auscultation. Coefficients...

Stethoscopes with hearing aid use: Case studies

Directory of Open Access Journals (Sweden)

Jacob, Regina Tangerino de Souza

2013-01-01

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

Stethoscopes with hearing aid use: Case studies

Science.gov (United States)

Jacob, Regina Tangerino de Souza; Zambonato, Ticiana Cristina de Souza; Mondelli, Maria Fernanda Capoani Garcia

2013-01-01

Summary Introduction: Description for using stethoscopes adapted to hearing aids. Aim: To describe the adaptation of HAs to stethoscopes used by 2 students in the health field with bilateral hearing impairment. Case reports: Two subjects with hearing loss had their stethoscopes coupled to HAs because of the individual requirements of their professions (healthcare) to perform auscultation. Conclusion: The improvement was measured in situ, and satisfaction was evaluated using a subjective questionnaire. The use of a stethoscope coupled to an HA allowed students with hearing loss to perform auscultation. PMID:25992000

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

Analysis of adventitious lung sounds originating from pulmonary tuberculosis.

Science.gov (United States)

Becker, K W; Scheffer, C; Blanckenberg, M M; Diacon, A H

2013-01-01

Tuberculosis is a common and potentially deadly infectious disease, usually affecting the respiratory system and causing the sound properties of symptomatic infected lungs to differ from non-infected lungs. Auscultation is often ruled out as a reliable diagnostic technique for TB due to the random distribution of the infection and the varying severity of damage to the lungs. However, advancements in signal processing techniques for respiratory sounds can improve the potential of auscultation far beyond the capabilities of the conventional mechanical stethoscope. Though computer-based signal analysis of respiratory sounds has produced a significant body of research, there have not been any recent investigations into the computer-aided analysis of lung sounds associated with pulmonary Tuberculosis (TB), despite the severity of the disease in many countries. In this paper, respiratory sounds were recorded from 14 locations around the posterior and anterior chest walls of healthy volunteers and patients infected with pulmonary TB. The most significant signal features in both the time and frequency domains associated with the presence of TB, were identified by using the statistical overlap factor (SOF). These features were then employed to train a neural network to automatically classify the auscultation recordings into their respective healthy or TB-origin categories. The neural network yielded a diagnostic accuracy of 73%, but it is believed that automated filtering of the noise in the clinics, more training samples and perhaps other signal processing methods can improve the results of future studies. This work demonstrates the potential of computer-aided auscultation as an aid for the diagnosis and treatment of TB.

Remote auscultatory patient monitoring during magnetic resonance imaging

DEFF Research Database (Denmark)

Henneberg, S; Hök, B; Wiklund, L

1992-01-01

A system for patient monitoring during magnetic resonance imaging (MRI) is described. The system is based on remote auscultation of heart sounds and respiratory sounds using specially developed pickup heads that are positioned on the precordium or at the nostrils and connected to microphones via...... 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...

Use of antibiotics in patients admitted to the hospital due to acute exacerbation of chronic obstructive pulmonary disease (COPD)

DEFF Research Database (Denmark)

Jacobsen, S K.; Weis, N; Almdal, T

2002-01-01

of antibiotics and steroids prior to admission, temperature, white blood cell (WBC) count, results of lung auscultation and X-ray examination of the thorax at admittance, and growth of sputum culture and antibiotic treatment in the hospital were all registered. RESULTS: A total of 400 admissions took place...... of the following indicators of infection: fever (temperature>37.5 degrees C), a raised WBC count (>9 billion/l), or crepitation at lung auscultation-were given antibiotics. In cases presenting with two or three of these indicators, 50-75% were given antibiotics. In 85% of the cases, penicillin or a macrolide...

A visual stethoscope to detect the position of the tracheal tube.

Science.gov (United States)

Kato, Hiromi; Suzuki, Akira; Nakajima, Yoshiki; Makino, Hiroshi; Sanjo, Yoshimitsu; Nakai, Takayoshi; Shiraishi, Yoshito; Katoh, Takasumi; Sato, Shigehito

2009-12-01

Advancing a tracheal tube into the bronchus produces unilateral breath sounds. We created a Visual Stethoscope that allows real-time fast Fourier transformation of the sound signal and 3-dimensional (frequency-amplitude-time) color rendering of the results on a personal computer with simultaneous processing of 2 individual sound signals. The aim of this study was to evaluate whether the Visual Stethoscope can detect bronchial intubation in comparison with auscultation. After induction of general anesthesia, the trachea was intubated with a tracheal tube. The distance from the incisors to the carina was measured using a fiberoptic bronchoscope. While the anesthesiologist advanced the tracheal tube from the trachea to the bronchus, another anesthesiologist auscultated breath sounds to detect changes of the breath sounds and/or disappearance of bilateral breath sounds for every 1 cm that the tracheal tube was advanced. Two precordial stethoscopes placed at the left and right sides of the chest were used to record breath sounds simultaneously. Subsequently, at a later date, we randomly entered the recorded breath sounds into the Visual Stethoscope. The same anesthesiologist observed the visualized breath sounds on the personal computer screen processed by the Visual Stethoscope to examine changes of breath sounds and/or disappearance of bilateral breath sound. We compared the decision made based on auscultation with that made based on the results of the visualized breath sounds using the Visual Stethoscope. Thirty patients were enrolled in the study. When irregular breath sounds were auscultated, the tip of the tracheal tube was located at 0.6 +/- 1.2 cm on the bronchial side of the carina. Using the Visual Stethoscope, when there were any changes of the shape of the visualized breath sound, the tube was located at 0.4 +/- 0.8 cm on the tracheal side of the carina (P Stethoscope (not significant). During advancement of the tracheal tube, alterations of the shape of the

An open real-time tele-stethoscopy system

Directory of Open Access Journals (Sweden)

Foche-Perez Ignacio

2012-08-01

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

An open real-time tele-stethoscopy system.

Science.gov (United States)

Foche-Perez, Ignacio; Ramirez-Payba, Rodolfo; Hirigoyen-Emparanza, German; Balducci-Gonzalez, Fernando; Simo-Reigadas, Francisco-Javier; Seoane-Pascual, Joaquin; Corral-Peñafiel, Jaime; Martinez-Fernandez, Andres

2012-08-23

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

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

Science.gov (United States)

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

2017-02-01

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

Heart sounds: are you listening? Part 1.

Science.gov (United States)

Reimer-Kent, Jocelyn

2013-01-01

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

Final Report of the Final Meeting of Project Coordinators

International Nuclear Information System (INIS)

Cordero Calderon, Carlos F.

1996-06-01

The Costa Rican Electricity Institute has always been worried of the verification of the good state of the works and thus to guarantee their operation. For that reason, it has established different sorts of auscultation of the Arenal's Dam. Some investigations have been done to find new methods to improve and to eliminate risks in different works or projects. The Arenal's Dam is one of the greatest engineering works in Costa Rica, it has the Arenal, Corobici and Sandillal Hydroelectric Plants. Furthermore, the irrigation system in the Tempisque River Valley, in the Guanacaste province. One special characteristic of the Site of the Dam, is the near location of the Arenal Volcano, in full activity and located at 6 Km. from the dam. This report has two goals, one is the traditional permanent measurements report for the project, and the other, is to present it as a final work of the Project Arcal XVIII, to the International Atomic Energy Agency. This report analyses the geo-hydraulic, structural and topographic auscultation, as well as the activities accomplished during the ARCAL XVIII /8/018, Application of Tracer Techniques for Leakage in Dams and Damming Project, based on information gathered through the geo-chemical auscultation, until June 1996. (author).30 ills., 80 charts, 35 tabs

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.

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

Science.gov (United States)

Pesic, Peter

2016-04-01

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

Laser Stethoscope for Use in Noisy Spacecraft Environments, Phase I

Data.gov (United States)

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

Afican Health Sciences Vol 10 No 1.pmd

African Journals Online (AJOL)

Administrator

Both lung fields were clear on auscultation His abdomen was flat and soft with a firm sausage-shaped non-tender ... risk factor for colorectal neoplasia10. .... Keywords: Thyroid, Abscess, Klebsiella Pneumoniae, Acute Suppurative Thyroiditis.

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

Science.gov (United States)

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

2016-01-01

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

Acoustic phenomena observed in lung auscultation

Science.gov (United States)

Korenbaum, V. I.; Tagil'Tsev, A. A.; Kulakov, Yu. V.

2003-05-01

The results of studying respiratory noise at the chest wall by the method of acoustic intensimetry reveal the presence of frequency components with different signs of the real and imaginary parts of the cross spectrum obtained for the responses of the receivers of vibratory displacement and dynamic force. An acoustic model is proposed to explain this difference on the basis of the hypothesis that the contributions of both air-borne and structure-borne sound are significant in the transmission of respiratory noise to the chest wall. It is shown that, when considered as an acoustic channel for the basic respiratory noise, the respiratory system of an adult subject has two resonances: in the frequency bands within 110 150 and 215 350 Hz. For adults in normal condition, the air-borne component of the basic respiratory noise predominates in the region 100 300 Hz in the lower parts of lungs. At forced respiration of healthy adults, the sounds of vesicular respiration are generated by the turbulent air flow in the 11th-through 13th-generation bronchi, and the transmission of these sounds to the chest wall in normal condition is mainly through air and is determined by the resonance of the vibratory system formed by the elasticity of air in the respiratory ducts of lungs and by the surface mass density of the chest wall. It is demonstrated that the distance from the chest wall to the sources of structure-borne additional respiratory noise, namely, wheezing with frequencies above 300 Hz, can be estimated numerically from the ratio between the real and imaginary parts of the cross spectrum on the assumption that the source is of the quadrupole type.

Case report

African Journals Online (AJOL)

ebutamanya

2015-08-05

Aug 5, 2015 ... Cardiac auscultation revealed rhythmic sounds with no murmur or friction rub. .... occur at any point of time during the course of sarcoidosis. Vishal S .... underlying cardiac anatomy and the prospective utility of programmed ...

Case report

African Journals Online (AJOL)

abp

2013-01-09

Jan 9, 2013 ... transurethral resection of the prostate under spinal anesthesia. 30 minutes after the end of the surgery, the patient presented signs of TURP syndrome with ... abdomen and lung auscultation were normal. He was intubated ...

In defense of the stethoscope.

Science.gov (United States)

Murphy, Raymond Lh

2008-03-01

The stethoscope is widely considered to be an unreliable instrument. Many studies document the significant observer variability in its use. Numerous other diagnostic tools are available that are generally regarded to provide more reliable diagnostic information. Some even argue that teaching of the ancient art should be de-emphasized in medical schools. Yet auscultation with an acoustic stethoscope can provide important, even life-saving, information. The purpose of this article is to present evidence that supports the use of the stethoscope in clinical medicine. The argument for the stethoscope will be made by presenting relevant investigations, including clinical studies acknowledged to meet the criteria of evidence-based medicine. It will focus on studies that have employed computerized acoustic technology to correlate lung sounds with disease states. This technology has advanced in recent years, which has stimulated a resurgence of interest in auscultation. Numerous studies have been done that utilized objective methods that circumvented the problem of observer variability. There is now a good deal of scientific evidence to support the hypothesis that lung sounds contain information that is clinically useful. This technology also allows this information to be collected more efficiently than previously possible. Advances in educational technology have made it possible to impart information on auscultation much more easily than was possible in the past. Contrary to predictions, the stethoscope is not likely to be relegated to the museum shelf in the near future. Computer technology is making it an even more useful clinical instrument.

The stethoscope: some preliminary investigations

Science.gov (United States)

Welsby, P; Parry, G; Smith, D

2003-01-01

Textbooks, clinicians, and medical teachers differ as to whether the stethoscope bell or diaphragm should be used for auscultating respiratory sounds at the chest wall. Logic and our results suggest that stethoscope diaphragms are more appropriate. PMID:14707247

N-Terminal Pro-B-Type Natriuretic Peptide and Phonocardiography in Differentiating Innocent Cardiac Murmurs from Congenital Cardiac Anomalies in Asymptomatic Puppies

NARCIS (Netherlands)

Marinus, S M; Engelen, H.G.H.; Szatmári, V.

2017-01-01

Background: Differentiating innocent cardiac murmurs from murmurs caused by congenital cardiac anomalies can be challenging with auscultation alone in asymptomatic puppies. Hypothesis: Plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations and phonocardiograms recorded by an

Oxytocin use in South Africa — a review

African Journals Online (AJOL)

Nicky

2005-06-28

Jun 28, 2005 ... The aim of this study was to examine the use of oxytocin by obstetricians ... Use with grand multipara ... Labour is induced when delivery will benefit the health of ..... intensive nursing. ... No one used auscultation exclusively in.

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

DEFF Research Database (Denmark)

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

2012-01-01

a history of previous malignancies (cases of malignant disease within 5 years of anti-TNF-alpha treatment should be carefully considered). The physical examination should include lung/heart auscultation and lymph node examination, and the paraclinical investigations should include chest X...

Towards the standardisation of lung sound nomenclature

NARCIS (Netherlands)

Pasterkamp, Hans; Brand, Paul L. P.; Everard, Mark; Garcia-Marcos, Luis; Melbye, Hasse; Priftis, Kostas N.

Auscultation of the lung remains an essential part of physical examination even though its limitations, particularly with regard to communicating subjective findings, are well recognised. The European Respiratory Society (ERS) Task Force on Respiratory Sounds was established to build a reference

Utility of physical examination and comparison to echocardiography for cardiac diagnosis

Directory of Open Access Journals (Sweden)

Ashish Patel

2017-03-01

Conclusion: Careful clinical auscultation using a stethoscope remains a valuable tool for cardiac diagnosis. Decision on initial diagnosis and management of valvular and congenital heart diseases should be based on clinical examination and integrating such information with echocardiography as required.

Neonatal cardiac emergencies

African Journals Online (AJOL)

flow) or require intervention (surgical or catheter) within the first ... Cardiac. History. Risk factors, e.g. meconium-stained liquor, prematurity, ... 'snowman' sign for supracardiac total anomalous pulmonary venous drainage (TAPVD), cardiomegaly with plethora for ... central cyanosis and on auscultation you hear no murmurs.

TBscore: Signs and symptoms from tuberculosis patients in a low-resource setting have predictive value and may be used to assess clinical course

DEFF Research Database (Denmark)

Wejse, Christian; Gustafson, Per; Nielsen, Jens

2008-01-01

We developed a clinical score to monitor tuberculosis patients in treatment and to assess clinical outcome. We used the WHO clinical manual to choose signs and symptoms, including cough, haemoptysis, dyspnoea, chest pain, night sweating, anaemia, tachycardia, lung-auscultation finding, fever, low...

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.

Laser metrology applied to the nuclear maintenance

International Nuclear Information System (INIS)

Garrido Garcia, J.; Sarti Fernandez, F.

2012-01-01

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.

Pythium aphanidermatum Infection Following Combat Trauma

Science.gov (United States)

2011-10-01

reactive pupils and bibasilar crackles upon lung auscultation. Wound examination revealed complete exposure of the posterior thighs to the deep muscle layers...abdominal abscess formation, ventilator-associated pneumonias, and recurrent bacteremias. The patient died of multiorgan system failure 16 weeks after his

association of hypertelorism in children with congenital acyanotic ...

African Journals Online (AJOL)

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

International perception of lung sounds : a comparison of classification across some European borders

NARCIS (Netherlands)

Aviles-Solis, Juan Carlos; Vanbelle, Sophie; Halvorsen, Peder A; Francis, Nick; Cals, Jochen W L; Andreeva, Elena A; Marques, Alda; Piirilä, Päivi; Pasterkamp, Hans; Melbye, Hasse

2017-01-01

Introduction: Lung auscultation is helpful in the diagnosis of lung and heart diseases; however, the diagnostic value of lung sounds may be questioned due to interobserver variation. This situation may also impair clinical research in this area to generate evidence-based knowledge about the role

1. Association between Presence of Haptoglobin Phenotypes and ...

African Journals Online (AJOL)

RICHY

and hypertension in indigenous Zambian patients attending ... the arteries is chronically elevated, is a common and ... Haptoglobin genes have been cited as risk factors in the. 4 ... Blood pressure Measurement. The auscultator method was used utilising a mercury sphygmomanometer and krotkoff sounds heard at the.

Analysis of acoustic cardiac signals for heart rate variability and murmur detection using nonnegative matrix factorization-based hierarchical decomposition

DEFF Research Database (Denmark)

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

2014-01-01

The detection of heart rate variability (HRV) via cardiac auscultation examination can be a useful and inexpensive tool which, however, is challenging in the presence of pathological signals and murmurs. The aim of this research is to analyze acoustic cardiac signals for HRV and murmur detection...

A System Approach to Navy Medical Education and Training. Appendix 12. General Duty Corpsman.

Science.gov (United States)

1974-08-31

PERSON 18 IDOSERVE/RERORT PATIFNTOS LEVEL OF RESPONSIVENESS 19 IOSERVE PATIENT’S PHYSICAL MOVEMENT, E.G. MUSCULAR COORDINATION, JPOSTUPE, BALANCE 20... DISTENSION (HARONESS/SOFTMFSSI 44 1AUSCULTATE ABDOMEN FOR BOWEL SOUNDS 4’ OBSERVE FOR/REPORT SYMPTOMS OF DIARRHEA 46 IOBSERVE FOR/PEPORT SYMPTOMS OF

Hearing, listening, action: Enhancing nursing practice through aural awareness education.

Science.gov (United States)

Collins, Anita; Vanderheide, Rebecca; McKenna, Lisa

2014-01-01

Abstract Noise overload within the clinical environment has been found to interfere with the healing process for patients, as well as nurses' ability to assess patients effectively. Awareness and responsibility for noise production begins during initial nursing training and consequently a program to enhance aural awareness skills was designed for graduate entry nursing students in an Australian university. The program utilized an innovative combination of music education activities to develop the students' ability to distinguishing individual sounds (hearing), appreciate patients' experience of sounds (listening) and improve their auscultation skills and reduce the negative effects of noise on patients (action). Using a mixed methods approach, students reported heightened auscultation skills and greater recognition of both patients' and clinicians' aural overload. Results of this pilot suggest that music education activities can assist nursing students to develop their aural awareness and to action changes within the clinical environment to improve the patient's experience of noise.

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

Science.gov (United States)

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

2012-01-01

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

[A vertebral arteriovenous fistula diagnosed by auscultation].

Science.gov (United States)

Iglesias Escalera, G; Diaz-Delgado Peñas, R; Carrasco Marina, M Ll; Maraña Perez, A; Ialeggio, D

2015-01-01

Cervical artery fistulas are rare arteriovenous malformations. The etiology of the vertebral arteriovenous fistulas (AVF) can be traumatic or spontaneous. They tend to be asymptomatic or palpation or continuous vibration in the cervical region. An arteriography is necessary for a definitive diagnosis. The treatment is complete embolization of the fistula. We present the case of a two year-old male, where the mother described it «like a washing machine in his head». On palpation during the physical examination, there was a continuous vibration, and a continuous murmur in left cervical region. A vascular malformation in vertebral region was clinically suspected, and confirmed with angio-MRI and arteriography. AVF are rare in childhood. They should be suspected in the presence of noises, palpation or continuous vibration in the cervical region. Early diagnosis can prevent severe complications in asymptomatic children. Copyright © 2013 Asociación Española de Pediatría. Published by Elsevier Espana. All rights reserved.

Direct Doppler auscultation of the carotid arteries

International Nuclear Information System (INIS)

Nix, L.

1984-01-01

The results of the carotid Doppler examinations and contrast arteriograms are presented. The overall sensitivity of the carotid Doppler examinations in detecting severe stenosis or occlusion of the carotid artery was 92%. The Doppler studies correctly differentiated these two conditions in 84% of the diseased vessels. In carotid arteries with stenosis greater than or equal to 50%, the sensitivity of the Doppler examinations was 90%, and these studies suggested stenosis in all but two of the 36 abnormal examinations. In two patent carotids with greater than 90% stenosis, a signal could not be elicited, presumably because of the low blood flow through the severely stenotic segment

Accuracy of abdominal auscultation for bowel obstruction.

