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At least 685 records · Page 38Linked to original sources
PubMed1986

Fetal acid-base balance in low-risk patients in labor.

The fetal acid-base balance from scalp blood in the early and late first stage of labor and from cord arterial blood was assessed in 120 low-risk patients only monitored electronically for 15 minutes at admission. The mean scalp blood pH values were 7.332 at a cervical dilatation of 5 cm and 7.335 at 10 cm cervical dilatation. A low pH value (less than 7.25) was found in 14 patients; five (4.2%) of them had fetal distress. Stethoscopic auscultation failed to identify these cases. Another nine patients had transient abnormal acid-base balance (a check value within 30 minutes was normal), and the fetal heart rate trace (obtained immediately after the sampling) showed no ominous changes in these cases. It is concluded that an abnormal fetal acid-base balance is not uncommon in a low-risk population in labor. However, a critical evaluation of the acid-base balance is necessary, since in most cases the abnormal acid-base balance is transient and of a respiratory, innocuous type without concomitant fetal distress.

Acid-Base Equilibrium↗
PubMed1987

Transesophageal Doppler scanning versus thermodilution during general anesthesia. An initial comparison of cardiac output techniques.

Measurement of cardiac output has become an essential feature of anesthetic management of patients with cardiac disease requiring operation. Thermodilution by way of a Swan-Ganz catheter is the current popular technique for cardiac output determination. Unfortunately, this method is costly and has an associated irreducible morbidity rate and has, in rare instances, resulted in death. The suprasternal ultrasonographic Doppler technique has shown promise for measuring cardiac output noninvasively; however, it is too cumbersome for continuous intraoperative use. In an effort to overcome this limitation, the esophageal stethoscope was modified to accept a Doppler probe. Herein, we have reported an initial comparison of transesophageal Doppler scanning and thermodilution in 23 adult men during general anesthesia. The average difference between thermodilution and descending cardiac output was 0.16 +/- 0.81 liters/min. The correlation between thermodilution and descending cardiac output increased with operator experience. In the last 13 patients, there was an average correlation of 0.85. After the equipment was mastered and improvements in design were made, descending cardiac output had a high correlation with thermodilution and appeared to track the dynamic changes during general anesthesia.

Aged↗
PubMed1987

Use of tuning fork in diagnostic auscultation of fractures.

This study was conducted on 50 patients in the Central Institute of Orthopaedics, Safdarjung Hospital, New Delhi, from June to October 1985. With the help of a child's stethoscope and a tuning fork of 128 Hz, the sound conducted by an injured limb was compared with that by the uninjured limb. The presence of a fracture reduced or abolished the conduction of sound by a bone. This method allows a quick examination without causing any pain, which is an advantage in an uncooperative patient. It is also reliable in the unconscious. The test is so simple that paramedical staff can use it. The results were correct in 94 per cent of patients and were confirmed by radiological examination whereas clinical diagnosis was correct in only 88 per cent of cases.

Auscultation↗
PubMed1990

Devices for the diagnosis and treatment of temporomandibular disorders. Part II: Electromyography and sonography.

This second article in the three-part series on temporomandibular disorder (TMD) devices compares the claimed diagnostic usefulness of electromyography and sonography with the present scientific evidence. This review concludes that there is no evidence to support the use of either surface electromyography or silent period duration for the evaluation or diagnosis of TMD. Furthermore, in view of the available evidence, sonography and Doppler ultrasound have no particular advantage over a conventional stethoscope or direct auscultation.

Auscultation↗
PubMed1992

Effects of posterior teeth replacement on temporomandibular joint sounds: a preliminary report.

Previous reports have shown the prevalence of jaw clicking to be significantly higher in a population with missing posterior teeth compared with an dentulous population. This study presents a 2- to 5-year assessment of the effects of posterior teeth replacement on the amplitude of jaw clicking in subjects who were asymptomatic in all respects except jaw clicking. Patients requiring removable partial dentures (RPDs) were clinically and anamnestically examined and temporomandibular joint (TMJ) sounds were recorded using a modified stethoscope attached to an adjustable headgear. Amplified signals were displayed on a strip chart recorder. The amplitude of TMJ sounds at preinsertion of RPDs were 27.5 +/- 17.7 dB at opening, and 11.1 +/- 12.7 dB at closing. Similar values after prosthesis insertion were 15.8 +/- 17.0 dB and 7.4 +/- 7.5 dB, respectively. Paired t test analyses showed significant differences in the amplitude of sound for opening and closing before inserting the prosthesis (p = 0.003) and for opening before and after treatment (p = 0.014). Following replacement of posterior teeth, the clicking amplitude decreased in 68% of recordings, remained unchanged in 11%, and increased in 21%.

