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[Laennec. The bicentenary of the birth of the author of "auscultation mèdiate" (author's transl)].

R. T. H. Laennec (17. 2. 1781-13. 8. 1826), the founder of the principles of auscultation, started from poor beginnings to become the leading clinician of France. In the prime of life, holder of two chairs of clinical medicine and physician to prominent persons in public life, Laennec contracted pulmonary tuberculosis, which led to his death at his home in Brittany at the early age of 45 years. Laennec is still remembered by posterity as the inventor of the stethoscope and author of a pioneering textbook on diseases of the heart and lungs, which is still worth reading today.

Auscultation↗

Orbital auscultation.

Orbital auscultation is recommended as a screening technique in patients with subjective bruit or tinnitus, persistent conjunctivitis, exophthalmos, headache, seizure disorder and other neurologic and psychiatric symptoms. It can reveal carotid-cavernous fistula, cerebral arteriovenous malformation, an intracranial mass which is producing increased intracerebral pressure, Paget's disease and other vascular abnormalities.

Arteriovenous Fistula↗

Clinical comparison of temporomandibular joint sound auscultation and emission imaging studies.

Single photon-emission computerized tomography scintigraphy was used to examine 250 patients who previously had temporomandibular joint sounds auscultated and recorded with a Doppler machine. Patients were divided into four groups based on the presence of joint sounds: no sound, reciprocal clicks, reciprocal clicks with crepitus, and crepitus. Statistically significant differences between the groups and the single photon-emission computerized tomography scintigraphy results were determined. There was no correlation between these results and the no sound and crepitus groups, but significant correlation was established between positive results and crepitant joints with reciprocal clicks and noncrepitant clicking joints.

Analysis of Variance↗

[What is the value of palpation and auscultation?].

In the diagnosis of heart disease--as in other domains of medicine--an integral approach to the patient complaints is essential. Careful observation and evaluation of his personality during medical history taking as well as an optimal clinical examination by palpation and auscultation of the heart, great vessels and lungs may lead to a semiquantitative diagnosis specially in valvular and congenital heart disease. The results of select imaging techniques may therefore be anticipated in these conditions by skilled clinical judgment alone. The palpatory and auscultatory findings are easily explained by the underlying hemodynamics. This article summarizes the most relevant clinical diagnostic clues in valvular and some congenital heart diseases.

Diagnosis, Differential↗

Pleurectomy through the triangle of auscultation for treatment of recurrent pneumothorax in younger patients. Evaluation of 60 consecutive cases.

Sixty patients, aged 14 to 35 years, with recurrent pneumothorax were treated with pleurectomy through the triangle of auscultation, with no chest wall muscle transection. The advantages of this approach over a full thoracotomy are that with no muscle transection, a shorter postoperative recovery is expected and, subsequently, early return to normal activity is achieved. The scar may also be more cosmetically acceptable. There was no postoperative mortality, and only one patient required reoperation because of bleeding. The technique is simple, and exposure is adequate. If necessary, this limited thoracotomy can be converted to a full thoracotomy with no difficulty.

Adolescent↗

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

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

Adult↗

Problems in the detection of intrapartum fetal asphyxia with intermittent auscultation.

We present 4 cases of severe intrapartum fetal asphyxia occurring during spontaneous unaugmented labours at term in low-risk women. In each case the baseline heart rate was completely normal, and the only indication of asphyxia was markedly decreased variability detected with electronic fetal heart rate monitoring. Correct action was taken in 3 cases that probably prevented fetal death or reduced neonatal morbidity. In no case would intermittent auscultation have been able to identify the compromised fetus.

Adolescent↗

Alcohol- and Caffeine-Induced Changes in Mitral Valve Echo Morphology and Auscultation in Healthy Females.

Mitral valve prolapse (MVP) is a common cardiac valve abnormality that affects women more frequently than men. We have shown that mild dehydration induces echocardiographic signs of MVP in healthy females more frequently than in males. The present study investigated whether ethanol and caffeine, two commonly used substances, will induce changes in mitral leaflet morphology in normal subjects and whether these changes are gender dependent. Ten healthy volunteers were examined after ingesting 0.95 g/kg ethanol at breath ethanol values of 0.025% +/- 0.005%, 0.050% +/- 0.005%, and 0.075% (peak) +/- 0.005%, and at decreasing ethanol levels of 0.050% +/- 0.005% and 0.025% +/- 0.005%. Twelve healthy subjects were studied at 1.5, 3, and 4.5 hours after ingesting 5 mg/kg body weight of caffeine in a randomized, double-blind, crossover manner. A significant increase in mitral valve shape index (MVSI) on apical four-chamber view was documented in females following ethanol ingestion at all ethanol levels. These changes were accompanied by auscultatory findings characteristic of MVP. Decreased systemic vascular resistance, and afterload and increased heart rate, also occurred after ethanol ingestion. A significant increase in MVSI occurred on parasternal long axis in females at peak caffeine level; auscultatory findings characteristic of MVP also were documented. MVSI increased slightly on apical four-chamber view in males; however, no male subject developed auscultatory MVP. Body mass index was significantly lower in females (20.8 +/- 0.7 kg/m(2)) versus males (23.7 +/- 0.3 kg/m(2), P < 0.05). All subjects lost weight after caffeine intake; afterload and contractility also were increased. This study documents that ethanol and caffeine, at concentrations similar to those present in social intake, induced significant echo changes in mitral leaflet morphology and auscultation suggestive of MVP in healthy females. These results suggest that in addition to apparent hydration state, recent ethanol or caffeine intake should be taken into consideration before making the diagnosis of MVP.

Journal Article↗

Triangle of auscultation thoracotomy for esophageal atresia.

A technique of thoracotomy via the triangle of auscultation is described. It avoids the division of latissimus dorsi, serratus anterior, and trapezius muscles, with its consequent morbidity, and provides excellent access to the thoracic cavity and the posterior aspect of the mediastinum.

Esophageal Atresia↗

[Comparison of auscultation findings using a classic stethoscope (Litmann 2120) and electronically amplified stethoscope (Medmax2)].

Heart auscultation has one of the key roles in beside diagnosis, especially in patients with cardiovascular diseases. Sometimes, because of the human cars' low sensitivity, a problem emerges in the proper evaluation of heart sounds and murmurs of lower frequencies. Our study compared two stethoscopes, the classic acoustic stethoscope (Littmann 2120) and an electronic one with the sound amplifier and the noise filtering system (Medmax2) in 10 patients examined by 10 physicians. Significantly better detection of low frequency sounds was found in favour of electronic stethoscope (chi 2 = 17.9; p < 0.0001). It is concluded that the selective amplificator improves the stethoscope performance and has its place in everyday bedside practice, especially in departments of cardiology.

Aged↗