Science.gov (United States)

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

2015-09-14

To investigate the accuracy and inter-observer variation of bowel sound assessment in patients with clinically suspected bowel obstruction. Bowel sounds were recorded in patients with suspected bowel obstruction using a Littmann(®) Electronic Stethoscope. The recordings were processed to yield 25-s sound sequences in random order on PCs. Observers, recruited from doctors within the department, classified the sound sequences as either normal or pathological. The reference tests for bowel obstruction were intraoperative and endoscopic findings and clinical follow up. Sensitivity and specificity were calculated for each observer and compared between junior and senior doctors. Interobserver variation was measured using the Kappa statistic. Bowel sound sequences from 98 patients were assessed by 53 (33 junior and 20 senior) doctors. Laparotomy was performed in 47 patients, 35 of whom had bowel obstruction. Two patients underwent colorectal stenting due to large bowel obstruction. The median sensitivity and specificity was 0.42 (range: 0.19-0.64) and 0.78 (range: 0.35-0.98), respectively. There was no significant difference in accuracy between junior and senior doctors. The median frequency with which doctors classified bowel sounds as abnormal did not differ significantly between patients with and without bowel obstruction (26% vs 23%, P = 0.08). The 53 doctors made up 1378 unique pairs and the median Kappa value was 0.29 (range: -0.15-0.66). Accuracy and inter-observer agreement was generally low. Clinical decisions in patients with possible bowel obstruction should not be based on auscultatory assessment of bowel sounds.

Accuracy of abdominal auscultation for bowel obstruction

DEFF Research Database (Denmark)

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

2015-01-01

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

Heart murmur and N-terminal pro-brain natriuretic peptide as predictors of death in 2977 consecutive hospitalized patients

DEFF Research Database (Denmark)

Iversen, Kasper; Nielsen, O.W.; Kirk, V.

2008-01-01

were studied. Auscultation, echocardiography were performed and levels of natriuretic peptides were measured. Results: A total of 21.8% of the 2977 patients had a murmur. After adjusting for sex and age there was a significant difference in the one-year mortality of patients with and without murmur (OR...

DESIGN AND APPLICATION OF SENSOR FOR RECORDING SOUNDS OVER HUMAN EYE AND NOSE

NARCIS (Netherlands)

JOURNEE, HL; VANBRUGGEN, AC; VANDERMEER, JJ; DEJONGE, AB; MOOIJ, JJA

The recording of sounds over the oribt of the eye has been found to be useful in the detection of intracranial aneurysms. A hydrophone for auscultation over the eye has been developed and is tested under controlled conditions. The tests consist of measurement over the eyes in three healthy

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

DEFF Research Database (Denmark)

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

2011-01-01

. METHODS: We evaluated the association between blood pressures and ECG signs of LVH, cardiac auscultation, and symptoms related to heart disease in the recently recovered data from the survey of 1851 Inuit conducted in 1962-1964 in East Greenland. RESULTS: The participation rate was 97%. Among the 812...

Bronchoscopy in children suspected of lower airway aspiration

DEFF Research Database (Denmark)

Holst-Albrechtsen, Sine; Kristensen, Søren; Larsen, Knud

2017-01-01

%) and pulmonary auscultation in 21 patients (73%). Two patients (7%) were in need of post-operative anaesthetic support as a result of respiratory failure, and the over-all complication rate was 28% (eight patients). No fatal outcomes were observed. Conclusions: The majority of the children in our study were...

Angiographic Evidence of Coronary Embolism and Resolution*

African Journals Online (AJOL)

1971-04-27

Apr 27, 1971 ... on exertion, orthopnoea and haemoptysis. She had atrial fibrillation, there was no evidence of heart failure and a right ventricular lift was palpable; auscultation revealed the classical findings of pure mitral stenosis with mobile valve cusps. The electrocardiogram (Fig. 1) showed atrial fibrillation, a mean ...

A clinical observational study analysing the factors associated with hyperventilation during actual cardiopulmonary resuscitation in the emergency department.

Science.gov (United States)

Park, Sang O; Shin, Dong Hyuk; Baek, Kwang Je; Hong, Dae Young; Kim, Eun Jung; Kim, Sang Chul; Lee, Kyeong Ryong

2013-03-01

This is the first study to identify the factors associated with hyperventilation during actual cardiopulmonary resuscitation (CPR) in the emergency department (ED). All CPR events in the ED were recorded by video from April 2011 to December 2011. The following variables were analysed using review of the recorded CPR data: ventilation rate (VR) during each minute and its associated factors including provider factors (experience, advanced cardiovascular life support (ACLS) certification), clinical factors (auscultation to confirm successful intubation, suctioning, and comments by the team leader) and time factors (time or day of CPR). Fifty-five adult CPR cases including a total of 673 min sectors were analysed. The higher rates of hyperventilation (VR>10/min) were delivered by inexperienced (53.3% versus 14.2%) or uncertified ACLS provider (52.2% versus 10.8%), during night time (61.0 versus 34.5%) or weekend CPR (53.1% versus 35.6%) and when auscultation to confirm successful intubation was performed (93.5% versus 52.8%) than not (all p<0.0001). However, experienced (25.3% versus 29.7%; p=0.448) or certified ACLS provider (20.6% versus 31.3%; p<0.0001) could not deliver high rate of proper ventilation (VR 8-10/min). Comment by the team leader was most strongly associated with the proper ventilation (odds ratio 7.035, 95% confidence interval 4.512-10.967). Hyperventilation during CPR was associated with inexperienced or uncertified ACLS provider, auscultation to confirm intubation, and night time or weekend CPR. And to deliver proper ventilation, comments by the team leader should be given regardless of providers' expert level. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.

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

Science.gov (United States)

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

2015-04-01

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

Processing bronchial sonograms to detect respiratory cycle fragments

International Nuclear Information System (INIS)

Bureev, A Sh; Zhdanov, D S; Zemlyakov, I Yu; Svetlik, M V

2014-01-01

This article describes the authors' results of work on the development of a method for the automated assessment of the state of the human bronchopulmonary system based on acoustic data. In particular, the article covers the method of detecting breath sounds on bronchial sonograms obtained during the auscultation process

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.

Cardiovascular and neuroendocrine responses to left lateral position in non-obese young males

DEFF Research Database (Denmark)

Schou, M; Pump, B; Gabrielsen, A

2001-01-01

by magnetic resonance (n=6) to be 7.0 +/- 0.2 cm below the sternum in SUP (1/3 of anteroposterior chest diameter below the sternum) and 2.5 +/- 0.2 cm below the midsternal level in LAT. Brachial mean (auscultation) and finger mean arterial pressures (infrared photoplethysmography), cardiac output (foreign gas...

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…

International perception of lung sounds: a comparison of classification across some European borders.

Science.gov (United States)

Aviles-Solis, Juan Carlos; Vanbelle, Sophie; Halvorsen, Peder A; Francis, Nick; Cals, Jochen W L; Andreeva, Elena A; Marques, Alda; Piirilä, Päivi; Pasterkamp, Hans; Melbye, Hasse

2017-01-01

Lung auscultation is helpful in the diagnosis of lung and heart diseases; however, the diagnostic value of lung sounds may be questioned due to interobserver variation. This situation may also impair clinical research in this area to generate evidence-based knowledge about the role that chest auscultation has in a modern clinical setting. The recording and visual display of lung sounds is a method that is both repeatable and feasible to use in large samples, and the aim of this study was to evaluate interobserver agreement using this method. With a microphone in a stethoscope tube, we collected digital recordings of lung sounds from six sites on the chest surface in 20 subjects aged 40 years or older with and without lung and heart diseases. A total of 120 recordings and their spectrograms were independently classified by 28 observers from seven different countries. We employed absolute agreement and kappa coefficients to explore interobserver agreement in classifying crackles and wheezes within and between subgroups of four observers. When evaluating agreement on crackles (inspiratory or expiratory) in each subgroup, observers agreed on between 65% and 87% of the cases. Conger's kappa ranged from 0.20 to 0.58 and four out of seven groups reached a kappa of ≥0.49. In the classification of wheezes, we observed a probability of agreement between 69% and 99.6% and kappa values from 0.09 to 0.97. Four out of seven groups reached a kappa ≥0.62. The kappa values we observed in our study ranged widely but, when addressing its limitations, we find the method of recording and presenting lung sounds with spectrograms sufficient for both clinic and research. Standardisation of terminology across countries would improve international communication on lung auscultation findings.

Comparative study between atropine and hyoscine-N-butylbromide for reversal of detomidine induced bradycardia in horses.

Science.gov (United States)

Pimenta, E L M; Teixeira Neto, F J; Sá, P A; Pignaton, W; Garofalo, N A

2011-05-01

Bradycardia may be implicated as a cause of cardiovascular instability during anaesthesia. Hyoscine would induce positive chronotropism of shorter duration than atropine, without adversely impairing intestinal motility in detomidine sedated horses. Ten minutes after detomidine (0.02 mg/kg bwt, i.v.), physiological saline (control), atropine (0.02 mg/kg bwt) or hyoscine (0.2 mg/kg bwt) were randomly administered i.v. to 6 horses, allowing one week intervals between treatments. Investigators blinded to the treatments monitored cardiopulmonary data and intestinal auscultation for 90 min and 24 h after detomidine, respectively. Gastrointestinal transit was assessed for 96 h via chromium detection in dry faeces. Detomidine significantly decreased heart rate (HR) and cardiac index (CI) from baseline for 30 and 60 min, respectively (control). Mean ± s.d. HR increased significantly 5 min after atropine (79 ± 5 beats/min) and hyoscine (75 ± 8 beats/min). After this time, HR was significantly higher after atropine in comparison to other treatments, while hyoscine resulted in intermediate values (lower than atropine but higher than controls). Hyoscine and atropine resulted in significantly higher CI than controls for 5 and 20 min, respectively; but this effect coincided with significant hypertension (mean arterial pressures >180 mmHg). Auscultation scores decreased from baseline in all treatments. Time to return to auscultation scores ≥12 (medians) did not differ between hyoscine (4 h) and controls (4 h) but atropine resulted in significantly longer time (10 h). Atropine induced colic in one horse. Gastrointestinal transit times did not differ between treatments. Hyoscine is a shorter acting positive chronotropic agent than atropine, but does not potentiate the impairment in intestinal motility induced by detomidine. Because of severe hypertension, routine use of anticholinergics combined with detomidine is not recommended. Hyoscine may represent an alternative to

Locked Twins: A Rarity

African Journals Online (AJOL)

On examination, her vitals were stable. Per abdominal examination revealed uterine fundal height of 28 weeks' size and a fetal heart rate of 136 beats/minute, auscultated just above the level of the umbilicus. No heart sound was found for the first baby. Vaginal examination showed the head of the second baby. [Figure 1].

Radiology

International Nuclear Information System (INIS)

Meyers, M.A.

1989-01-01

This paper reports on disease processes originating within the alimentary tract, may extend through the extraperitoneal spaces, and abnormalities primarily arising within other extraperitoneal sites may significantly affect the bowel. Symptoms and signs may be obscure, delayed, or nonspecific, and the area is generally not accessible to auscultation, palpation, or percussion. Radiologic evaluation thus plays a critical role

The United States Army Medical Department Journal, April - June 2011. Prehospital combat casualty care; The starting point of battlefield survival

Science.gov (United States)

2011-04-01

from a porcine model of acute respiratory diseases secondary to pulmonary contusion. TRANSCUTANEOUS CO2 Are more accurate methods of estimating...combat medic diagnoses a tension pneumothorax from observing the patient and, if feasible, by auscultation with a stethoscope . Dyspnea, distended...Jugular veins, hypotension, and decreased unilateral breath sounds are the major findings for the diagnosis. The stethoscope was invented in 1816 by

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.

Interobserver agreement in the assessment of pulmonary infiltrates on chest radiography in community-acquired pneumonia

International Nuclear Information System (INIS)

Pauls, S.; Billich, C.; Boll, D.; Aschoff, A.J.; Krueger, S.; Richter, K.; Marre, R.; Gonschior, S.; Muche, R.; Welte, T.; Schumann, C.; Suttorp, N.

2007-01-01

Purpose: To assess interobserver agreement (IOA) in the diagnosis of pulmonary infiltrates on chest X-rays for patients with community-acquired pneumonia (CAP). Materials and methods: From 7/2002 to 12/2005, 806 adults with CAP were included in the multicenter study ''CAPNETZ'' (7 hospitals). Inclusion criteria were clinical signs of pneumonia and pulmonary opacification on chest X-rays. Each X-ray was reevaluated by two radiologists from the university hospital in consensus reading against the interpreter at the referring hospital in regard to: presence of infiltrate (yes/no/equivocal), transparency (≤/> 50%), localization, and pattern of infiltrates (alveolar/interstitial). The following parameters were documented: digital or film radiography, hospitalization, fever, findings of auscultation, microbiological findings. Results: The overall IOA concerning the detection of infiltrates was 77.7% (n 626; Cl 0.75 - 0.81), the infiltrates were not verified in 16.4% (n = 132) by the referring radiologist with equivocal findings in 5.9% (n = 48). The IOA of the different clinical centers varied between 63.2% (n = 38, Cl 0.48 - 0.78) and 92.3% (n = 65, Cl 0.86 - 0.99). The IOA for the diagnosis of infiltrates was significantly higher for inpatients with 82.6% (n = 546; Cl 0.80-0.85) than for outpatients with 55.2% (n = 80; Cl 0.47 - 0.63), p 50% was 95.1% (n = 215; Cl 0.92 - 0.98) versus 80.4% (n = 403; Cl 0.77 - 0.84) for infiltrates with a transparency > 50% (p < 0.0001). In patients with positive auscultation, the IOA was higher (p = 0,034). Chest X-rays of patients with antibiotic therapy or an alveolar infiltrate showed more equivocal findings compared to patients without these features. Conclusion: There is considerable interobserver variability in the diagnosis of pulmonary infiltrates on chest radiographs. The IOA is higher in more opaque infiltrates, positive auscultation and inpatients. (orig.)

Interobserver agreement in the assessment of pulmonary infiltrates on chest radiography in community-acquired pneumonia; Detektion pneumonischer Infiltrate bei ambulant erworbener Pneumonie: Uebereinstimmung in der Befundung der Roentgen-Thoraxaufnahme

Energy Technology Data Exchange (ETDEWEB)

Pauls, S.; Billich, C.; Boll, D.; Aschoff, A.J. [Diagnostische und Interventionelle Radiologie, Universitaetskliniken Ulm (Germany); Krueger, S. [Medizinische Klinik I, Universitaetskliniken RWTH Aachen (Germany); Richter, K.; Marre, R.; Gonschior, S. [Mikrobiologie und Hygiene, Universitaetskliniken Ulm (Germany); Muche, R. [Inst. fuer Biometrie, Univ. Ulm (Germany); Welte, T. [Abt. fuer Pneumologie, Medizinische Hochschule Hannover (Germany); Schumann, C. [Medizinische Klinik II, Universitaetskliniken Ulm (Germany); Suttorp, N. [Abt. Innere Medizin, Charite Universitaetsmedizin Berlin (Germany)

2007-11-15

Purpose: To assess interobserver agreement (IOA) in the diagnosis of pulmonary infiltrates on chest X-rays for patients with community-acquired pneumonia (CAP). Materials and methods: From 7/2002 to 12/2005, 806 adults with CAP were included in the multicenter study 'CAPNETZ' (7 hospitals). Inclusion criteria were clinical signs of pneumonia and pulmonary opacification on chest X-rays. Each X-ray was reevaluated by two radiologists from the university hospital in consensus reading against the interpreter at the referring hospital in regard to: presence of infiltrate (yes/no/equivocal), transparency ({<=}/> 50%), localization, and pattern of infiltrates (alveolar/interstitial). The following parameters were documented: digital or film radiography, hospitalization, fever, findings of auscultation, microbiological findings. Results: The overall IOA concerning the detection of infiltrates was 77.7% (n = 626; Cl 0.75 - 0.81), the infiltrates were not verified in 16.4% (n = 132) by the referring radiologist with equivocal findings in 5.9% (n = 48). The IOA of the different clinical centers varied between 63.2% (n = 38, Cl 0.48 - 0.78) and 92.3% (n = 65, Cl 0.86 - 0.99). The IOA for the diagnosis of infiltrates was significantly higher for inpatients with 82.6% (n = 546; Cl 0.80-0.85) than for outpatients with 55.2% (n = 80; Cl 0.47 - 0.63), p < 0.0001. The IOA of infiltrates with a transparency > 50% was 95.1% (n = 215; Cl 0.92 - 0.98) versus 80.4% (n = 403; Cl 0.77 - 0.84) for infiltrates with a transparency > 50% (p < 0.0001). In patients with positive auscultation, the IOA was higher (p = 0,034). Chest X-rays of patients with antibiotic therapy or an alveolar infiltrate showed more equivocal findings compared to patients without these features. Conclusion: There is considerable interobserver variability in the diagnosis of pulmonary infiltrates on chest radiographs. The IOA is higher in more opaque infiltrates, positive auscultation and inpatients. (orig.)

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

Directory of Open Access Journals (Sweden)

Mehmood M

2014-08-01

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

[Evaluation and symptomatic treatment of surinfectious exacerbations of COPD: preliminary study of antibiotic treatment combined with fenspiride (Pneumorel 80mg) versus placebo].

Science.gov (United States)

Lirsac, B; Benezet, O; Dansin, E; Nouvet, G; Stach, B; Voisin, C

2000-02-01

Exacerbations of chronic obstructive pulmonary disease (COPD) have an inflammatory component in addition to the possible infectious component. The antiinflammatory properties of fenspiride (Pneumorel(R) 80 mg) should be evaluated in this frequent clinical situation. Assess the supplementary therapeutic benefit provided by fenspiride administered in combination with antibiotics in COPD patients presenting an episode of bronchial infection. A preliminary randomized placebo-controlled double-blind study was conduced in 7 centers. Patients under 80 years of age of both sexes were included. All patients had COPD and presented a bronchial infection defined as the presence of at least 2 of the 3 criteria defined by Anthonisen. Patients were randomly assigned to group F or group P. Group F received an antibiotic therapy from day 1 to day 11 plus fenspiride (3 x 80mg/d from day 0 to day 30). Group P received the same antibiotic therapy plus placebo. Amoxicillin 500mg plus clavulanic acid 125, 3 tablets/day, was administered in both groups. Thirty-nine patients were included (group F 19 patients, group P 20 patients; 6 women and 33 men; mean age 61.1 +/- 9.8 years). The 3 Anthonisen criteria were present in 79% and 75% of the patients in group F and P respectively (NS). On day 11, expectoration resolved in 39% and 32% (NS) and cough in 44% and 16% (NS) of the patients in groups F and P respectively. Lung auscultation returned to normal in 83% of the patients in group F compared with 47% in group P (p=0.05). A composite clinical score including expectoration cough and auscultation findings showed that 28% of the patients in group F were symptom-free on day 11 compared with 0% in group P (p=0.04). On day 30, the two groups were comparable. In this preliminary study of patients with COPD presenting a bronchial superinfection, there was a significant improvement in lung auscultation and in the composite clinical score in patients given fenspiride. Fenspiride was thus found to

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.

The rising of the land at the nuclear power plant Asco II

International Nuclear Information System (INIS)

Garcia Sanchez, J.; Ubalde, L.

1997-01-01

The rising of the land on which Asco II is settled is a geological process of slow and falling evolution in the time, studied and followed by means of geophysical models of the underground and continuous auscultation. Their influence on the structures, equipment, components and systems is contemplated in the bases of the design of the power station, whose behaviour towards this phenomenon evolves satisfactorily in accordance with control parameters. (Author)

A Data Mining Approach for Acoustic Diagnosis of Cardiopulmonary Disease

Science.gov (United States)

2008-06-01

technology offered new methods to diagnose patients with lung diseases , the use of a stethoscope for auscultation waned in popularity and methods such as...lung sounds that were outside the normal range. The investigators found that the sensitivity for detection of respiratory disease rose from 71% to... diseases which can be costly and harmful to the patient because of over medicating. The “smart” stethoscope will help resolve some of these

The bicentennial of the stethoscope: a reappraisal

Science.gov (United States)

DAVID, LILIANA; DUMITRASCU, DAN L.

2017-01-01

Background and aim Two hundred years ago Laennec, a young French physician discovered the stethoscope, in order to improve the lung auscultation. The stethoscope became the emblematic appendix of the physicians. Nurses use it also to monitor patients and medical students are proud to use it. We critically review the significance of the stethoscope 200 years after its discovery. Methods Pertinent literature was searched on PubMed and Google about the stethoscope, using also other terms: auscultation, Laennec, medical education, clinical diagnosis. Data were collected in a narrative review. Results Two centuries after its invention, the stethoscope still remains a major tool in the hands of healthcare professionals. It is routinely used by medical doctors and has become a mark of their status. Nurses use it also to monitor heart rate and blood pressure. Medical students get familiarized to use it during the medical faculty. Patients perceive the stethoscope as an important symbol of the medical profession. Conclusions Two hundred years ago the stethoscope was invented by Laennec. Despite the advent of X rays, CT, ECG, echocardiography and more recently of the electronic stethoscope, the classical stethoscope invented by Laennec still has its major role in the representation of healthcare providers and is a major utility in clinical diagnosis. PMID:28781536

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

Science.gov (United States)

Cottin, Vincent; Richeldi, Luca

2014-03-01

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

Application of semi-supervised deep learning to lung sound analysis.

Science.gov (United States)

Chamberlain, Daniel; Kodgule, Rahul; Ganelin, Daniela; Miglani, Vivek; Fletcher, Richard Ribon

2016-08-01

The analysis of lung sounds, collected through auscultation, is a fundamental component of pulmonary disease diagnostics for primary care and general patient monitoring for telemedicine. Despite advances in computation and algorithms, the goal of automated lung sound identification and classification has remained elusive. Over the past 40 years, published work in this field has demonstrated only limited success in identifying lung sounds, with most published studies using only a small numbers of patients (typically Ndeep learning algorithm for automatically classify lung sounds from a relatively large number of patients (N=284). Focusing on the two most common lung sounds, wheeze and crackle, we present results from 11,627 sound files recorded from 11 different auscultation locations on these 284 patients with pulmonary disease. 890 of these sound files were labeled to evaluate the model, which is significantly larger than previously published studies. Data was collected with a custom mobile phone application and a low-cost (US$30) electronic stethoscope. On this data set, our algorithm achieves ROC curves with AUCs of 0.86 for wheeze and 0.74 for crackle. Most importantly, this study demonstrates how semi-supervised deep learning can be used with larger data sets without requiring extensive labeling of data.

Wheezing recognition algorithm using recordings of respiratory sounds at the mouth in a pediatric population.

Science.gov (United States)

Bokov, Plamen; Mahut, Bruno; Flaud, Patrice; Delclaux, Christophe

2016-03-01

Respiratory diseases in children are a common reason for physician visits. A diagnostic difficulty arises when parents hear wheezing that is no longer present during the medical consultation. Thus, an outpatient objective tool for recognition of wheezing is of clinical value. We developed a wheezing recognition algorithm from recorded respiratory sounds with a Smartphone placed near the mouth. A total of 186 recordings were obtained in a pediatric emergency department, mostly in toddlers (mean age 20 months). After exclusion of recordings with artefacts and those with a single clinical operator auscultation, 95 recordings with the agreement of two operators on auscultation diagnosis (27 with wheezing and 68 without) were subjected to a two phase algorithm (signal analysis and pattern classifier using machine learning algorithms) to classify records. The best performance (71.4% sensitivity and 88.9% specificity) was observed with a Support Vector Machine-based algorithm. We further tested the algorithm over a set of 39 recordings having a single operator and found a fair agreement (kappa=0.28, CI95% [0.12, 0.45]) between the algorithm and the operator. The main advantage of such an algorithm is its use in contact-free sound recording, thus valuable in the pediatric population. Copyright © 2016 Elsevier Ltd. All rights reserved.

The Accutension Stetho, an automated auscultatory device to validate automated sphygmomanometer readings in individual patients.

Science.gov (United States)

Alpert, Bruce S

2018-04-06

The aim of this report is to describe a new device that can validate, by automated auscultation, individual blood pressure (BP) readings taken by automated sphygmomanometers.The Accutension Stetho utilizes a smartphone application in conjunction with a specially designed stethoscope that interfaces directly into the smartphone via the earphone jack. The Korotkoff sounds are recorded by the application and are analyzed by the operator on the screen of the smartphone simultaneously with the images from the sphygmomanometer screen during BP estimation. Current auscultatory validation standards require at least 85 subjects and strict statistical criteria for passage. A device that passes can make no guarantee of accuracy on individual patients. The Accutension Stetho is an inexpensive smartphone/stethoscope kit combination that estimates precise BP values by auscultation to confirm the accuracy of an automated sphygmomanometer's readings on individual patients. This should be of great value for both professional and, in certain circumstances, self-measurement BP. Patients will avoid both unnecessary treatment and errors of underestimation of BP, in which the patient requires therapy. The Stetho's software has been validated in an independent ANSI/AAMI/ISO standard study. The Stetho has been shown to perform without difficulty in multiple deflation-based devices by many manufacturers.

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

Science.gov (United States)

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

2016-10-01

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

An open real-time tele-stethoscopy system

OpenAIRE

Foche-Perez, Ignacio; Ramirez-Payba, Rodolfo; Hirigoyen-Emparanza, German; Balducci-Gonzalez, Fernando; Simo-Reigadas, Francisco-Javier; Seoane-Pascual, Joaquin; Corral-Peñafiel, Jaime; Martinez-Fernandez, Andres

2012-01-01

Abstract Background Acute respiratory infections are the leading cause of childhood mortality. The lack of physicians in rural areas of developing countries makes difficult their correct diagnosis and treatment. The staff of rural health facilities (health-care technicians) may not be qualified to distinguish respiratory diseases by auscultation. For this reason, the goal of this project is the development of a tele-stethoscopy system that allows a physician to receive real-time cardio-respir...

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

OpenAIRE

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

2011-01-01

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

Laryngeal granuloma in a thorougbread horse: a multidisciplinary study

OpenAIRE

Morales B, Abelardo; Campos A, Gerardo; Zerpa, Héctor; Fernández, David; García, Francisco; Bermúdez G, Víctor; Morales B, María

2011-01-01

A two year-old racing thoroughbred mare presented with loud respiratory stertor, that was auscultated in the tracheal and laryngeal regions. Upon palpitation of the larynx, no changes were noted. The upper respiratory tract was examined via a fiberoptic endoscopy where the nasal passages were observed to be unchanged and the scope passed with normal resistance. The guttural pouches and their openings were normal. The right arytenoid cartilage appeared thickened throughout its length and faile...

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

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

International Nuclear Information System (INIS)

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

2017-01-01

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

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

International Nuclear Information System (INIS)

Bohn, F.K.

1994-01-01

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

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

International Nuclear Information System (INIS)

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

2005-01-01

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

Auscultación y pruebas de carga

OpenAIRE

Sánchez García, Ibán

2011-01-01

[ES] Trata sobre la auscultación de estructuras. Los diferentes tipos de pruebas de carga,en puentes de carretera y en puentes de ferrocarril, además de los aparatos de medida y forma de ejecutarlas. [EN] Explains auscultation of structures. The different types of load tests on road bridges and railway bridges, plus the measuring apparatus and method of executing them. Proyecto Fin de Carrera-Universidad de Salamanca, Escuela Politécnica Superior de Zamora, 2011

AORTIC ANEURYSM: A RARE CAUSE OF ORTNER’S SYNDROME

OpenAIRE

Sukanta; Biswal Pradipta; Swetapadma; Jyoti; Manoranjan

2014-01-01

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

Diabetic ketoacidosis with pneumomediastinum: a case report

OpenAIRE

Makdsi, Fadi; Kolade, Victor O

2009-01-01

An 18-year-old male with type 1 diabetes mellitus presented to the emergency department after one day of lethargy and vomiting. Physical examination revealed a dehydrated male with tachycardia and Kussmaul?s respiration. There was subcutaneous emphysema in both supraclavicular regions. Chest auscultation revealed a positive Hamman?s sign. Laboratory investigation was significant for metabolic acidosis with venous blood pH 7.08. Plasma glucose was 1438 mg/dl; ketones were present in the urine....

The stethoscope - A 200th anniversary.

Science.gov (United States)

Permin, Henrik; Norn, Svend

René T.H. Laënnec was the man who designed the first monaural instrument for mediate auscultation. The invention became a medical breakthrough. An instrument capable of enhancing the subtle sounds created by the human heart and lungs. This evolutionary instrument also had the benefit of decreasing the oftentim s too direct bodily contact between the doctor and the patient. Laënnec carefully described the different sounds created by the human organs and attempted to link them to the post mortem findings. Even though many doctors were enthusiastic regarding this new medical breakthrough, the stethoscope also had its opponents, but John Forbes' English translation of Laënnec's De l'auscultation midiate as well as William Stokes' treatise on the use of the stethoscope spread the news to the medical world. In Denmark the stethoscope was introduced by Oluf Lundt Bang, S.M. Trier and E. Hornemann. The next step forward was the develop- ment of the binaural stethoscope by G.P. Camman in New York. The Littmann Electronic Stethoscope (3M Health Care) created by David Littmann is considered the leading product globally in this medical field. Digitization, ultrasound and Doppler effect, as well as 2D and 3D printing, are evidence of an on-going evolution within this field of medical equipment as we get ready to celebrate the stethoscopes 200th anniversary.

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

Science.gov (United States)

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

2013-06-01

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

High prevalence of rheumatic heart disease detected by echocardiography in school children.

Science.gov (United States)

Bhaya, Maneesha; Panwar, Sadik; Beniwal, Rajesh; Panwar, Raja Babu

2010-04-01

It is fairly easy to detect advanced valve lesions of established rheumatic heart disease by echocardiography in the clinically identified cases of rheumatic heart disease. However, to diagnose a subclinical case of rheumatic heart disease, no uniform set of echocardiographic criteria exist. Moderate thickening of valve leaflets is considered an indicator of established rheumatic heart disease. World Health Organization criteria for diagnosing probable rheumatic heart disease are more sensitive and are based on the detection of significant regurgitation of mitral and/or aortic valves by color Doppler. We attempted diagnosing RHD in school children in Bikaner city by cardiac ultrasound. The stratified cluster sampling technique was employed to identify 31 random clusters in the coeducational schools of Bikaner city. We selected 1059 school children aged 6-15 years from these schools. An experienced operator did careful cardiac auscultation and echocardiographic study. A second expert confirmed the echocardiographic findings. The prevalence of lesions suggestive of rheumatic heart disease by echocardiography was 51 per 1,000 (denominator = 1059; 95% CI: 38-64 per 1,000). We were able to clinically diagnose RHD in one child. None of these children or their parents having echocardiographic evidence of RHD could provide a positive history of acute rheumatic fever. By echocardiographic screening, we found a high prevalence of rheumatic heart disease in the surveyed population. Clinical auscultation had much lower diagnostic efficacy.

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

International Nuclear Information System (INIS)

Riebeling, V.; Bubenheimer, P.

1984-01-01

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

Risk factors for occurrence of displaced abomasum and their relation to nutritional management of Holstein dairy cattle

OpenAIRE

Behluli, Behlul; Musliu, Arben; Sherifi, Kurtesh; Youngs, Curtis R.; Rexhepi, Agim

2017-01-01

The aim of the present study was to identify nutritional risk factors for the occurrence of displaced abomasum (DA) in Holstein dairy cattle raised in regions with highly variable nutritional management. Feeding program data were collected from 30 dairy farms throughout Kosovo via use of a standardized questionnaire, and an AgriNIR™ Analyser was used to analyze the nutrient composition of forage (hay, corn silage) fed to cattle on those farms. A diagnosis of DA was made via auscultation/percu...

CT pulmonay angiography features of a hepatopulmonary syndrome

International Nuclear Information System (INIS)

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

2015-01-01

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

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

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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.

New Stethoscope With Extensible Diaphragm.

Science.gov (United States)

Takashina, Tsunekazu; Shimizu, Masashi; Muratake, Torakazu; Mayuzumi, Syuichi

2016-08-25

This study compared the diagnostic efficacy of the common suspended diaphragm stethoscope (SDS) with a new extensible diaphragm stethoscope (EDS) for low-frequency heart sounds. The EDS was developed by using an ethylene propylene diene monomer diaphragm. The results showed that the EDS enhanced both the volume and quality of low-frequency heart sounds, and improved the ability of examiners to auscultate such heart sounds. Based on the results of the sound analysis, the EDS is more efficient than the SDS. (Circ J 2016; 80: 2047-2049).

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.

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

OpenAIRE

L. Hindle*

2013-01-01

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

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

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M Amiri-Siavoshani

2016-10-01

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

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

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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.

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

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

2013-02-01

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

A comparison between swallowing sounds and vibrations in patients with dysphagia

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Movahedi, Faezeh; Kurosu, Atsuko; Coyle, James L.; Perera, Subashan

2017-01-01

The cervical auscultation refers to the observation and analysis of sounds or vibrations captured during swallowing using either a stethoscope or acoustic/vibratory detectors. Microphones and accelerometers have recently become two common sensors used in modern cervical auscultation methods. There are open questions about whether swallowing signals recorded by these two sensors provide unique or complementary information about swallowing function; or whether they present interchangeable information. The aim of this study is to present a broad comparison of swallowing signals recorded by a microphone and a tri-axial accelerometer from 72 patients (mean age 63.94 ± 12.58 years, 42 male, 30 female), who underwent videofluoroscopic examination. The participants swallowed one or more boluses of thickened liquids of different consistencies, including thin liquids, nectar-thick liquids, and pudding. A comfortable self-selected volume from a cup or a controlled volume by the examiner from a 5ml spoon was given to the participants. A comprehensive set of features was extracted in time, information-theoretic, and frequency domains from each of 881 swallows presented in this study. The swallowing sounds exhibited significantly higher frequency content and kurtosis values than the swallowing vibrations. In addition, the Lempel-Ziv complexity was lower for swallowing sounds than those for swallowing vibrations. To conclude, information provided by microphones and accelerometers about swallowing function are unique and these two transducers are not interchangeable. Consequently, the selection of transducer would be a vital step in future studies. PMID:28495001

Protocol compliance and time management in blunt trauma resuscitation.

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Spanjersberg, W R; Bergs, E A; Mushkudiani, N; Klimek, M; Schipper, I B

2009-01-01

To study advanced trauma life support (ATLS) protocol adherence prospectively in trauma resuscitation and to analyse time management of daily multidisciplinary trauma resuscitation at a level 1 trauma centre, for both moderately and severely injured patients. All victims of severe blunt trauma were consecutively included. Patients with a revised trauma score (RTS) of 12 were resuscitated by a "minor trauma" team and patients with an RTS of less than 12 were resuscitated by a "severe trauma" team. Digital video recordings were used to analyse protocol compliance and time management during initial assessment. From 1 May to 1 September 2003, 193 resuscitations were included. The "minor trauma" team assessed 119 patients, with a mean injury severity score (ISS) of 7 (range 1-45). Overall protocol compliance was 42%, ranging from 0% for thoracic percussion to 93% for thoracic auscultation. The median resuscitation time was 45.9 minutes (range 39.7-55.9). The "severe team" assessed 74 patients, with a mean ISS of 22 (range 1-59). Overall protocol compliance was 53%, ranging from 4% for thoracic percussion to 95% for thoracic auscultation. Resuscitation took 34.8 minutes median (range 21.6-44.1). Results showed the current trauma resuscitation to be ATLS-like, with sometimes very low protocol compliance rates. Timing of secondary survey and radiology and thus time efficiency remains a challenge in all trauma patients. To assess the effect of trauma resuscitation protocols on outcome, protocol adherence needs to be improved.

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

Science.gov (United States)

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

2008-12-01

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

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

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

2014-12-01

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

Collecting, archiving, and sharing of digitized medical information.

Science.gov (United States)

Campbell, W E

1996-05-01

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

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

International Nuclear Information System (INIS)

Fraga, Andrea de Melo Alexandre; Reis, Marcelo Conrado dos; Zambon, Mariana Porto; Toro, Ivan Contrera; Ribeiro, Jose Dirceu; Baracat, Emilio Carlos Elias

2008-01-01

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)

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

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Parsaei H.

2017-03-01

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

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

Energy Technology Data Exchange (ETDEWEB)

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

2008-02-15

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)

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

Science.gov (United States)

Parsaei, H.; Vakily, A.; Shafiei, A.M.

2017-01-01

Background: The basic requirements for monitoring anesthetized patients during surgery are assessing cardiac and respiratory function. Esophageal stethoscopes have been developed for this purpose, but these devices may not provide clear heart and lung sound due to existence of various noises in operating rooms. In addition, the stethoscope is not applicable for continues monitoring, and it is unsuitable for observing inaccessible patients in some conditions such as during CT scan. Objective: A wireless electronic esophageal stethoscope is designed for continues auscultation of heart and lung sounds in anesthetized patients. The system consists of a transmitter and a receiver. The former acquires, amplifies and transmits the acquired sound signals to the latter via a frequency modulation transmitter. The receiver demodulates, amplifies, and delivers the received signal to a headphone to be heard by anesthesiologist. Results: The usability and effectiveness of the designed system was qualitatively evaluated by 5 anesthesiologists in Namazi Hospital and Shahid Chamran Hospital, Shiraz, Iran on 30 patients in several operating rooms in different conditions; e.g., when electro surgery instruments are working. Fortunately, the experts on average ranked good quality for the heard heart and lung sounds and very good on the user friendly being of the instrument. Conclusion: Evaluation results demonstrate that the developed system is capable of capturing and transmitting heart and lung sounds successfully. Therefore, it can be used to continuously monitor anesthetized patients’ cardiac and respiratory function. Since via the instrument wireless auscultation is possible, it could be suitable for observing inaccessible patients in several conditions such as during CT scan. PMID:28451580

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

Applying cybernetic technology to diagnose human pulmonary sounds.

Science.gov (United States)

Chen, Mei-Yung; Chou, Cheng-Han

2014-06-01

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

Assessment of the swallowing function in older individuals referred to myocardial revascularization surgery.

Science.gov (United States)

Dantas, Mara de Oliveira Rodrigues Luiz; Auler, José Otávio Costa; Andrade, Claudia Regina Furquim de

2010-01-01

Swallowing evaluation of older individuals with coronary disease referred to heart surgery. To identify the characteristics of the swallowing function in older individuals referred to myocardial revascularization surgery (MR), using an evaluating protocol composed by a water test, cervical auscultation and pulse oximetry. The Assessment Protocol for Dysphagia Risk through a Combined Swallowing test and Vital Signs monitoring was used (PADTC)--measurements of HR and SpO2 (heart rate and oxygen saturation), water swallowing test with 1, 3, 5, 10, 15 e 20 ml, measurement of respiratory rate and cervical auscultation. The electronic stethoscope was used to analyze the number of swallows, response time and swallowing sound classification. In the Research Group (RG) older individuals with heart disease who were referred to MR were included. In the Control Group (CG) healthy older individuals were included. 38 older individuals were evaluated in the RG (mean age 68 years). In the CG, 30 older individuals were evaluated (mean age 70 years). There was a significant difference for the swallowing response time in older individuals with heart disease who presented HR below 60: swallowing response was shorter for 3 ml, 10 ml, 15 ml e 20 ml. HR was lower for individuals with heart disease. No significant difference was found between the groups for the other analyzed parameters. Older individuals with heart disease presented differences in the swallowing function when compared to healthy older individuals. Older individuals with heart disease presented alterations in the temporal coordination between breathing and swallowing, thus indicating risk for dysphagia.

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

International Nuclear Information System (INIS)

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

1989-01-01

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

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.

A case of acute respiratory failure in a young man

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Fabio Di Stefano

2007-06-01

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

L’insuffisance mitrale chez le cheval : revue de la littérature et comparaison avec la pathologie chez l’homme et chez le chien

OpenAIRE

Al Haidar, Ali; Leroux, Aurélia; Amory, Hélène

2013-01-01

L’insuffisance mitrale (IM) est l’une des pathologies cardiaques les plus fréquemment rencontrées dans l’espèce équine. C’est, en outre, la pathologie valvulaire qui présente le plus de risque d’entraver les performances sportives, d’évoluer en insuffisance cardiaque congestive (ICC) et donc de mettre en jeu la vie de l’animal affecté. Le diagnostic clinique de l’IM dépend beaucoup l’expertise du vétérinaire en cardiologie et repose en grande partie sur l’auscultation cardiaque. Dans tous ...

Estudio de caso del Postgrado Comunicación e Imagen del IADE Lisboa

OpenAIRE

Pereira, María Helena Cardoso Simoes

2006-01-01

El Proceso de Bolonia ha creado huevas reglas para la uniformación de la Enseñanza Superior en la Europa, implantando nuevos paradigmas, entre los cuales está el aseguramiento de la calidad y la importancia de la formación a lo largo de la vida. El objetivo de este estudio se inserta en estas dos temáticas, pretendiendo saber si el curso de Postgrado en Comunicac ión e Imagen del IADE (Lisboa) administra una enseñanza de calidad. La metodología utilizada se basó en el modelo EFQM. Se auscultó...

iStethoscope: a demonstration of the use of mobile devices for auscultation.

Science.gov (United States)

Bentley, Peter J

2015-01-01

iStethoscope Pro is the first piece of software (an "App") produced for iOS devices, which enabled users to exploit their smartphones, music players, or tablets as stethoscopes. The software exploits the built-in microphone (and supports externally added microphones) and performs real-time amplification and filtering to enable heart sounds to be heard with high fidelity. The software also enables the heart sounds to be recorded, analyzed using a spectrogram, and to be transmitted to others via e-mail. This chapter describes the motivation, functionality, and results from this work.

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.

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

Science.gov (United States)

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

2003-01-01

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

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

International Nuclear Information System (INIS)

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

2003-01-01

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

Developing a reference of normal lung sounds in healthy Peruvian children.

Science.gov (United States)

Ellington, Laura E; Emmanouilidou, Dimitra; Elhilali, Mounya; Gilman, Robert H; Tielsch, James M; Chavez, Miguel A; Marin-Concha, Julio; Figueroa, Dante; West, James; Checkley, William

2014-10-01

Lung auscultation has long been a standard of care for the diagnosis of respiratory diseases. Recent advances in electronic auscultation and signal processing have yet to find clinical acceptance; however, computerized lung sound analysis may be ideal for pediatric populations in settings, where skilled healthcare providers are commonly unavailable. We described features of normal lung sounds in young children using a novel signal processing approach to lay a foundation for identifying pathologic respiratory sounds. 186 healthy children with normal pulmonary exams and without respiratory complaints were enrolled at a tertiary care hospital in Lima, Peru. Lung sounds were recorded at eight thoracic sites using a digital stethoscope. 151 (81%) of the recordings were eligible for further analysis. Heavy-crying segments were automatically rejected and features extracted from spectral and temporal signal representations contributed to profiling of lung sounds. Mean age, height, and weight among study participants were 2.2 years (SD 1.4), 84.7 cm (SD 13.2), and 12.0 kg (SD 3.6), respectively; and, 47% were boys. We identified ten distinct spectral and spectro-temporal signal parameters and most demonstrated linear relationships with age, height, and weight, while no differences with genders were noted. Older children had a faster decaying spectrum than younger ones. Features like spectral peak width, lower-frequency Mel-frequency cepstral coefficients, and spectro-temporal modulations also showed variations with recording site. Lung sound extracted features varied significantly with child characteristics and lung site. A comparison with adult studies revealed differences in the extracted features for children. While sound-reduction techniques will improve analysis, we offer a novel, reproducible tool for sound analysis in real-world environments.

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

International Nuclear Information System (INIS)

Azarine, A.; Lions, C.; Beregi, J.P.; Koussa, M.

2001-01-01

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

Acute Pulmonary Edema Caused by a Giant Atrial Myxoma

Directory of Open Access Journals (Sweden)

Andrea Fisicaro

2013-01-01

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

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.

Classification of Normal Subjects and Pulmonary Function Disease Patients using Tracheal Respiratory Sound Detection System

Energy Technology Data Exchange (ETDEWEB)

Im, Jae Joong; Yi, Young Ju; Jeon, Young Ju [Chonbuk National University (Korea)

2000-04-01

A new auscultation system for the detection of breath sound from trachea was developed in house. Small size microphone(panasonic pin microphone) was encapsuled in a housing for resonant effect, and hardware for the sound detection was fabricated. Pulmonary function test results were compared with the parameters extracted from frequency spectrum of breath sound obtained from the developed system. Results showed that the peak frequency and relative ratio of integral values between low(80-400Hz) and high(400-800Hz) frequency ranges revealed the significant differences. Developed system could be used for distinguishing normal subject and the patients who have pulmonary disease. (author). 13 refs., 9 figs.

Internal Mammary Arterial Injury from Lead Extraction: A Clinically Subtle yet Important Complication of Implantable Device Removal

Directory of Open Access Journals (Sweden)

Cesar Cruz

2011-01-01

Full Text Available Percutaneous implantable device extraction has increased in recent years and is associated with small but significant risk. Arteriovenous fistula formation is an uncommon complication of this procedure. We report two cases where lead extraction was complicated by an arteriovenous fistula between the left internal mammary artery and the left brachiocephalic vein. In both cases, the patients were asymptomatic and the presence of a continuous murmur in the left subclavicular region led to the appropriate diagnosis. These were successfully treated with coil embolization. Auscultation around prior extraction sites should be routinely done to aid in the diagnosis of this potentially harmful complication.

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

Energy Technology Data Exchange (ETDEWEB)

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

2001-08-01

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

On stethoscope design: a challenge for biomedical circuit designers.

Science.gov (United States)

Hahn, A W

2001-01-01

Most clinicians learned the art and science of auscultation using an acoustic stethoscope. While many models of electronic stethoscopes have been marketed over the years, none of them seem to do a very good job of emulating the most common forms of acoustic stethoscopes available. This paper is an appeal to biomedical circuit designers to learn more about the acoustics of commonly used stethoscopes and to develop an appropriate group of circuits which would emulate them much like music synthesizers can emulate almost any musical instrument. The implications are for creative designers to move toward a rational and acceptable design for both personal physician use and for telemedicine.

An Ineffective Differential Diagnosis of Infective Endocarditis and Rheumatic Heart Disease after Streptococcal Skin and Soft Tissue Infection.

Science.gov (United States)

Suzuki, Tetsuya; Mawatari, Momoko; Iizuka, Toshihiko; Amano, Tatsuya; Kutsuna, Satoshi; Fujiya, Yoshihiro; Takeshita, Nozomi; Hayakawa, Kayoko; Ohmagari, Norio

2017-09-01

We herein report the case of a 68-year-old woman with a skin and soft tissue infection at her extremities. The blood culture results were positive for Streptococcus pyogenes, and we started treatment using ampicillin and clindamycin, although subsequent auscultation revealed a new-onset heart murmur. We therefore suspected rheumatic heart disease and infective endocarditis. The case met both the Jones criteria and the modified Duke criteria. Transesophageal echocardiography revealed vegetation on the aortic valve, although the pathological findings were also compatible with both rheumatic heart disease and infective endocarditis. The present findings suggest that these two diseases can coexist in some cases.

Chronic hypersensitivity pneumonitis.

Science.gov (United States)

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

2016-01-01

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

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.

Developing a Reference of Normal Lung Sounds in Healthy Peruvian Children

Science.gov (United States)

Ellington, Laura E.; Emmanouilidou, Dimitra; Elhilali, Mounya; Gilman, Robert H.; Tielsch, James M.; Chavez, Miguel A.; Marin-Concha, Julio; Figueroa, Dante; West, James

2018-01-01

Purpose Lung auscultation has long been a standard of care for the diagnosis of respiratory diseases. Recent advances in electronic auscultation and signal processing have yet to find clinical acceptance; however, computerized lung sound analysis may be ideal for pediatric populations in settings, where skilled healthcare providers are commonly unavailable. We described features of normal lung sounds in young children using a novel signal processing approach to lay a foundation for identifying pathologic respiratory sounds. Methods 186 healthy children with normal pulmonary exams and without respiratory complaints were enrolled at a tertiary care hospital in Lima, Peru. Lung sounds were recorded at eight thoracic sites using a digital stethoscope. 151 (81 %) of the recordings were eligible for further analysis. Heavy-crying segments were automatically rejected and features extracted from spectral and temporal signal representations contributed to profiling of lung sounds. Results Mean age, height, and weight among study participants were 2.2 years (SD 1.4), 84.7 cm (SD 13.2), and 12.0 kg (SD 3.6), respectively; and, 47 % were boys. We identified ten distinct spectral and spectro-temporal signal parameters and most demonstrated linear relationships with age, height, and weight, while no differences with genders were noted. Older children had a faster decaying spectrum than younger ones. Features like spectral peak width, lower-frequency Mel-frequency cepstral coefficients, and spectro-temporal modulations also showed variations with recording site. Conclusions Lung sound extracted features varied significantly with child characteristics and lung site. A comparison with adult studies revealed differences in the extracted features for children. While sound-reduction techniques will improve analysis, we offer a novel, reproducible tool for sound analysis in real-world environments. PMID:24943262

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

Science.gov (United States)

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

2016-01-01

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

Clinical algorithms for the diagnosis and prognosis of interstitial lung disease in systemic sclerosis.

Science.gov (United States)

Hax, Vanessa; Bredemeier, Markus; Didonet Moro, Ana Laura; Pavan, Thaís Rohde; Vieira, Marcelo Vasconcellos; Pitrez, Eduardo Hennemann; da Silva Chakr, Rafael Mendonça; Xavier, Ricardo Machado

2017-10-01

Interstitial lung disease (ILD) is currently the primary cause of death in systemic sclerosis (SSc). Thoracic high-resolution computed tomography (HRCT) is considered the gold standard for diagnosis. Recent studies have proposed several clinical algorithms to predict the diagnosis and prognosis of SSc-ILD. To test the clinical algorithms to predict the presence and prognosis of SSc-ILD and to evaluate the association of extent of ILD with mortality in a cohort of SSc patients. Retrospective cohort study, including 177 SSc patients assessed by clinical evaluation, laboratory tests, pulmonary function tests, and HRCT. Three clinical algorithms, combining lung auscultation, chest radiography, and percentage predicted forced vital capacity (FVC), were applied for the diagnosis of different extents of ILD on HRCT. Univariate and multivariate Cox proportional models were used to analyze the association of algorithms and the extent of ILD on HRCT with the risk of death using hazard ratios (HR). The prevalence of ILD on HRCT was 57.1% and 79 patients died (44.6%) in a median follow-up of 11.1 years. For identification of ILD with extent ≥10% and ≥20% on HRCT, all algorithms presented a high sensitivity (>89%) and a very low negative likelihood ratio (algorithms, especially the algorithm C (HR = 3.47, 95% CI: 1.62-7.42), which identified the presence of ILD based on crackles on lung auscultation, findings on chest X-ray, or FVC 20% on HRCT or, in indeterminate cases, FVC algorithms had a good diagnostic performance for extents of SSc-ILD on HRCT with clinical and prognostic relevance (≥10% and ≥20%), and were also strongly related to mortality. Non-HRCT-based algorithms could be useful when HRCT is not available. This is the first study to replicate the prognostic algorithm proposed by Goh et al. in a developing country. Copyright © 2017 Elsevier Inc. All rights reserved.

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

Science.gov (United States)

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

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

Acoustic heart. Interpretation of Phonocardiograms by computer

International Nuclear Information System (INIS)

Granados, J; Tavera, F; Velázquez, J M; Hernández, R T; Morales, A; López, G

2015-01-01

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

Use of nuclear technology for peace and progress

International Nuclear Information System (INIS)

Cordero-C., C.F.

1994-01-01

The Costa Rican Electricity Institute and the Atomic Energy Commission of Costa Rica, has signed an agreement, in the year of 1994, in order to promote and develop the peaceful utilization of nuclear energy. This agreement has allowed the ICE Works Auscultation Office, to participate within the ARCAL XVIII RLA/8/018, Application of Tracer Technique for Leakage in Dams and Damming Project, promoted and directed by the International Organization of Atomic Energy. The work chosen in our country to apply these techniques is the Arenal's Dam and Damming. We hope to know more in depth of this thematic and to use it, in other similar works of institutional or national interest. (author)

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.

Dynamic monitoring equipment for earthworks and sub grades

International Nuclear Information System (INIS)

Alvarez de Sotomayor, R.

2013-01-01

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

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

International Nuclear Information System (INIS)

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

1998-01-01

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

Development of digital stethoscope for telemedicine.

Science.gov (United States)

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

2016-01-01

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

Physical examination of the hemodialysis arteriovenous fistula to detect early dysfunction.

Science.gov (United States)

Abreo, Kenneth; Amin, Bakhtiar M; Abreo, Adrian P

2018-04-01

The maintenance of vascular access patency for end-stage renal disease patients on hemodialysis is necessary for survival. Many nephrologists, nurse practitioners, and nurses have limited experience with the physical examination of the arteriovenous fistula. In this review, we define key terms used in the assessment of an arteriovenous fistula. We discuss the arteriovenous fistula physical exam, including details of inspection, palpation, and auscultation. Using these concepts, we review the abnormal findings that can assist practitioners in determining the location of a stenosis. We review the existing literature that validates physical exam findings with gold standard tests such as ultrasound and angiography. Finally, we review data supporting the value of training physicians and nurses in arteriovenous fistula physical examination.

Analysis of Respiratory Sounds: State of the Art

Directory of Open Access Journals (Sweden)

Sandra Reichert

2008-01-01

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

VII CORENDE. Abstracts book

International Nuclear Information System (INIS)

2009-01-01

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

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

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

Student Nurses' Knowledge in Relation to Blood Pressure Measurement by Sphygmomanometry and Auscultation.

Science.gov (United States)

Torrance, Colin; Serginson, Eve

1996-01-01

British nursing students (78 of 93) completed a questionnaire about blood pressure; 90% were not familiar with Korotkoff sounds or auscultary gap; most thought blood pressure was the same in both arms; 63% knew resting was essential before measurement; 59% assessed the arm for cuff size; only 25% thought the cuff should be placed at heart level.…

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

NARCIS (Netherlands)

Sprikkelman, A. B.; Grol, M. H.; Lourens, M. S.; Gerritsen, J.; Heymans, H. S.; van Aalderen, W. M.

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 (FEV1). A study was

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

NARCIS (Netherlands)

Sprikkelman, A. B.; Schouten, J. P.; Lourens, M. S.; Heymans, H. S.; van Aalderen, W. M.

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

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.)

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

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

A mobile gateway for medical auscultation : Enhanced Client Certificate Authentication and MTLS Security

OpenAIRE

Leijon, Jon

2016-01-01

  Attempting to re-engineer a telemedicine application, this report sets out to make a cheap yet robust solution that is portable and easy to use. It will be a Inera compliant system using Android that authenticates in a secure way with a .NET server behind F5 full proxy.The report begins with a background to telemedicine, and a technical specification that might fulfill the demands of privacy laws regarding health care records. The focus of the report moves on to inspects the choices for aut...

Accuracy and reliability of wrist-cuff devices for self-measurement of blood pressure.

Science.gov (United States)

Kikuya, Masahiro; Chonan, Kenichi; Imai, Yutaka; Goto, Eiji; Ishii, Masao

2002-04-01

Self-measurement of blood pressure (BP) might offer some advantages in diagnosis and therapeutic evaluation and in patient management of hypertension. Recently, wrist-cuff devices for self-measurement of BP have gained more than one-third of the world market share. In the present study, we validated wrist-cuff devices and compared the results between wrist- and arm-cuff devices. The factors affecting the accuracy of wrist-cuff devices were also studied. The research group to assess the validity of automated blood pressure measuring device consisted of 13 institutes in Japan, which validated two wrist-cuff devices (WC-1 and WC-2) and two arm-cuff devices (AC-1 and AC-2). They used a crossover method, where the comparison was done between auscultation, by two observers by means of a double stethoscope on one arm and the device on the opposite arm or wrist. There was good inter-observer agreement for the auscultation method in each institute (systolic blood pressure (SBP), -0.1 +/- 2.8 mmHg; diastolic blood pressure (DBP), -0.1 +/- 2.6 mmHg, n = 498). The mean difference between auscultation and the device was minimal both in arm-cuff devices (mean difference for AC-1, 2.2/1.9 mmHg, n = 97 and for AC-2, 5.1/2.9 mmHg, n = 136, SBP/DBP) and wrist-cuff devices (mean difference for WC-1, -2.1/1.2 mmHg, n = 173 mmHg and for WC-2, -2.3/-5.6 mmHg, n = 92). The standard deviation of the difference (SDD) in wrist-cuff devices, however (SDD for WC-1, 9.7/7.3 mmHg and for WC-2, 10.2/8.6 mmHg), was larger than that of the arm-cuff devices (SDD for AC-1, 5.6/6.6 mmHg and for AC-2, 6.3/5.1 mmHg). Grading of AC-1 and AC-2 based on criteria of British Hypertension Society was A/A and B/A, respectively, while that of WC-1 and WC-2 was C/B and D/B, respectively. Using the same validation protocol, the results of validation for one device were divergent in each institute. In wrist-cuff devices, the BP value obtained in palmar flexion was significantly higher and that obtained in palmar

Anomalous Origin of Left Coronary Artery from Pulmonary Artery (ALCAPA)

International Nuclear Information System (INIS)

Younus, Z.; Ahmed, I.; Iftikhar, R.

2013-01-01

Anomalous origin of the left coronary artery from the pulmonary artery also recognized as Bland White Garland syndrome is a very rare congenital condition. A two-months old baby boy presented with dyspnoea for two weeks and a pansystolic murmur on auscultation. The base line investigations showed cardiomegaly and bilateral basal haze on X-ray chest. ECG showed ST elevation in leads l and AVl and echocardiography showed situs solitus, levocardia, hypokinetic intraventricular septum, ejection fraction of 30%, mitral regurgitation of grade-I and an anomalous origin of the left coronary artery from pulmonary artery was diagnosed. Patient was in left heart failure. It was rectified surgically by creating a transpulmonary tunnel (Takeuchi repair). Postoperative course was uneventful and he was finally discharged in stable condition. (author)

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

Science.gov (United States)

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

2015-01-01

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

Acoustics based assessment of respiratory diseases using GMM classification.

Science.gov (United States)

Mayorga, P; Druzgalski, C; Morelos, R L; Gonzalez, O H; Vidales, J

2010-01-01

The focus of this paper is to present a method utilizing lung sounds for a quantitative assessment of patient health as it relates to respiratory disorders. In order to accomplish this, applicable traditional techniques within the speech processing domain were utilized to evaluate lung sounds obtained with a digital stethoscope. Traditional methods utilized in the evaluation of asthma involve auscultation and spirometry, but utilization of more sensitive electronic stethoscopes, which are currently available, and application of quantitative signal analysis methods offer opportunities of improved diagnosis. In particular we propose an acoustic evaluation methodology based on the Gaussian Mixed Models (GMM) which should assist in broader analysis, identification, and diagnosis of asthma based on the frequency domain analysis of wheezing and crackles.

Nuclear technology for peace and progress

International Nuclear Information System (INIS)

Cordero Calderon, C.F.

1997-01-01

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

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.

Non destructive characterization of cracks in concrete by ultrasonic auscultation of civil engineering structures

International Nuclear Information System (INIS)

Quiviger, A.; Payan, C.; Chaix, J.F.; Zardan, J.P.; Garnier, V.; Salin, J.

2011-01-01

Concrete Non Destructive Characterisation is one of the important issues to evaluate the life duration in the present and future civil engineering structures. The damaging modes of the structures often imply the phases of the appearance and after growth of the cracks. We have to detect, identify and characterize them. The characterization result must lead to a diagnosis of the criticality of a crack regarding to the integrity of the structure and its ability to fulfill its function. The Non Destructive Evaluation techniques are numerous but the ultrasonic ones are able to give an answer to both the characterization and the follow-up of the defect on site. Yet if this method is potentially relevant to detect and identify the cracks in the concrete, we have today a certain amount of locks to remove in order to offer robust and reproducible industrial solutions. These locks range from research points like the description of the real propagation of linear or non linear ultrasonic waves in a heterogeneous material, to more industrial concepts such as the development of devices designed to be applied in the concrete control. For this purpose, we present our latest works on this topic. We develop an overview of the problem: first, to extract the most important theoretical solutions to analyse an unstopping and closed crack in concrete with an only one face access. Then we suggest a methodology to apply one of these solutions on site. A first step of this work after having chosen a solution is to check the ability of the technique to detect a crack, and its sensitivity to the length, depth and opening of the crack. We have developed an experimental plan based on theoretical concept to compare the linear and non linear survey on a set of specimens composed of concrete beams cracked to different depths. We describe the devices and give the latest results. The non linear technique is able to extract information on the size of the cracks. It is an important step to progress in the methodology. Some points are identified to improve its reproducibility and its applicability on site. That is the next works we are developing. (authors)

Non destructive characterization of cracks in concrete by ultrasonic auscultation of civil engineering structures

Energy Technology Data Exchange (ETDEWEB)

Quiviger, A.; Payan, C.; Chaix, J.F.; Zardan, J.P.; Garnier, V. [EDF, LCND (France); Salin, J. [EDF Paris (France)

2011-07-01

Concrete Non Destructive Characterisation is one of the important issues to evaluate the life duration in the present and future civil engineering structures. The damaging modes of the structures often imply the phases of the appearance and after growth of the cracks. We have to detect, identify and characterize them. The characterization result must lead to a diagnosis of the criticality of a crack regarding to the integrity of the structure and its ability to fulfill its function. The Non Destructive Evaluation techniques are numerous but the ultrasonic ones are able to give an answer to both the characterization and the follow-up of the defect on site. Yet if this method is potentially relevant to detect and identify the cracks in the concrete, we have today a certain amount of locks to remove in order to offer robust and reproducible industrial solutions. These locks range from research points like the description of the real propagation of linear or non linear ultrasonic waves in a heterogeneous material, to more industrial concepts such as the development of devices designed to be applied in the concrete control. For this purpose, we present our latest works on this topic. We develop an overview of the problem: first, to extract the most important theoretical solutions to analyse an unstopping and closed crack in concrete with an only one face access. Then we suggest a methodology to apply one of these solutions on site. A first step of this work after having chosen a solution is to check the ability of the technique to detect a crack, and its sensitivity to the length, depth and opening of the crack. We have developed an experimental plan based on theoretical concept to compare the linear and non linear survey on a set of specimens composed of concrete beams cracked to different depths. We describe the devices and give the latest results. The non linear technique is able to extract information on the size of the cracks. It is an important step to progress in the methodology. Some points are identified to improve its reproducibility and its applicability on site. That is the next works we are developing. (authors)

The diagnostic accuracy of physical examination compared to lung ultrasound for determining lung congestion in hemodialysis patients who have reached their dry weight

Science.gov (United States)

Rahardjo, K. D.; Dharmaeizar; Nainggolan, G.; Harimurti, K.

2017-08-01

Research has shown that hemodialysis patients with lung congestion have high morbidity and mortality. Patients were assumed to be free of lung congestion if they had reached their post-dialysis dry weight. Most often, to determine if the patient was free of lung congestion, physical examination was used. However, the accuracy of physical examination in detecting lung congestion has not been established. To compare the capabilities of physical examination and lung ultrasound in detection of lung congestion, cross-sectional data collection was conducted on hemodialysis patients. Analysis was done to obtain proportion, sensitivity, specificity, positive predictive value, negative predictive value, and positive likelihood ratio. Sixty patients participated in this study. The inter observer variation of 20 patients revealed a kappa value of 0.828. When all 60 patients were taken into account, we found that 36 patients (57.1%) had lung congestion. Mild lung congestion was found in 24 (38.1%), and 12 (19%) had a moderate degree of congestion. In the analysis comparing jugular venous pressure to lung ultrasound, we found that sensitivity was 0.47 (0.31-0.63), specificity was 0.73 (0.54-0.86), positive predictive value (PPV) was 0.51 (0.36-0.67), negative predictive value (NPV) was 0.70 (0.49-0.84), positive likelihood ratio (PLR) was 1.75 (0.88-3.47), and the negative likelihood ratio (NLR) was 0.72 (0.47-1.12). In terms of lung auscultation, we found that sensitivity was 0.56 (0.39-0.71), specificity was 0.54 (0.35-0.71), PPV was 0.61 (0.44-0.76), NPV was 0.48 (0.31-0.66), PLR was 1.21 (0.73-2.0), and NLR was 0.82 (0.49-1.38). The results of our study showed that jugular venous distention and lung auscultation examination are not reliable means of detecting lung congestion.

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

Science.gov (United States)

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

2014-01-01

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

Pulmonary ventilation and perfusion scintigraphy in patients with bronchial asthma

International Nuclear Information System (INIS)

Ono, Seiji; Hoshi, Hiroaki; Watanabe, Katsushi.

1988-01-01

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, %FEV 1.0 ). 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 %FEV 1.0 . 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)

Pain in the chest in a user of cocaine

International Nuclear Information System (INIS)

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

1987-01-01

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

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.

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

Science.gov (United States)

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

2013-04-17

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

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

Directory of Open Access Journals (Sweden)

Babu Kanjirakadavath

2013-07-01

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

Pulmonary artery dissection following balloon valvuloplasty in a dog with pulmonic stenosis.

Science.gov (United States)

Grint, K A; Kellihan, H B

2017-04-01

A 3-month-old, 9.9 kg, male pit bull cross was referred for evaluation of collapse. A left basilar systolic heart murmur graded V/VI and a grade IV/VI right basilar systolic heart murmur were ausculted. Echocardiography showed severe pulmonic stenosis characterized by annular hypoplasia, leaflet thickening, and leaflet fusion. After 1 month of atenolol therapy, a pulmonic valve balloon valvuloplasty procedure was performed, and the intra-operative right ventricular pressure was reduced by 43%. Echocardiography, performed the following day, showed apparent rupture of a pulmonary valve leaflet and a membranous structure within the pulmonary artery consistent with a dissecting membrane. Short-term follow-up has shown no apparent progression of the pulmonary artery dissection and the patient remains free of clinical signs. Copyright © 2016 Elsevier B.V. All rights reserved.

SOKOLSKY GRIGORY IVANOVICH: CONTRIBUTION TO THE DEVELOPMENT OF RUSSIAN AND INTERNATIONAL MEDICINE. ON THE OCCASION OF THE 210th ANNIVERSARY OF HIS BIRTH

Directory of Open Access Journals (Sweden)

D. I. Abdulganieva

2018-01-01

Full Text Available The paper is devoted to the anniversary – the 210th anniversary of the birth of the outstanding scientist and clinician Grigory Ivanovich Sokolsky. G.I. Sokolsky made a huge contribution to the development of rheumatology, internal medicine, pathofisiology, and to the enhancement of disease diagnostic capabilities. He published many works in various branches of medicine. The surprising fact is that the young scientist published one or two large works every year in the second half of the 1830s. The scientist won international recognition for his work “On Rheumatism of Heart Muscle Tissue” (1836 that opened up a new understanding of the pathophysiology of rheumatism, by establishing a relationship of joint injuries to the heart. The clinical introduction and teaching of auscultation and percussion also became G.I. Sokolsky’s priceless merit to Russian medicine.

Digital stethoscope: technology update

Science.gov (United States)

Swarup, Supreeya; Makaryus, Amgad N

2018-01-01

Cardiovascular disease (CVD) is recognized as the leading cause of mortality throughout the world. About one-third of global mortality is attributable to CVD. In addition to clinical presentation, specific clinical exam findings can assist in treating and preventing CVD. CVD may initially manifest as pulmonary pathology, and thus, accurate cardiopulmonary auscultation is paramount to establishing accurate diagnosis. One of the most powerful tools available to physicians is the stethoscope. The stethoscope first emerged in the year 1818, invented by a French physician, René Laennec. Since then, the initial modest monaural wooden tube has evolved into a sophisticated digital device. This paper provides an analysis of the evolution of the stethoscope as well as highlights the advancement made by the modern digital stethoscope including the application of this tool in advancing care for patients suffering from CVD. PMID:29379321

Egophony: is this classic semeiological sign still helpful?

Directory of Open Access Journals (Sweden)

Domenico Viviani

2013-04-01

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

Use of antibiotics in patients admitted to the hospital due to acute exacerbation of chronic obstructive pulmonary disease (COPD)

DEFF Research Database (Denmark)

Jacobsen, S K.; Weis, N; Almdal, T

2002-01-01

BACKGROUND: The purpose of this study was to assess to what extent symptoms and signs of bacterial infection are present and evaluated in patients admitted to the hospital for exacerbation of chronic obstructive pulmonary disease (COPD) in relation to initiation of antibiotic treatment. METHODS...... of antibiotics and steroids prior to admission, temperature, white blood cell (WBC) count, results of lung auscultation and X-ray examination of the thorax at admittance, and growth of sputum culture and antibiotic treatment in the hospital were all registered. RESULTS: A total of 400 admissions took place....... In 104 of them, chest X-ray was compatible with pneumonia, and 99 cases were treated with antibiotics. In 44% of the remaining 296 cases, antibiotics were given. It was found that 25-45% of the patients with very little evidence of infection-i.e. the absence of, or only the presence of, one...

Problematic diagnosis of bronchial foreign bodies in children

International Nuclear Information System (INIS)

Myllylae, V.; Paeivaensalo, M.; Seppaenen, U.; Hyrynkangas, K.; Linna, O.; Kortelainen, M.L.

1987-01-01

Bronchial foreign bodies by children are dangerous and require immediate therapeutic measures. Findings and significance of chest film in the diagnosis of bronchial foreign bodies in 24 children were analysed. All patients were symptomatic. 18 patients had an abnormal and 6 normal auscultation finding. In three cases the physician did not suspect aspiration, and the diagnosis was delayed, which caused the death of one child. Roentgenpositive foreign bodies were found in 8 and -negative in 16 cases. Secondary changes (obstructive emphysema, atelectasis, pneumonia) were seen in 16 cases. In emergency cases the chest films were analysed by physician and later by a radiologist, who found 88% of them to be abnormal. Fluoroscopy of expiratory chest film helps to detect the unilateral emphysema more distinctly. The diagnosis must always be confirmed with bronchoscopy and extraction thereby is the adequate treatment of bronchial bodies. (orig.) [de

Application of Clustering Techniques for Lung Sounds to Improve Interpretability and Detection of Crackles

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Germán D. Sosa

2015-01-01

Full Text Available Due to the subjectivity involved currently in pulmonary auscultation process and its diagnostic to evaluate the condition of respiratory airways, this work pretends to evaluate the performance of clustering algorithms such as k-means and DBSCAN to perform a computational analysis of lung sounds aiming to visualize a representation of such sounds that highlights the presence of crackles and the energy associated with them. In order to achieve that goal, Wavelet analysis techniques were used in contrast to traditional frequency analysis given the similarity between the typical waveform for a crackle and the wavelet sym4. Once the lung sound signal with isolated crackles is obtained, the clustering process groups crackles in regions of high density and provides visualization that might be useful for the diagnostic made by an expert. Evaluation suggests that k-means groups crackle more effective than DBSCAN in terms of generated clusters.

Techniques for Non-Invasive Monitoring of Arterial Blood Pressure

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Agnes S. Meidert

2018-01-01

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

Cardiovascular Sound and the Stethoscope, 1816 to 2016

Science.gov (United States)

Segall, Harold N.

1963-01-01

Cardiovascular sound escaped attention until Laennec invented and demonstrated the usefulness of the stethoscope. Accuracy of diagnosis using cardiovascular sounds as clues increased with improvement in knowledge of the physiology of circulation. Nearly all currently acceptable clinicopathological correlations were established by physicians who used the simplest of stethoscopes or listened with the bare ear. Certain refinements followed the use of modern methods which afford greater precision in timing cardiovascular sounds. These methods contribute to educating the human ear, so that those advantages may be applied which accrue from auscultation, plus the method of writing quantitative symbols to describe what is heard, by focusing the sense of hearing on each segment of the cardiac cycle in turn. By the year 2016, electronic systems of collecting and analyzing data about the cardiovascular system may render the stethoscope obsolete. ImagesFig. 1Fig. 2Fig. 3Fig. 5Fig. 8 PMID:13987676

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

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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.

Unsupervised Feature Learning for Heart Sounds Classification Using Autoencoder

Science.gov (United States)

Hu, Wei; Lv, Jiancheng; Liu, Dongbo; Chen, Yao

2018-04-01

Cardiovascular disease seriously threatens the health of many people. It is usually diagnosed during cardiac auscultation, which is a fast and efficient method of cardiovascular disease diagnosis. In recent years, deep learning approach using unsupervised learning has made significant breakthroughs in many fields. However, to our knowledge, deep learning has not yet been used for heart sound classification. In this paper, we first use the average Shannon energy to extract the envelope of the heart sounds, then find the highest point of S1 to extract the cardiac cycle. We convert the time-domain signals of the cardiac cycle into spectrograms and apply principal component analysis whitening to reduce the dimensionality of the spectrogram. Finally, we apply a two-layer autoencoder to extract the features of the spectrogram. The experimental results demonstrate that the features from the autoencoder are suitable for heart sound classification.

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

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

2016-05-01

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

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

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Ryohei Suzuki

2018-02-01

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

Hypertrophic osteopathy characterized by nuclear scintigraphy in a horse

International Nuclear Information System (INIS)

Long, M.T.; Foreman, J.H.; Wallig, M.A.; Chambers, M.D.; Losonsky, J.M.; Muhlbauer, M.C.

1994-01-01

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

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

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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 ...

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

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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.

Innovative Application of a Microlaryngeal Surgery Tube for difficult Airway Management in a Case of Down's Syndrome.

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Gulabani, Michell; Gupta, Akhilesh; Bannerjee, Neerja Gaur; Sood, Rajesh; Dass, Prashant

2016-04-01

An 11-year-old male child, known case of down's syndrome with congenital oesophageal stricture was posted for oesophageal dilatation. Preoperative airway assessment revealed a high arched palate, receding mandible and Mallampati Score of 2. During surgery, after loss of consciousness which was described as loss of eyelash reflex and adequate jaw relaxation, direct laryngoscopy and endotracheal intubation was attempted with a cuffed endotracheal tube number 5.0mm ID (internal diameter). The endotracheal tube could not be negotiated smoothly, so 5.0mm ID uncuffed endotracheal tube was used which passed through easily, but on auscultation revealed a significant leak. Later, intubation via a Micro Laryngeal Surgery (MLS) cuffed tube 4.0mm ID was attempted. The MLS tube advanced smoothly and there was no associated leak on positive pressure ventilation. Thus by innovative thinking and avant-garde reasoning, a definitive airway device could be positioned with no other suitable alternative at hand.

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 ...

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

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

2017-12-01

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

Frequency shifting approach towards textual transcription of heartbeat sounds.

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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.

Frequency shifting approach towards textual transcription of heartbeat sounds

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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.

Lymphoma and broncho-pneumonia in a calf

International Nuclear Information System (INIS)

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

2005-01-01

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

Extravascular Lung Water and Acute Lung Injury

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Ritesh Maharaj

2012-01-01

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

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

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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.

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

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Silvia Fernandes

2016-06-01

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

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

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

2001-12-01

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

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

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Ghandi

2016-05-01

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

Left coronary aneurysmal dilation and subaortic stenosis in a dog.

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Hernandez, Juan L; Bélanger, Marie-Claude; Benoit-Biancamano, Marie-Odile; Girard, Christiane; Pibarot, Philippe

2008-06-01

A 6-month-old German shepherd dog was referred for evaluation of a cardiac murmur. Upon physical examination, the auscultated heart rate was 120 beats/min, and a grade IV/VI systolic heart murmur with a point of maximal intensity over the left heart base radiating up the neck was heard. The standard echocardiographic examination showed subaortic stenosis and an anechoic tubular structure extending from the sinus of Valsalva to the left ventricular posterior wall. Aneurysmal left coronary artery (CA) was confirmed by angiography. The dog was euthanized and post-mortem examination showed severe dilatation of the proximal left CA and confirmed the subaortic stenosis. Histopathology did not demonstrate abnormalities in the walls of the CA, aorta or pulmonary artery. The exact cause of the CA aneurysmal dilation remains unknown. Subaortic stenosis, elevated coronary vascular resistance or a congenital anomaly may have contributed to the dilation. To our knowledge, coronary aneurysmal dilation has never been described in dogs. Standard echocardiography provides reliable information on coronary anatomy.

Resistencia del hormigón en estructuras terminadas

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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.

Chronic hypersensitivity pneumonitis

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Pereira CA

2016-09-01

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

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

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Raschke RA

2014-07-01

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

Ureaplasma parvum causing life-threatening disease in a susceptible patient.

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Korytny, Alexander; Nasser, Roni; Geffen, Yuval; Friedman, Tom; Paul, Mical; Ghanem-Zoubi, Nesrin

2017-08-16

A 56-year-old man with lymphoma developed orchitis followed by septic arthritis of his right glenohumeral joint. Synovial fluid cultures were negative but PCR amplification test was positive for Ureaplasmaparvum. The patient was treated with doxycycline. Two and a half years later, the patient presented with shortness of breath and grade III/IV diastolic murmur on auscultation. Echocardiography revealed severely dilated left heart chambers, severe aortic regurgitation and several mobile masses on the aortic valve cusps suspected to be vegetations. He underwent valve replacement; valve tissue culture was negative but the 16S rRNA gene amplification test was positive for U. parvum He was treated again with doxycycline. In an outpatient follow-up 1 year and 3 months later, the patient was doing well. Repeated echocardiography showed normal aortic prosthesis function. © BMJ Publishing Group Ltd (unless otherwise stated in the text of the article) 2017. All rights reserved. No commercial use is permitted unless otherwise expressly granted.

Reliability of palpation of the radial artery compared with auscultation of the brachial artery in measuring SBP

NARCIS (Netherlands)

van der Hoeven, Niels V.; van den Born, Bert-Jan H.; van Montfrans, Gert A.

2011-01-01

Background Systolic blood pressure contributes more to cardiovascular disease than DBP, especially in elderly persons. Palpation of the radial artery to assess SBP - Riva-Rocci's technique-may be an attractive alternative for auscultatory SBP in these patients. Therefore, we investigated the

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

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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…

Caracterisation des Ondes Radar de Surface par la Simulation Numerique et les Mesures GPR pour l'Auscultation en

Science.gov (United States)

Filali, Bilai

Graphene, as an advanced carbon nano-structure, has attracted a deluge of interest of scholars recently because of it's outstanding mechanical, electrical and thermal properties. There are several different ways to synthesis graphene in practical ways, such as Mechanical Exfoliation, Chemical Vapor Deposition (CVD), and Anodic Arc discharge. In this thesis a method of graphene synthesis in plasma will be discussed, in which this synthesis method is supported by the erosion of the anode material. This graphene synthesis method is one of the most practical methods which can provide high production rate. High purity of graphene flakes have been synthesized with an anodic arc method under certain pressure (about 500 torr). Raman spectrometer, Scanning Electron Microscope (SEM), Atomic Force Microscopy (AFM) and Transmission Electron Microscopy (TEM) have been utilized for characterization of the synthesis products. Arc produced graphene and commercially available graphene was compared by those machine and the difference lies in the number of layers, the thicknesses of each layer and the shape of the structure itself. Temperature dependence of the synthesis procedure has been studied. It has been found that the graphene can be produced on a copper foil substrate under temperatures near the melting point of copper. However, with a decrease in substrate temperature yields a transformation of the synthesized graphene into amorphous carbon. Glow discharge was utilized to functionalize grapheme. SEM and EDS observation indicated increases of oxygen content in the graphene after its exposure to glow discharge.

A RARE CASE OF SINUS OF VALSALVA ANEURYSM PRESENTING WITH TRICUSPID STENOSIS AND RIGHT HEART FAILURE

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P. V. R. S. Subrahmanya Sarma

2017-12-01

Full Text Available PRESENTATION OF CASE A female patient of age 48 years came with the complaints of dyspnoea on exertion, no history of orthopnoea or PND attacks. There is history of easy fatigability and mild abdominal distension, since past 3 months. On clinical examination, she is moderately built and nourished. There was no pallor, cyanosis, clubbing, lymphadenopathy, oedema and icterus. Family history was not significant. She was conscious and coherent. Vitals were within the normal limits. Her BP being 120/76 mmHg. She was found to have an elevated JVP up to angle of the mandibule with a prominent "A" wave, and on palpation, there are no thrills or sounds palpable and on auscultation first heart sound and a normal split second heart sounds were heard with no added sounds or murmurs being heard and the presence of free fluid in the abdomen was confirmed. Hepatomegaly was also noticed. Clinically, she was thought to have right heart failure. Her ECG showed that she was in atrial fibrillation with controlled ventricular rate.

Rumenolith formation in a Bapedi ram

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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.

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

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Michael D. Prislin

2011-01-01

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

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.

Conformidade das práticas assistenciais de enfermagem com as recomendações técnicas para o parto normal

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Natasha Faria Barros Guida

2017-01-01

Full Text Available Objective: to describe the compliance of obstetric nursing care practices with the technical recommendations for normal birth. Methods: cross-sectional study of records of normal birth care delivered by nurse-midwifes from two public maternity hospitals. The compliance assessment was based on the World Health Organization recommendations. The two-tailed Z-test was applied. Results: Appropriate compliance was found for all practices assessed at maternity hospital A. At maternity hospital B, the timely clamping of the umbilical cord obtained partial compliance (70.9%. Prescriptions were found for a null diet, 85.7% and 59.8%; oxytocin during labor, 38.7% and 48.4%; and peri-parturient tocodynamometry, 30.5% and 47.2%, at maternity hospitals A and B, respectively. Conclusion: the presence of the companion; use of the partogram; non-pharmacological care; intermittent auscultation of fetal heart beat; non-supinal maternal position during child birth; and postpartum application of intramuscular oxytocin obtain appropriate compliance, although inappropriate conducts were observed, such as prescriptions for a null diet, oxytocin and intrapartum tocodynamometry.

Pulmonary hantavirus syndrome: case report and brief review

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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 ...

Digital stethoscope: technology update

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Swarup S

2018-01-01

Full Text Available Supreeya Swarup,1 Amgad N Makaryus1,2 1Department of Cardiology, Nassau University Medical Center, East Meadow, NY, 2Department of Cardiology, Zucker School of Medicine at Hofstra/Northwell Health, Hempstead, NY, USA Abstract: Cardiovascular disease (CVD is recognized as the leading cause of mortality throughout the world. About one-third of global mortality is attributable to CVD. In addition to clinical presentation, specific clinical exam findings can assist in treating and preventing CVD. CVD may initially manifest as pulmonary pathology, and thus, accurate cardiopulmonary auscultation is paramount to establishing accurate diagnosis. One of the most powerful tools available to physicians is the stethoscope. The stethoscope first emerged in the year 1818, invented by a French physician, René Laennec. Since then, the initial modest monaural wooden tube has evolved into a sophisticated digital device. This paper provides an analysis of the evolution of the stethoscope as well as highlights the advancement made by the modern digital stethoscope including the application of this tool in advancing care for patients suffering from CVD. Keywords: cardiovascular disease, physical exam, diagnosis, treatment

Bilateral tension pneumothorax following equipment improvisation.

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Zambricki, Christine; Schmidt, Carol; Vos, Karen

2014-02-01

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

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

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

2007-02-01

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

Hippocrates: the forefather of neurology.

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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.

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

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

2015-07-01

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

MITRAL VALVE PROLAPSE AND SUDDEN CARDIAC DEATH: WHO IS IN THE RISK GROUP?

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O. E. Shirobokikh

2016-01-01

Full Text Available Mitral valve prolapse (MVP is a congenital heart disease, fairly widespread in the population (2-8%. It rarely has complications, but they are serious and include sudden cardiac death (SCD, risk of which rises twofold from 0.2-0.4% cases by MVP. Most deaths are observed among young healthy women. This work is a review of literature dedicated to connection between MVP and SCD designed to explore possible predicts of SCD within patients suffering from MVP and to determine the subset of patients. A conclusion has been made that the connection between MVP and SCD is realized through life-threatening ventricular arrhythmias (VT, VF. The most common site of arrhythmias origin is the inferobasal left ventricular wall. A high-risk subset of patients is determined as young adult women with a midsystolic click at auscultation, bileaflet involvement of the mitral valve, T-wave abnormalities on inferior leads (II, III, aVF and frequent complex ventricular ectopic activity. Such patients require more intensive disease management of ventricular arrhythmias including consideration of surgical treatment.

The state of the cardiovascular system in young patients with mitral valve prolapse

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M. A. Kuznetsova

2014-12-01

Full Text Available Aim. Due to the signifi cant increase of complications developing in young patients with mitral valve prolapse detection of this disease is important.In order to examine the state of the cardiovascular system in young patients 135 patients with mitral valve prolapse at the age of 16–25 years were examined. Methods and results. During the survey medical history was taken, the information from the medical records of оutpatients and extracts from the medical histories of patients were studied, clinical examination, electrocardiography (ECG and echocardiography (EchoCG were conducted with subsequent analysis of the obtained data. Conclusion. It was established that signifi cant differences were obtained in the analysis of auscultative symptoms in groups with MVP of grade 1 and grade 2. ECG studies in young patients showed that functional impairment was signifi cantly more frequently observed in the group with grade 2 MVP (56.4%, less frequently – in the group with grade 1 MVP (50.0% and only in 30.0% of cases in the control group (p <0.01.

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

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Miguel A. Franesqui

2017-08-01

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

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

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

2017-08-01

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

Does "hidden undercuffing" occur among obese patients? Effect of arm sizes and other predictors of the difference between wrist and upper arm blood pressures.

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Doshi, Hardik; Weder, Alan B; Bard, Robert L; Brook, Robert D

2010-02-01

Arm size can affect the accuracy of blood pressure (BP) measurement, and "undercuffing" of large upper arms is likely to be a growing problem. Therefore, the authors investigated the relationship between upper arm and wrist readings. Upper arm and wrist circumferences and BP were measured in 261 consecutive patients. Upper arm auscultation and wrist BP was measured in triplicate, rotating measurements every 30 seconds between sites. Upper arm BP was 131.9+/-20.6/71.6+/-12.6 mm Hg in an obese population (body mass index, 30.6+/-6.6 kg/m(2)) with mean upper arm size of 30.7+/-5.1 cm. Wrist BP was higher (2.6+/-9.2 mm Hg and 4.9+/-6.6 mm Hg, respectively, PBlood Pressure (JNC 7) strata (kappa value=0.27-0.71), and the difference was >or=5 mm Hg in 72% of the patients. The authors conclude that there was poor concordance between arm and wrist BP measurement and found no evidence that "hidden undercuffing" was associated with obesity; therefore, they do not support routine use of wrist BP measurements.

Classification of pulmonary pathology from breath sounds using the wavelet packet transform and an extreme learning machine.

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Palaniappan, Rajkumar; Sundaraj, Kenneth; Sundaraj, Sebastian; Huliraj, N; Revadi, S S

2017-06-08

Auscultation is a medical procedure used for the initial diagnosis and assessment of lung and heart diseases. From this perspective, we propose assessing the performance of the extreme learning machine (ELM) classifiers for the diagnosis of pulmonary pathology using breath sounds. Energy and entropy features were extracted from the breath sound using the wavelet packet transform. The statistical significance of the extracted features was evaluated by one-way analysis of variance (ANOVA). The extracted features were inputted into the ELM classifier. The maximum classification accuracies obtained for the conventional validation (CV) of the energy and entropy features were 97.36% and 98.37%, respectively, whereas the accuracies obtained for the cross validation (CRV) of the energy and entropy features were 96.80% and 97.91%, respectively. In addition, maximum classification accuracies of 98.25% and 99.25% were obtained for the CV and CRV of the ensemble features, respectively. The results indicate that the classification accuracy obtained with the ensemble features was higher than those obtained with the energy and entropy features.

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

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

2016-04-29

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

Hazards of the ‘Hard Cash’: Hypersensitivity Pneumonitis

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Elif Kupeli

2010-01-01

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

Hazards of the 'hard cash': hypersensitivity pneumonitis.

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

2010-01-01

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

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

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Kay, Jay F L; Chow, Wing Hing

2002-01-01

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

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

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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 ...

Focal intramural pericardial effusion and cardiac tamponade associated with necrotic adipose tissue in a dog.

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

2017-07-15

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

July 2017 critical care case of the month

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Raschke RA

2017-07-01

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

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

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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.

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

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Khoudja Ali-Benyahia

2017-06-01

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

Echocardiographic Diagnostics of Myocardial Infarction in Newborns

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G. V. Revunenkov

2015-01-01

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

A case of intralobar pulmonary sequestration

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Misawa, Takuo; Hongo, Minoru; Okubo, Shinichi; Yamada, Hiroyoshi; Matsuoka, Ken; Soga, Naoko; Kono, Jun; Kusama, Shozo

1985-01-01

A 57-year-old female was admitted to our hospital, complaining of hemoptysis. On auscultation, moist rales were audible at the lower portion of left posterior chest. Plain chest roentgenogram showed a round shadow in the left lower lung field. Computed tomography with contrast enhancement revealed an abnormal structure which was contiguous to a strand structure. Dynamic scanning demonstrated opacification of the strand structure and that of the greater part of the abnormal structure during peak opacification of the descending aorta. A part of the abnormal structure was opacified during the same phase as the opacification of the right ventricle and pulmonary artery. A diagnosis of intralobar pulmonary sequestration associated with pulmonary arterio-venous malformation was confirmed by thoracic aortography and left pulmonary arteriography. The hemoptysis was found to be caused by chronic bronchitis. It was emphasized that dynamic computed tomography is very useful to diagnose intralobar pulmonary sequestration and to assess the presence of pulmonary arterio-venous malformation. In addition, it is of particular interest that this case cannot be assigned to any category of Pryce's classification although it resembles both type I and IV. (author)

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

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Song Gao

2014-01-01

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

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

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

2001-05-01

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

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

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

2008-03-01

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

Randomised trial of amnioinfusion during labour with meconium stained amniotic fluid.

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Rathor, Asmita Muthal; Singh, Ruchira; Ramji, S; Tripathi, Reva

2002-01-01

To assess the effect of amnioinfusion during labour with meconium stained amniotic fluid on caesarean section rate and perinatal outcome. Prospective randomised controlled study. A tertiary care teaching hospital in India. Women in labour at term with meconium stained amniotic fluid. Two hundred women in labour with > or = 37 weeks gestation, single cephalic presentation with moderate or thick meconium were randomised to control and amnioinfusion groups at a 1:1 ratio. Amnioinfusion was performed using 500 mL of normal saline over a period of 30 minutes in a study group. The control group received routine care. Both groups had intermittent auscultation of fetal heart rate during labour. The primary outcome measure was caesarean section rate. Secondary outcome measures were meconium aspiration syndrome, 1 minute and 5 minute apgar amnioinfusion group was less than the control group (RR 0.47; 95% CI 0.24-0.93). Amnioinfusion was associated with a significant decrease in the incidence of meconium at the vocal cords (P = 0.001); improvement in 1 minute apgar scores (P Amnioinfusion in an under resourced labour ward decreases caesarean section rates and fetal morbidity.

Mural endocarditis caused by Corynebacterium mustelae in a dog with a VSD.

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Winter, Randolph L; Gordon, Sonya G; Zhang, Shuping; Hariu, Crystal D; Miller, Matthew W

2014-01-01

A 6 yr old female spayed large Munsterlander was evaluated following a 3 wk history of lethargy, inappetence, intermittent fever, and a recent change to the timing of her previously diagnosed heart murmur. Physical examination revealed marked dehydration, lethargy, and a grade 5/6 to-and-fro heart murmur that was auscultated best at the right sternal border. The dog was febrile, and echocardiography revealed a large, mobile, vegetative lesion in the right ventricular outflow tract associated with a ventricular septal defect (VSD). Mild aortic insufficiency was present. Corynebacterium mustelae (C. mustelae) was isolated from a pooled blood culture. Treatment of infective endocarditis (IE) was initiated along with supportive care, and the patient was discharged 9 days later. The dog remained without clinical signs 132 days after discharge. VSD is rarely mentioned as a predisposing factor for development of IE in veterinary literature; however, this report highlights that dogs with a VSD may be at risk for IE. To the authors' knowledge, this is the first documented case of a canine infection with C. mustelae. Infection with C. mustelae in this case represents a novel agent for IE in the dog.

Porcupine quill migration in the thoracic cavity of a German shorthaired pointer.

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Guevara, Jose L; Holmes, Elaine S; Reetz, Jennifer; Holt, David E

2015-01-01

A 7 yr old German shorthaired pointer presented with progressive respiratory distress and lethargy. Two weeks prior to presentation, the dog had porcupine quills removed from the left forepaw, muzzle, and sternal area. At the time of presentation, the dog had bounding pulses and friction rubs in the right dorsal lung field. Harsh lung sounds and decreased lung sounds were ausculted in multiple lung fields. Radiographs revealed a pneumothorax and rounding of the cardiac silhouette suggestive of pericardial effusion. Computed tomographic imaging was performed and revealed multiple porcupine quills in the thoracic cavity. Surgery was performed and quills were found in multiple lung lobes and the heart. Following surgery the dog remained hypotensive. A post-operative echocardiogram revealed multiple curvilinear soft-tissue opacities in the heart. Given the grave prognosis the dog was subsequently euthanized and a postmortem examination was performed. A single porcupine quill was discovered in the left atrium above the mitral valve annulus. The quill extended across the aortic root, impinging on the coronary artery below the level of the aortic valve. To the authors' knowledge, this is the first known report of porcupine quill migration through the heart.

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

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Dante L. Escuissato

2005-06-01

Full Text Available As neoplasias mediastinais de origem mesenquimal são raras, representando menos de 6% dos casos. A maioria são lipossarcomas, apesar da aparência cística ser incomum. Os autores apresentam um caso de paciente feminina com 58 anos de idade, com queixa de dispnéia, com piora progressiva desde os 52 anos. Estridor laríngeo era auscultado durante o exame físico, e a tomografia computadorizada de tórax demonstrou uma lesão cística no mediastino posterior. O tumor foi ressecado e o estudo histológico definiu o diagnóstico de lipossarcoma mixóide.Mediastinal neoplasms of mesenchymal origin are rare, accounting for less than 6% of these tumors. Most of these tumors are liposarcomas, although cystic lesions are uncommon. The authors present a case of a 58-year-old woman with progressively worsening dyspnea since she was 52-years-old. Laryngeal stridor was auscultable and a chest CT scan showed a cystic lesion in the posterior mediastinum. The tumor was resected and the histological examination revealed myxoid liposarcoma.

Challenges of education for authorship in the academic sphere

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Mary Elizabeth Cerutti-Rizzatti

2016-09-01

Full Text Available http://dx.doi.org/10.5007/2175-8026.2016v69n3p63 The theme of this article is 'Education for authorship in university'; it is organized to answer the following question: What challenges does the academic sphere face as regards education for authorship today? In order to answer that question, the text spouses a theoretical-epistemological affiliation of a historical-cultural basis, employing a comprehensive approach in the generation and analysis of data, which derive from a number of studies consolidated or in phase of consolidation in the Research Group 'Writing Culture and Schooling' of Universidade Federal de Santa Catarina. In response to the research question, it is argued that there are, among many others, three major challenges of substantive relevance in education for authorship: (i appropriation of knowledge tensioned by relativistic fundamentals in the school sphere; (ii academic expectations with condescending attitudes; and (iii selective attention as opposed to auscultation. It is argued that an education for authorship in the academic sphere involves the expansion of individuals’ cultural repertoire throughout their education so as they consolidate a condition of autonomy in opposition to heteronomy.

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

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

2017-09-01

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

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

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Sharma, O P

1995-09-01

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

The association of physical examination abnormalities and carboxyhemoglobin concentrations in 21 dogs trapped in a kennel fire.

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Ashbaugh, Elizabeth A; Mazzaferro, Elisa M; McKiernan, Brendan C; Drobatz, Kenneth J

2012-06-01

To evaluate physical examination findings and their association with carboxyhemoglobin (COHb) concentrations in 21 dogs that were exposed to smoke during a kennel fire. Twenty-one dogs were exposed to a kennel fire. Physical exam findings, presenting, and posttherapy COHb concentrations as well as therapeutic interventions were evaluated. COHb concentrations upon presentation were increased in all smoke inhalation exposed dogs. These dogs were compared to a small set of clinically normal staff-owned dogs who were not exposed to fire. Physical parameters significantly associated with higher COHb concentrations included lower body temperature, increased respiratory effort, abnormal respiratory auscultation, altered neurologic status, and length of hospital stay. Oxygen therapy resulted in a more rapid decline in COHb concentrations although 5 dogs still had mildly increased COHb concentrations 24-hour postadmission. This study describes the relationship of admitting clinical findings of dogs exposed to a kennel fire with their initial blood COHb concentrations. It also describes the resolution of increased COHb concentrations with use of oxygen therapy and hospitalization. Additionally, COHb concentrations for a control group of dogs was evaluated and compared to the dogs exposed to smoke inhalation. © Veterinary Emergency and Critical Care Society 2012.

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

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Ronny Cohen

2015-01-01

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

Point-of-Care Diagnostic Device for Traumatic Pneumothorax: Low Sensitivity of the Unblinded PneumoScan™

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M. Rehfeldt

2018-01-01

Full Text Available Background. Traumatic Pneumothorax (PTX is a potentially life-threatening injury. It requires a fast and accurate diagnosis and treatment, but diagnostic tools are limited. A new point-of-care device (PneumoScan based on micropower impulse radar (MIR promises to diagnose a PTX within seconds. In this study, we compare standard diagnostics with PneumoScan during shock-trauma-room management. Patients and Methods. Patients with blunt or penetrating chest trauma were consecutively included in the study. All patients were examined including clinical examination with auscultation (CE and supine chest radiography (CXR. In addition, PneumoScan-readings and thoracic ultrasound scan (US were performed. Computed tomography (CT served as gold standard. Results. CT scan revealed PTX in 11 patients. PneumoScan detected two PTX correctly but missed nine. 15 false-positive results were found by PneumoScan, leading to a sensitivity of 20% and specificity of 80%. Six PTX were detected through CE (sensitivity: 54,5%. CXR detected four (sensitivity: 27,3% and thoracic US two PTX correctly (sensitivity: 25%. Conclusion. The unblinded PneumoScan prototype did not confirm the promising results of previous studies. The examined standard diagnostics and thoracic US showed rather weak sensitivity as well. Until now, there is no appropriate point-of-care tool to rule out PTX.

Cardiovascular whole-body MRI

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Kramer, Harald [Department of Clinical Radiology, University Hospitals Munich - Grosshadern Campus, Ludwig Maxmilians University Munich, Marchioninistr. 15, 81377 Munich (Germany)], E-mail: harald.kramer@med.uni-muenchen.de; Nikolaou, Konstantin; Reiser, Maximilian F. [Department of Clinical Radiology, University Hospitals Munich - Grosshadern Campus, Ludwig Maxmilians University Munich, Marchioninistr. 15, 81377 Munich (Germany)

2009-06-15

Cardiovascular diseases still rank number one in mortality statistics in the industrialized world. In these countries the five most common causes of death are associated to atherosclerotic changes of the arterial vasculature. Due to its often long lasting treatment and the possible loss of ability to work atherosclerotic disease constitutes an economic factor which should not be disregarded. Thus screening for atherosclerotic disease seems to be reasonable because as known the potential to influence atherosclerotic changes is higher in an early stage of the disease. Not in every case it is possible to cure the disease but sometimes progression can be controlled and decelerated. Imaging of the arterial vasculature was limited to invasive procedures associated with ionizing radiation for a long time. Non-invasive exams like the 'ankle-brachial-index' (ABI) can indicate the presence of PAOD, an exact localization of the pathologic changes is only possible with imaging methods. For cardiac imaging likewise the only non-invasive exams have been ECG and auscultation. Certainly echocardiography is an excellent technique to access cardiac function but it depends very much on both, the examining physician and the patient. MRI constitutes a non-invasive imaging modality without ionizing radiation offering excellent reproducible image quality.

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

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

2018-03-01

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

Cardiac papillary fibroelastoma; when, how, why?

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Nikolaos G Baikoussis

2016-01-01

Full Text Available We would like to present an interesting case operated on in our department and discuss the international bibliography about this issue. We also present some interesting images of this case. Our material is composed from a 68-year-old woman treated by the authors. She presented with a small murmur in the auscultation while she was asymptomatic and then she diagnosed with a tumor on of the left coronary cusp of the aortic valve with the characteristics of papillary fibroelastoma. On the basis of the potential embolic risk either of the mass itself or of associated thrombus and the possibility of further enlargement, the patient although asymptomatic at the time of diagnosis was referred for elective surgical excision of the mass. She underwent on median sternotomy and through extracorporeal circulation the mass has been excised with the preservation of the well-functioning valve. Through this case, we would like to discuss the bibliography for the decision making in these cases. Hence, the aim of our study is that we have to keep in mind that this kind of friable mass may be the cause of embolism, stroke or coronary artery occlusion and must be excided in a conservative setting, sparing the aortic valve.

Cardiovascular whole-body MRI

International Nuclear Information System (INIS)

Kramer, Harald; Nikolaou, Konstantin; Reiser, Maximilian F.

2009-01-01

Cardiovascular diseases still rank number one in mortality statistics in the industrialized world. In these countries the five most common causes of death are associated to atherosclerotic changes of the arterial vasculature. Due to its often long lasting treatment and the possible loss of ability to work atherosclerotic disease constitutes an economic factor which should not be disregarded. Thus screening for atherosclerotic disease seems to be reasonable because as known the potential to influence atherosclerotic changes is higher in an early stage of the disease. Not in every case it is possible to cure the disease but sometimes progression can be controlled and decelerated. Imaging of the arterial vasculature was limited to invasive procedures associated with ionizing radiation for a long time. Non-invasive exams like the 'ankle-brachial-index' (ABI) can indicate the presence of PAOD, an exact localization of the pathologic changes is only possible with imaging methods. For cardiac imaging likewise the only non-invasive exams have been ECG and auscultation. Certainly echocardiography is an excellent technique to access cardiac function but it depends very much on both, the examining physician and the patient. MRI constitutes a non-invasive imaging modality without ionizing radiation offering excellent reproducible image quality.

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

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Hassani Kamran

2011-05-01

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

Temporomandibular joint examination reviewed

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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.

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

International Nuclear Information System (INIS)

Bonne, A.; Beckers, H.; Beaufays, R.; Buyens, M.; Coursier, J.; Bruyn, D. de; Fonteyne, A.; Genicot, J.; Lamy, D.; Meynendonckx, P.; Monsecour, M.; Neerdael, B.; Noynaert, L.; Voet, M.; Volekaert, G.

1992-01-01

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

Biomedical risks of multiple lung lavages in beagle dogs

International Nuclear Information System (INIS)

Muggenburg, B.A.; Mauderly, J.L.; Slauson, D.O.; Halliwell, W.H.

1976-01-01

The biomedical risk of a series of 10 lung lavages was evaluated in 10 Beagle dogs. The dogs were divided into three groups: one group of six dogs was given 10 lung lavages over a 49-day period and sacrificed at 77 days of the study; the second group contained two dogs that were controls that were not treated, but sacrificed on day 77 of the study; and the third group contained two dogs that were control dogs that were sacrificed 56 days into the study. The dogs were evaluated by cardiopulmonary function tests, clinical studies, and studies of the tissues at sacrifice. No significant changes were detected in the cardiopulmonary function tests of the dogs in the study. Clinical studies revealed a very mild, transient reaction to some of the lavage procedures. The reaction was mainly mild, scattered, moist rales heard on auscultation of the chest and a slight rise in body temperature. A mild, scattered tissue reaction was also observed on histologic examination of selected lung tissues. The observed tissue reactions did not appear to be chronic, permanent or progressive. Results of this study indicate that multiple lung lavages carry little biomedical risk and that the primary risk is that associated with general anesthesia

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

International Nuclear Information System (INIS)

Singh, A.K.; Iqbal, M.J.; Akhtar, R.; Afzal, M.F.

2012-01-01

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)

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

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Jose Rodrigues Coura

2013-12-01

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

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

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Shih-Hong Li

2017-01-01

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

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

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

2016-05-12

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

Reversion of left ventricular systolic dysfunction and abnormal stress test: by catheter ablation, in a patient with Wolff-Parkinson-White syndrome from Para-Hisian Kent bundle.

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Tu, Chung-Ming; Chu, Kai-Ming; Cheng, Cheng-Chung; Cheng, Shu-Mung; Lin, Wei-Shiang

2010-01-01

The diagnosis of Wolff-Parkinson-White syndrome is typically reserved for patients who experience ventricular pre-excitation and symptoms that are related to paroxysmal supraventricular tachycardia, such as chest pain, dyspnea, dizziness, palpitations, or syncope. Herein, we report the case of a 38-year-old woman who presented at our outpatient department because of exercise intolerance. Cardiac auscultation revealed a grade 2/6 pansystolic murmur over the left lower sternal border. Twelve-lead electrocardiography showed sinus rhythm at a rate of 76 beats/min, with a significant delta wave. Transthoracic echocardiography revealed abnormal left ventricular systolic function. The results of a thallium stress test were also abnormal. Coronary artery disease was suspected; however, coronary angiography yielded normal results. Electrophysiologic study revealed a para-Hisian Kent bundle and a dual atrioventricular nodal pathway. After radiofrequency catheter ablation was performed, the patient's left ventricular function improved and her symptoms disappeared. In Wolff-Parkinson-White syndrome, left ventricular systolic dyssynchrony can yield abnormal findings on echocardiography and thallium scanning--even in persons who have no cardiovascular risk factors. Physicians who are armed with this knowledge can avoid performing coronary angiography unnecessarily. Catheter ablation can reverse the dyssynchrony of the ventricle and improve the patient's symptoms.

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

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McGuirk, Sheila M; Peek, Simon F

2014-12-01

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

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

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

2015-01-01

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

Spontaneous Pneumomediastinum with a Rare Presentation

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Ehsan Bolvardi

2014-01-01

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

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

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

2015-01-01

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

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

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Cleliani de Cassia da Silva

2014-06-01

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

[Telemonitoring of swallowing function: technologies in speech therapy practice.

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Tedesco, Angela; Lavermicocca, Valentina; Notarnicola, Marilina; De Francesco, Luca; Dellomonaco, Anna Rita

2018-02-01

The process of medical-healthcare technological revolution represents an advantage for the patient and for the care provider, in terms of costs and distances reduction. The telehomecare approach could be useful for monitoring the swallowing disorder in neurodegenerative diseases, preventing complications. In this study the applicability of telemedicine techniques for the monitoring of swallowing function, in patients affected by Huntington's disease (HD), was evaluated through the acquisition and analysis of the sound of swallowing. Two patients with HD were outpatient screened for dysphagia through the Bedside Swallowing Assessment Scale (BSAS) sensitized with pulse oximetry and cervical auscultation. Subsequently, the swallowing functionality was telemonitored for three months with Skype. The swallowing sounds were acquired with a detection microphone attached to the lateral edge of the trachea during fluid intake. The sounds were instantly processed and graphically represented through the Praat software. The analysis of the acoustic signal acquired remotely has made it possible to identify the situations that required immediate speech therapy intervention, suggesting to the patients further modifications of food consistencies, and saving frequent moving to the hospital even in the absence of critical situations. Remote assistance applied to speech therapy could represent a benefit for patients and their carers and a more efficient use of medical and health resources.

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

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Sonnenschein, Martin J.; Anderson, Suzanne E.; Lourens, Steven; Triller, Juergen

2004-01-01

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

028. Migratory pneumonia—cryptogenic organizing pneumonia (COP)

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

2015-01-01

In this study were presented the clinical and laboratory findings of eight patients with migratory pneumonia, who were hospitalised in our clinic. It is about eight women with average age of 58±13 years with fever, weakness, dry cough, shortness of breath and who already had received antibiotics. Crackles were the most frequent evidence by the auscultation. All patients showed consolidation in chest radiography which resolved completely from the initial area and migrated in different areas. The chest HRCT showed opacity with air bronchogram and ground glass in places. Regarding to the respiratory function, patients showed mild restriction disorder (average values ± SD: FEV1% 83±24, FVC% 86±21, TLC% 82±16, DLco% 74±15). The average price of pO2 was 68+7 mmHg. The findings of BAL were: macrophages 51%±20%, lymphocytes 33.5%±14%, neutrophils 7.5%±3%, eosinophils 7%±8%. From diagnosis, we excluded eosinophilic pneumonia, infectious causes, collagen diseases and vasculitis. The findings of physical examination, chest radiography and the results of the BAL of all of the patients argued for Bronchiolitis obliterans organizing pneumonia (BOOP), the cause of which was not found (cryptogenic organizing pneumonia-COP). All patients responded directly to corticosteroids.

A man with multiple cardiac masses.

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Indrabhinduwat, Manasawee; Arciniegas Calle, Maria C; Colgan, Joseph P; Villarraga, Benoy N

2018-06-12

A 37-year-old male presented with cough, dyspnea, significant weight loss (45 pounds) and subacute fever for the past two months. Physical examination revealed inspiratory and expiratory wheezing bilaterally. A normal S1, S2 and a 3/6 systolic ejection murmur at the left upper parasternal border with respiratory variation were found during cardiac auscultation. Kidney and bone marrow biopsy reported a high grade B cell lymphoma. Echocardiography and cardiac CT findings consisted of multiple intracardiac masses affecting the right ventricular (RV) outflow track, RV apex, medial portion of the right atrium and posterior left atrium, as well as mild impairment of the RV systolic function. The masses in the RV outflow track caused partial obstruction (Pulmonary Valve peak velocity 2.3 m/s) with a RV systolic pressure of 43 mmHg. The infiltrative mass in the interatrial septum extended into both the right and left atrial cavities. The right superior pulmonary vein was occluded. This patient was treated with aggressive chemotherapy and had a good clinical response that resulted in mass size reduction after the first course of chemotherapy. Multimodality imaging techniques such as echocardiography, cardiac CT and PET scan can provide complementary information to better evaluate, stage and manage these patients. © 2018 The authors.

A passive quantitative measurement of airway resistance using depth data.

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

2014-01-01

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

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

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Susana Corujeira

2015-01-01

Full Text Available Immunoglobulin G4-related disease (IgG4-RD is an increasingly recognized syndrome that can appear with multiple organ involvement, typically with tumor-like swelling, lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, and elevated serum IgG4 concentrations. We report the case of a 22-month-old female child with failure to thrive and recurrent respiratory tract infections since 8 months of age. Physical examination was normal except for pulmonary auscultation with bilateral crackles and wheezes. Laboratory tests revealed elevated erythrocyte sedimentation rate, and elevated serum IgG and IgG4 with polyclonal hypergammaglobulinemia. Thoracic CT and MRI showed multiple mediastinal lymphadenopathies and a nodular posterior mediastinal mass in right paratracheal location with bronchial compression. Initial fine needle aspiration biopsy was compatible with reactive lymphadenopathy but after clinical worsening a thoracoscopic partial resection of the mass was performed and tissue biopsy revealed lymphoplasmacytic infiltrate and increased number of IgG4-positive plasma cells and a ratio of IgG4/IgG positive cells above 40%. Glucocorticoids therapy was started with symptomatic improvement, reduction in the size of the mass, and decrease of serum IgG4 levels after 6 weeks. There are very few reports of IgG4-RD in children. Long-term follow-up is necessary to monitor relapses and additional organ involvement.

Computed Tomography Following Body Stuffing Heroin

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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.

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

International Nuclear Information System (INIS)

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

2013-01-01

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

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

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Rafael Vieira Martins

2013-07-01

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

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

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Érica Cesário Defilipo

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

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

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

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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.

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

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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.

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

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

2016-09-23

Today it is well demonstrated that stethoscopes can be as contaminated as hands, which are a recognized source of Health-Care Associated Infections (HCAIs). Ultraviolet C (UVC) light has proven disinfection capacity and the innovative UVC technology of Light Emitting Diode (LED) shows several potential benefits. To verify whether the use of UVC LEDs is effective and reliable in stethoscope membrane disinfection after prolonged use, a pre-post intervention study was conducted. A total of 1668 five-minute cycles were performed on two UVC LEDs to simulate their use; thereafter, their disinfection capacity was tested on stethoscope membranes used on a previously auscultated volunteer. Then, a further 1249 cycles were run and finally the LEDs were tested to assess performance in reducing experimental contamination by Staphylococcus aureus, Pseudomonas aeruginosa and Escherichia coli on the stethoscope membrane. Baseline volunteer contamination identified 104 Colony Forming Units (CFUs) while treated Petri dishes had 12 and 15 CFUs (p < 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.

Detection of bronchial breathing caused by pneumonia.

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Gross, V; Fachinger, P; Penzel, Th; Koehler, U; von Wichert, P; Vogelmeier, C

2002-06-01

The classic auscultation with stethoscope is the established clinical method for the detection of lung diseases. The interpretation of the sounds depends on the experience of the investigating physician. Therefore, a new computer-based method has been developed to classify breath sounds from digital lung sound recordings. Lung sounds of 11 patients with one-sided pneumonia and bronchial breathing were recorded on both the pneumonia side and on contralateral healthy side simultaneously using two microphones. The spectral power for the 300-600 Hz frequency band was computed for four respiratory cycles and normalized. For each breath, the ratio R between the time-segments (duration = 0.1 s) with the highest inspiratory and highest expiratory flow was calculated and averaged. We found significant differences in R between the pneumonia side (R = 1.4 +/- 1.3) and the healthy side (R = 0.5 +/- 0.5; p = 0.003 Wilcoxon-test) of lung. In 218 healthy volunteers we found R = 0.3 +/- 0.2 as a reference-value. The differences of ratio R (delta R) between the pneumonia side and the healthy side (delta R = 1.0 +/- 0.9) were significantly higher compared to follow-up studies after recovery (delta R = 0.0 +/- 0.1, p = 0.005 Wilcoxon-test). The computer based detection of bronchial breathing can be considered useful as part of a quantitative monitoring of patients at risk to develop pneumonia.

Classification of voluntary coughs applied to the screening of respiratory disease.

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Infante, Christian; Chamberlain, Daniel B; Kodgule, Rahul; Fletcher, Richard Ribon

2017-07-01

Pulmonary and respiratory diseases (e.g. asthma, COPD, allergies, pneumonia, tuberculosis, etc.) represent a large proportion of the global disease burden, mortality, and disability. In this context of creating automated diagnostic tools, we explore how the analysis of voluntary cough sounds may be used to screen for pulmonary disease. As a clinical study, voluntary coughs were recorded using a custom mobile phone stethoscope from 54 patients, of which 7 had COPD, 15 had asthma, 11 had allergic rhinitis, 17 had both asthma and allergic rhinitis, and four had both COPD and allergic rhinitis. Data were also collected from 33 healthy subjects. These patients also received full auscultation at 11 sites, given a clinical questionnaire, and underwent full pulmonary function testing (spirometer, body plethysmograph, DLCO) which culminated in a diagnosis provided by an experienced pulmonologist. From machine learning analysis of these data, we show that it is possible to achieve good classification of cough sounds in terms of Wet vs Dry, yielding an ROC curve with AUC of 0.94, and show that voluntary coughs can serve as an effective test for determining Healthy vs Unhealthy (sensitivity=35.7% specificity=100%). We also show that the use of cough sounds can enhance the performance of other diagnostic tools such as a patient questionnaire and peak flow meter; however voluntary coughs alone provide relatively little value in determining specific disease diagnosis.

Pharmacokinetics and pharmacodynamics of the injectable formulation of methadone hydrochloride and methadone in lipid nanocarriers administered orally to horses.

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Crosignani, N; Luna, S P; Dalla Costa, T; Pimenta, E L; Detoni, C B; Guterres, S S; Puoli Filho, J N; Pantoja, J C; Pigatto, M C

2017-08-01

We investigated the thermal, electrical and mechanical antinociceptive and physiological effects (heart rate, respiratory rate, arterial blood pressure, head height and abdominal auscultation score), and pharmacokinetics, of 0.5 mg/kg of the injectable formulation (ORAL) or nanoparticulated methadone (NANO) given orally, in six adult mares, using a crossover, blind and prospective design. Repeated-measure models were used to compare parametric data between and within treatments, followed by Tukey's test. Nonparametric data were analysed with Wilcoxon signed-rank, adjusted by Bonferroni tests. Blood samples were also collected up to 6 h after dosing for plasma drug quantification by LC-MS/MS. Methadone pharmacokinetic parameters were determined by noncompartmental and compartmental approaches. There were no differences in pharmacodynamic parameters. No statistical differences were observed in the pharmacokinetic parameters from noncompartmental analysis for both groups, except a significant decrease in peak plasma concentration, increase in apparent volume of distribution per fraction absorbed (Vd ss /F) and increased mean residence time (MRT) for NANO. One-compartment open model with first order elimination best described the pharmacokinetic profiles for both groups. Neither ORAL nor NANO administered orally to horses produced antinociception. The nanoencapsulated formulation of methadone given orally to horses did not improve methadone pharmacokinetic parameters or increased systemic body exposure to methadone. © 2017 John Wiley & Sons Ltd.

Medical audit on asthma in an emergency department.

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Linares, T; Campos, A; Torres, M; Reyes, J

2006-01-01

To determine the management of acute bronchial asthma in an adult emergency department. A retrospective medical audit of 46 consecutive adult patients with acute asthma exacerbations was performed. We collected information from 48 episodes of acute asthma over a 5-month period. Using classical audit methodology, four indicators were examined: severity evaluation, diagnostic tests, specific treatment, and discharge treatment plans. The least recorded severity indicators were respiratory rate (27 %), heart rate (50 %) and peak expiratory flow (20 %). Heart and respiratory auscultation were recorded in all patients and oxygen saturation was recorded in 93 %. Laboratory blood test and chest radiograph were performed in all patients. Arterial blood gas was tested in 57 %, electrocardiography in 17 %, and coagulation in 39 %. No treatment was provided in 12 % of patients. Bronchodilator medications were administered in all treated patients and oxygen was prescribed in 60 %. Systemic corticosteroids (methylprednisolone or hydrocortisone) were administered in 80 % of treated patients. Seventeen percent of patients were discharged from hospital with no change to their usual treatment. The following weak points were identified: 1) Severity assessment is inadequate, 2) use of diagnostic tests is excessive, 3) patients discharged to home with no treatment plan. Opportunities for improvement consisted of: 1) greater availability of peak expiratory flow meters, 2) individualized use of diagnostic tests, and 3) management protocols.

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

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

2016-01-01

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

Acoustic imagery applied to the examination of the internal condition of concrete structures; Imagerie acoustique appliquee a l`auscultation du beton de masse

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Rhazi, J.; Ballivy, G.; Rivest, M.

1997-12-31

A new process in civil engineering that can be used to examine the internal condition of a concrete structure using non-intrusive data acquisition techniques was discussed. The process described combines elements of computerized tomography with scientific visualization techniques to obtain representation of the structure showing the spatial distribution of stress wave velocity within the structure. An overview of the theory, details of the experimental procedure, and treatment of the data obtained are provided. Application of the technique to an existing structure is described. 10 refs., 1 tab., 7 figs.

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

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F Mir Mohammad Sadeghi

2002-09-01

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

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

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Petrovic Dejan

2016-09-01

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

Boerhaave syndrome - case report

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Biljana Radovanovic Dinic

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

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

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Marques, Alda; Bruton, Anne; Barney, Anna

2009-01-01

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

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

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Maria de Fátima Bazhuni Pombo March

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

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.

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

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

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)

Subcutaneous emphysema, a different way to diagnose

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Bruno José da Costa Medeiros

Full Text Available Summary Introduction: Subcutaneous emphysema (SE is a clinical condition that occurs when air gets into soft tissues under the skin. This can occur in any part of the body depending on the type of pathology. The most common site is under the skin that covers the chest wall or neck. It is characterized by painless swelling of tissues. The classic clinical sign is a crackling sensation upon touch, resembling that of touching a sponge beneath your fingers. Objective: To describe a new way to diagnose subcutaneous emphysema. Method: Our finding was a matter of serendipity while inspecting a patient with subcutaneous emphysema using a stethoscope. Instead only hearing the patient's chest, the stethoscope was gently pressed against the skin with SE and so we were able to detect a different sound. Results: This new way to diagnose subcutaneous emphysema consists in pressing the diaphragm part of stethoscope against the patient's skin where SE is supposed to be. Thus, we are able to hear a sound of small bubbles bursting. Crackle noise has an acoustic emission energy that varies between 750-1,200 Hz, considered high frequency. Conclusion: Although currently the use of imaging methods is widespread worldwide, we would like to strengthen the value of clinical examination. Auscultation is an essential diagnostic method that has become underestimated with the advances of healthcare and medicine as a whole. We therefore propose a different approach to diagnose SE.

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

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Shivendu Bansal

2011-01-01

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

Arrhythmogenic right ventricular cardiomyopathy in a dog : case report

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A.J. Möhr

2000-07-01

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

The history of thoracic surgical instruments and instrumentation.

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Hagopian, E J; Mann, C; Galibert, L A; Steichen, F M

2000-02-01

Thoracic surgical practice has evolved from the innovations of its pioneers. Beginning with the stethoscope discovered by Laënnec with his system of auscultation, to the tools we use in the dissection and control of the hilum of the lung for resection, our practice of thoracic surgery has been entwined with the development of instruments and instrumentation. The development of strategies to prevent death from the open pneumothorax began with manual control of the mediastinum and progressed through differential pressure to, finally, the technique of intubation and the methods of positive-pressure and insufflation anesthesia. The instruments we place in our hands are not enough to define our art. Entry into the chest would not be possible without the use of rib retractors, rib shears, and even periosteal elevators. Finally, to the present day of minimally invasive techniques and the application of thoracoscopy for therapeutic purposes, we find the efforts of our predecessors well developed. For the progression from the fear of the open pneumothorax to the present-day state of the ease of thoracotomy for lung resection we are indebted to those who gave so much of their time and, for some, their lives to death from tuberculosis, to allow the advancement of our practice of surgery. These great people should be remembered not only for their acceptance of novel ideas but also, more importantly, for their lack of fear of testing them.

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

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Jisa George

2015-06-01

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

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

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

2017-06-01

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

Comparison of peak flow velocity through the left ventricular outflow tract and effective orifice area indexed to body surface area in Golden Retriever puppies to predict development of subaortic stenosis in adult dogs.

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Javard, Romain; Bélanger, Marie-Claude; Côté, Etienne; Beauchamp, Guy; Pibarot, Philippe

2014-12-15

To evaluate the usefulness of Doppler-derived peak flow velocity through the left ventricular outflow tract (LVOT Vmax) and effective orifice area indexed to body surface area (EOAi) in puppies to predict development of subaortic stenosis (SAS) in the same dogs as adults. Prospective, longitudinal, observational study. 38 Golden Retrievers. Cardiac auscultation and echocardiography were performed on 2- to 6-month-old puppies, then repeated at 12 to 18 months. Subaortic stenosis was diagnosed when LVOT Vmax was ≥ 2.3 m/s in adult dogs with left basilar systolic murmurs. All puppies with EOAi 2.3 m/s in puppyhood was 63% sensitive and 100% specific for SAS in adulthood. In puppies, LVOT Vmax was more strongly associated with a future diagnosis of SAS (area under the curve [AUC], 0.89) than was EOAi (AUC, 0.80). In puppies, the combination of LVOT Vmax and EOAi yielded slightly higher sensitivity (69%) and specificity (100%) for adult SAS than did LVOT Vmax alone. In unaffected and affected dogs, LVOT Vmax increased significantly from puppyhood to adulthood but EOAi did not. In Golden Retriever puppies, LVOT Vmax > 2.3 m/s and EOAi < 1.46 cm(2)/m(2) were both associated with a diagnosis of SAS at adulthood. The combination of these 2 criteria may result in higher sensitivity for SAS screening. Unlike LVOT Vmax, EOAi did not change during growth in either unaffected Golden Retrievers or those with SAS.

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

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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.

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

International Nuclear Information System (INIS)

Ghfir, I.; Berehou, F.Z.; Ben Rais, N.

2007-01-01

Introduction Dynamic renal scintigraphy with 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 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)

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.

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

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Claudio Tinoco Mesquita

2013-02-01

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

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

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

2012-08-01

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

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

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F. Z. Benaich

2015-12-01

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

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.

A case of intralobar pulmonary sequestration

International Nuclear Information System (INIS)

Hongo, Minoru; Kambayashi, TakayukiF; Okubo, Shinichi

1983-01-01

A 41 year-old male was admitted to our hospital, complaining of slight fever, dry cough and general fatigue. On auscultation, bubbling rales were audible at the mid to lower portion of left posterior chest. Plain chest roentgenogram showed multiple cystic shadows with an air-fluid level in the left lower lobe. An abnormal finger-like shadow, which extended from the left hemidiaphragm to the multiple cysts, was found on lateral chest tomogram. Bronchogram revealed cystic dilatation of left B6 and B10. Computed tomogram with contrast enhancement demonstrated multiple cysts and an abnormal round-shaped structure, consisted of high density material, in the left lower lung. At the level of 12 mm below the round-shaped structure, an abnormal finger-like structure contiguous to the thoracic descending aorta was demonstrated. The density of these abnormal structures was 80 Hounsfield units, which was the same as that of the descending aorta. Thoracic aortogram disclosed an abnormal artery arising from the thoracic descending aorta, just above the left hemidiaphragm, which proceeded to the left lower lung horizontally, and extended to superior direction and divided into multiple branches. These vessels drained into the left atrium via left lower pulmonary vein. Diagnosis of intralobar pulmonary sequestration was confirmed by operation and consequently, the sequestered lung and the abnormal artery were successfully removed. It is emphasized that computed tomography with contrast enhancement is useful to detect the abnormal artery of pulmonary sequestration and that this method should be used to evaluate the vascular relationship of lung lesions. (author)

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

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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.

Clinical evaluation of the 3M Littmann Electronic Stethoscope Model 3200 in 150 cats.

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

2013-10-01

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

Determination of heart rate variability with an electronic stethoscope.

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Kamran, Haroon; Naggar, Isaac; Oniyuke, Francisca; Palomeque, Mercy; Chokshi, Priya; Salciccioli, Louis; Stewart, Mark; Lazar, Jason M

2013-02-01

Heart rate variability (HRV) is widely used to characterize cardiac autonomic function by measuring beat-to-beat alterations in heart rate. Decreased HRV has been found predictive of worse cardiovascular (CV) outcomes. HRV is determined from time intervals between QRS complexes recorded by electrocardiography (ECG) for several minutes to 24 h. Although cardiac auscultation with a stethoscope is performed routinely on patients, the human ear cannot detect heart sound time intervals. The electronic stethoscope digitally processes heart sounds, from which cardiac time intervals can be obtained. Accordingly, the objective of this study was to determine the feasibility of obtaining HRV from electronically recorded heart sounds. We prospectively studied 50 subjects with and without CV risk factors/disease and simultaneously recorded single lead ECG and heart sounds for 2 min. Time and frequency measures of HRV were calculated from R-R and S1-S1 intervals and were compared using intra-class correlation coefficients (ICC). The majority of the indices were strongly correlated (ICC 0.73-1.0), while the remaining indices were moderately correlated (ICC 0.56-0.63). In conclusion, we found HRV measures determined from S1-S1 are in agreement with those determined by single lead ECG, and we demonstrate and discuss differences in the measures in detail. In addition to characterizing cardiac murmurs and time intervals, the electronic stethoscope holds promise as a convenient low-cost tool to determine HRV in the hospital and outpatient settings as a practical extension of the physical examination.

Front teeth-to-carina distance in children undergoing cardiac catheterization.

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Hunyady, Agnes I; Pieters, Benjamin; Johnston, Troy A; Jonmarker, Christer

2008-06-01

Knowledge of normal front teeth-to-carina distance (FT-C) might prevent accidental bronchial intubation. The aim of the current study was to measure FT-C and to examine whether the Morgan formula for oral intubation depth, i.e., endotracheal tube (ETT) position at front teeth (cm) = 0.10 x height (cm) + 5, gives appropriate guidance when intubating children of different ages. FT-C was measured in 170 infants and children, aged 1 day to 19 yr, undergoing cardiac catheterization. FT-C was obtained as the sum of the ETT length at the upper front teeth/dental ridge and the distance from the ETT tip to the carina. The latter measure was taken from an anterior-posterior chest x-ray. There was close linear correlation between FT-C and height: FT-C (cm) = 0.12 x height (cm) + 5.2, R = 0.98. The linear correlation coefficients (R) for FT-C versus weight and age were 0.78 and 0.91, respectively. If the Morgan formula had been used for intubation, the ETT tip would have been at 90 +/- 4% of FT-C. No patient would have been bronchially intubated, but the ETT tip would have been less than 0.5 cm from the carina in 13 infants. FT-C can be well predicted from the height/length of the child. The Morgan formula provides good guidance for intubation in children but can result in a distal ETT tip position in small infants. Careful auscultation is necessary to ensure correct tube position.

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

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Yasmin Jahan

2018-01-01

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

Systemic arterial hypertension secondary to chronic kidney disease in two captive-born large felids.

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Leclerc, A; Trehiou-Sechi, E; Greunz, E M; Damoiseaux, C; Bouvard, J; Chetboul, V

2017-06-01

Systemic arterial hypertension (SHT) has been widely described in the domestic cat (Felis catus). In these feline patients, SHT is considered as the most common vascular disorder of middle-aged to older animals, and secondary SHT related to chronic kidney disease (CKD) represents the most common form of the disease. We describe here the first two cases of spontaneous SHT in large felids, i.e. one 18-year old, 34.4 kg, male North-Chinese leopard (Panthera pardus japonensis, case #1) and one 20-year old, 28.7 kg, female snow leopard (Panthera uncia, case #2), both captive-bred and previously diagnosed with CKD. Both animals underwent complete echocardiographic examination under general anesthesia due to abnormal cardiac auscultation (heart murmur and/or gallop sound), and recurrent lethargy in case #1. The combination of left ventricular remodeling with moderate aortic regurgitation of high velocity was highly suggestive of SHT, which was confirmed by indirect blood pressure measurement (systolic arterial blood pressure of 183 mmHg for case #1 and 180 mmHg for case #2). Amlodipine was prescribed (0.35-0.70 mg/kg/day orally) for 31 and 6 months respectively after the initial diagnosis. In case #1, concurrent amlodipine and benazepril treatment was associated with decreased heart murmur grade and reduced aortic insufficiency severity. These reports illustrate that, similarly to domestic cats, SHT should be suspected in old large felids with CKD and that amlodipine is a well-tolerated antihypertensive drug in these species. Copyright © 2017 Elsevier B.V. All rights reserved.

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

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Young Min Kang

2017-06-01

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

Sometimes Surgery is the Only Way to Make a Diagnosis and Treat the Patient: A Case of Congenital Partial Absence of Pericardium

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Phivos Costas Symeonides

2017-04-01

Full Text Available Introduction: A 47-year-old Caucasian woman with a past medical history of multiple ablative procedures for supraventricular arrhythmias and pacemaker implantation presented with increasing shortness of breath. The initial working diagnosis of the team treating her was ablation-induced pulmonary stenosis, especially after the recording of increased flow velocities through the right lower pulmonary vein. Case presentation: The patient was alert and oriented, but obviously dyspnoeic. The vital signs were normal. The physical examination revealed a soft cardiac systolic murmur and the lungs were clear on auscultation. The electrocardiogram showed a pacemaker rhythm. The echocardiogram showed borderline normal global systolic function of the left ventricle and severe mitral regurgitation. The transoesophageal echocardiogram confirmed the above findings and revealed increased velocities through the right lower pulmonary vein. The working diagnosis of ablation-induced pulmonary stenosis was reinforced by the cardiac CT angiography. The patient was subsequently referred for surgical intervention. The intra-operative findings were both unexpected and impressive: congenital partial absence of the pericardium was responsible for herniation of the right chambers into the pleural space. Mitral regurgitation was attributed to failure of coaptation due to the very short surface of the leaflets. Extensive external fibrosis around the pulmonary veins caused the pulmonary vein stenosis. Conclusion: The final diagnosis of a partial pericardial defect causing torsion and distortion of the heart chambers was made only at surgery. The consistent finding of pulmonary vein stenosis in the non-invasive modalities and the past medical history of ablations initially misleadingly led us to the assumption that they were related.

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

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

2007-01-01

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

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

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

2017-07-01

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

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

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

2016-11-01

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

Rheumatic heart disease screening: Current concepts and challenges

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Dougherty, Scott; Khorsandi, Maziar; Herbst, Philip

2017-01-01

Rheumatic heart disease (RHD) is a disease of poverty, is almost entirely preventable, and is the most common cardiovascular disease worldwide in those under 25 years. RHD is caused by acute rheumatic fever (ARF) which typically results in cumulative valvular lesions that may present clinically after a number of years of subclinical disease. Therapeutic interventions, therefore, typically focus on preventing subsequent ARF episodes (with penicillin prophylaxis). However, not all patients with ARF develop symptoms and not all symptomatic cases present to a physician or are correctly diagnosed. Therefore, if we hope to control ARF and RHD at the population level, we need a more reliable discriminator of subclinical disease. Recent studies have examined the utility of echocardiographic screening, which is far superior to auscultation at detecting RHD. However, there are many concerns surrounding this approach. Despite the introduction of the World Heart Federation diagnostic criteria in 2012, we still do not really know what constitutes the most subtle changes of RHD by echocardiography. This poses serious problems regarding whom to treat and what to do with the rest, both important decisions with widespread implications for already stretched health-care systems. In addition, issues ranging from improving the uptake of penicillin prophylaxis in ARF/RHD-positive patients, improving portable echocardiographic equipment, understanding the natural history of subclinical RHD and how it might respond to penicillin, and developing simplified diagnostic criteria that can be applied by nonexperts, all need to be effectively tackled before routine widespread screening for RHD can be endorsed. PMID:28163427

Distribution of craniomandibular disorders, occlusal factors and oral parafunctions in a paediatric population.

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Corvo, G; Tartaro, G; Giudice, A; Diomajuta, A

2003-06-01

The aim of this work was to gather clinical data on craniomandibular (CMD)/temporomandibular joint (TMJ) disorders in a paediatric population. The clinical study population comprised patients with TMJ disorders who were being treated in the orthognathic ambulatory clinic of the University of Naples, where an instrumental and clinical study was performed. Data were recorded for extra and intraoral findings, Angles classification and malocclusions. Radiographic examinations were carried out. Study models were fabricated for evaluation. TMJs were assessed by palpation as well as masseter, temporal, suprahyoid, sternocleidomastoid, suboccipital, paravertebral and trapezius muscles to evaluate any possible pain. Auscultation of the TMJ was used to determine presence of articular sounds and their type (cracks, crunches, clicks) by the use of a stethoscope. Pain localisation was evaluated according to these movements taking into account site, intensity, frequency, and duration. Episodes of headache were recorded according to its intensity (mild, moderate, intense), frequency (daily, weekly, monthly), site (top of the head, occiput, temple, frontal, overorbital region, back of the head) and the duration of the episodes (in minutes, hours or whether constant). A substantial number of the 106 patients included in the study showed a malocclusion with prevalence in Angles Class II cases. Bruxism, onychophagy, TMJ pain, headache, mouth opening partial inability, mastication difficulty and articular sound were the most representative symptoms. The identification and recognition of factors, such as malocclusions and parafunctions, are considered fundamental to early diagnosis of TMJ problems, which is the most useful way to avoid a dysfunctional state of the stomatognathic system.

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

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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.

Lung disease with chronic obstruction in opium smokers in Singapore

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

1971-01-01

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

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

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Secourgeon, J-F

2012-10-01

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

Effect of method of euthanasia on sperm motility of mature Sprague-Dawley rats.

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Stutler, Shannon A; Johnson, Eric W; Still, Kenneth R; Schaeffer, David J; Hess, Rex A; Arfsten, Darryl P

2007-03-01

Euthanasia is one of the most commonly performed procedures in laboratory animal settings. The method of euthanasia may affect experimental results in studies using animals and must be compatible with research objectives including subsequent tissue analyses. Our present study was performed to evaluate the effects of 7 euthanasia methods on sperm motility in mature rats. Rats were euthanized using CO2, 2 commercially available euthanasia solutions (Beuthanasia-D and Sleepaway), and 4 volatile anesthetics (enflurane, halothane, isoflurane, and sevoflurane). Rats euthanized by rapid decapitation alone served as negative controls, and a-chlorohydrin-treated rats euthanized by rapid decapitation were positive controls for sperm impairment. For 5 of these methods, we also measured time to ataxia, recumbency, respiratory arrest, and no auscultable heartbeat. Immediately after euthanasia of each rat, distal caudal epididymides were removed; 1 was processed for automated sperm motility analysis, and the other was frozen for subsequent concentration analysis. Time to all measured parameters was less for volatile anesthetics than for Beuthanasia-D. Times to last respiration and no heartbeat were less for halothane and isoflurane than for enflurane and sevoflurane. Percentage motile sperm did not differ significantly between methods. Percentage progressively motile sperm did not vary significantly between methods except for Beuthanasia-D, for which it was significantly less than the negative control value. Specific sperm motion parameters for each euthanasia method except CO2 and Sleepaway varied significantly from the negative control. Our results indicate that the method of euthanasia is an important consideration when rat sperm motility parameters must be evaluated.

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.

Effects of posture on upper and lower limb peripheral resistance following submaximal cycling.

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Swan, P D; Spitler, D L; Todd, M K; Maupin, J L; Lewis, C L; Darragh, P M

1989-09-01

The purpose of this study was to determine postural effects on upper and lower limb peripheral resistance (PR) after submaximal exercise. Twelve subjects (six men and six women) completed submaximal cycle ergometer tests (60% age-predicted maximum heart rate) in the supine and upright seated positions. Each test included 20 minutes of rest, 20 minutes of cycling, and 15 minutes of recovery. Stroke volume and heart rate were determined by impedance cardiography, and blood pressure was measured by auscultation during rest, immediately after exercise, and at minutes 1-5, 7.5, 10, 12.5, and 15 of recovery. Peripheral resistance was calculated from values of mean arterial pressure and cardiac output. No significant (p less than 0.05) postural differences in PR were noted during rest for either limb. Immediately after exercise, PR decreased (55% to 61%) from resting levels in both limbs, independent of posture. Recovery ankle PR values were significantly different between postures. Upright ankle PR returned to 92% of the resting level within four minutes of recovery, compared to 76% of the resting level after 15 minutes in the supine posture. Peripheral resistance values in the supine and upright arm were not affected by posture and demonstrated a gradual pattern of recovery similar to the supine ankle recovery response (85% to 88% of rest within 15 minutes). The accelerated recovery rate of PR after upright exercise may result from local vasoconstriction mediated by a central regulatory response to stimulation from gravitational pressure on lower body circulation.

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

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2013-01-01

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

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

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

2016-12-01

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

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.

Integration of point-of-care ultrasound during rapid sequence intubation in trauma resuscitation

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Prakash Ranjan Mishra

2018-01-01

Full Text Available Introduction: Airway and breathing management play critical role in trauma resuscitation. Early identification of esophageal intubation and detection of fatal events is critical. Authors studied the utility of integration of point-of-care ultrasound (POCUS during different phases of rapid sequence intubation (RSI in trauma resuscitation. Methods: It was prospective, randomized single-centered study conducted at the Emergency Department of a level one trauma center. Patients were divided into ultrasonography (USG and clinical examination (CE arm. The objectives were to study the utility of POCUS in endotracheal tube placement and confirmations and identification of potentially fatal conditions as tracheal injury, midline vessels, paratracheal hematoma, vocal cord pathology, pneumothorax, and others during RSI. Patient >1 year of age were included. Time taken for procedure, number of incorrect intubations, and pathologies detected were noted. The data were collected in Microsoft Excel spread sheets and analyzed using Stata (version 11.2, Stata Corp, Texas, U. S. A software. Results: One hundred and six patients were recruited. The mean time for primary survey USG versus CE arm was (20 ± 10.01 vs. 18 ± 11.03 seconds. USG detected four pneumothorax, one tracheal injury, and one paratracheal hematoma. The mean procedure time USG versus CE arm was (37.3 ± 21.92 vs. 58 ± 32.04 seconds. Eight esophageal intubations were identified in USG arm by POCUS and two in CE arm by EtCO2 values. Conclusion: Integration of POCUS was useful in all three phases of RSI. It identified paratracheal hematoma, tracheal injury, and pneumothorax. It also identified esophageal intubation and confirmed main stem tracheal intubation in less time compared to five-point auscultation and capnography.

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

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

2015-01-01

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

Serum Tumor Necrosis Factor-alpha associates with Myocardial Oxygen Demand and Exercise Tolerance in Postmenopausal Women.

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Carter, Stephen J; Bryan, David R; Neumeier, William H; Glasser, Stephen P; Hunter, Gary R

2018-01-01

The functional implications of serum tumor necrosis factor-alpha (TNF-α), a marker of oxidative stress, on hemodynamic parameters at rest and during physical exertion are unclear. The aims of this investigation were to examine the independent associations of TNF-α on myocardial oxygen demand at rest and during submaximal exercise, while also evaluating the association of TNF-α on exercise tolerance. Forty, postmenopausal women, provided blood samples and completed a modified-Balke protocol to measure maximal oxygen uptake (VO 2max ). Large artery compliance was measured by pulse contour analyses while rate-pressure product (RPP), an index of myocardial oxygen demand, was measured at rest and during two submaximal workloads (i.e., ≈55% and ≈75% VO 2max ). RPP was calculated by dividing the product of heart rate and systolic blood pressure (via auscultation) by 100. Exercise tolerance corresponded with the cessation of the graded exercise test. During higher-intensity exertion, ≈75% VO 2max , multiple linear regression revealed a positive association ( r = 0.43; p = 0.015) between TNF-α and RPP while adjusting for maximal heart rate, VO 2max , large artery compliance, and percent body fat. Path analyses revealed a significant indirect effect of large artery compliance on exercise tolerance through TNF-α, β = 0.13, CI [0.03, 0.35], indicating greater levels of TNF-α associated with poorer exercise tolerance. These data suggest TNF-α independently associates with myocardial oxygen demand during physical exertion, thus highlighting the utility of higher-intensity efforts to expose important phenomena not apparent at rest. TNF-α also appears to be indirectly associated with the link between large artery compliance and exercise tolerance.

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

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

2016-06-01

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

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

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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.

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

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

2014-01-01

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

Comparison of ProSeal laryngeal mask airway (PLMA with cuffed and uncuffed endotracheal tubes in infants

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Eyyup Sabri Ozden

2016-11-01

Full Text Available We aimed to compare cuffed and uncuffed endotracheal tubes (ETTs with ProSealTM laryngeal mask airway (PLMA in terms of airway security and extubation, starting out from the hypothesis that PLMA will provide alternative airway safety to the endotracheal tubes, and that airway complications will be less observed. After obtaining approval from the local Ethics Committee and parental informed consent, 120 pediatric patients 1-24 months old, American Society of Anesthesiologists physical status I-II, requiring general anesthesia for elective lower abdominal surgery, were randomized into PLMA (Group P, n = 40, cuffed ETT (Group C, n = 40, and uncuffed ETT (Group UC, n = 40 groups. The number of intubation or PLMA insertion attempts was recorded. Each patient’s epigastrium was auscultated for gastric insufflation, leak volumes and air leak fractions (leak volume/inspiratory volume were recorded. Post-operative adverse events related to airway management were also followed up during the first post-operative hour. Demographic and surgical data were similar among the groups. There were significantly fewer airway manipulations in the Group P than in the other groups (p < 0.01, and leak volume and air leak fractions were greater in the Group UC than in the other two groups (p < 0.01. Laryngospasm was significantly lower in the Group P during extubation and within the first minute of post-extubation than in the other groups (p < 0.01. Based on this study, PLMA may be a good alternative to cuffed and uncuffed ETTs for airway management of infants due to the ease of manipulation and lower incidence of laryngospasm.

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

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

2016-01-20

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

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