Adult↗
PubMed1986

Intrapartum fetal heart rate monitoring in a combined low- and high-risk population: a controlled clinical trial.

In a prospective clinical randomized investigation 487 women had the condition of the fetus during labour supervised by means of stethoscope (AUS), while 482 women went through labour under surveillance of electronic fetal monitoring, cardiotocography (EFM). 349 women refused to participate in the investigation (NAI) and had delivery conducted according to the normal procedures of the department (70% AUS, 30% EFM). Significantly more pathological fetal heart rate patterns (FHR) were found in the EFM group compared to the AUS group in both the first and the second stage of labour. As a result significantly more vacuum extractions were performed in the EFM group than in the AUS group, while no statistical difference was found between the groups in the incidence of acute cesarean sections carried out for asphyxia. One case of intrapartum death occurred in the AUS group. No differences were found in Apgar scores after 1 and 5 min or in neonatal morbidity at examination on the 2nd and 5th days after delivery. A tendency towards more biochemically compromised children was found in the AUS group. The specificity for both methods was found to be acceptably high (80%), while the predictive value for both methods was low (50%). More research is therefore urgently needed to evaluate supplementary investigations and parameters for the evaluation of the intrapartum fetal condition.

Acid-Base Equilibrium↗
PubMed1989

Cardiac gas embolism during carbon dioxide hysteroscopy: risk and management.

A relatively high number of fatal complications during hysteroscopy, where carbon dioxide was used as the uterine distension medium, plus a recent report on heart embolism during dog experiments with venous carbon dioxide infusion, audible by simple stethoscopic surveillance during the infusion, prompted the present study. Seventy women with no history of cardiac valvular disease or failure were observed during carbon dioxide hysteroscopy for the occurrence of the characteristic metallic heart sound caused by the intracardiac presence of free carbon dioxide during the heart contractions. In seven cases (10%) the typical metallic heart sounds appeared during the hysteroscopy, leading to immediate interruption of the hysteroscopy and withdrawal of the hysteroscope. This caused the pathological heart sounds to disappear, after which the hysteroscopy could continue. Heart auscultation should always be performed during carbon dioxide hysteroscopy in order to avoid serious cardiovascular complications. This simple precaution turns carbon dioxide hysteroscopy into a versatile and safe method for intra-uterine diagnosis and therapy.

Animals↗
PubMed1983

Cost/benefit analysis and capital investment decisions in nuclear cardiology.

This paper demonstrates an application of Cost-Benefit Analysis as an aid in capital investment medical decision making. Specifically, a cost-benefit analysis is used to compare three nuclear cardiology instruments (i.e. Nuclear Stethoscope, Mobile Camera/Computer and Fixed Cardiac Computer). The study examined both non-quantitative and quantitative comparative factors. Results of the study show: (1) Conversion of the non-quantitative factors into a numerical system (via medical opinion) greatly delineates the relative merits of each instrument. (2) Simulating the stochastic economic and equipment utilization factors reveals instrument selection to be a function of patient flow and amortization procedures. (3) Adjusting the quantitative assessment of each instrument by the non-quantitative assessment (via the numerical system) aids in the capital investment decision.

Capital Expenditures↗
PubMed1976

Necrotic testicle with increased blood flow on Doppler ultrasonic examination.

A twelve-year-old male with a five-day history of scrotal swelling and pain had increased blood flow on ultrasonic examination. A testicular flow and scan indicated an ischemic testicle. Surgical exploration revealed complete torsion of the spermatic cord. In chronic cases of torsion, the Doppler stethoscope may give a false negative result because of reactive hyperemia.

Adolescent↗
PubMed1980

Radioisotope angiography in diagnosis of varicocele.

A varicocele, the most common surgically correctable cause of subfertility in men, is a manifestation of abnormal retrograde venous blood flow through the internal spermatic vein into the peritesticular pampiniform plexus. Methods of diagnosing the varicocele, including careful physical examination using a Valsalva maneuver as well as a Doppler stethoscope, remain somewhat subjective. Venography, while a reliable and objective technique, is invasive and not without morbidity. In the present study, 16 patients with clinically detectable varicoceles of various sizes were studied using a testicular radioisotope angiogram developed in our laboratory. Following the injection of 15 mg. of stannous pyrophosphate which results in tagging of the circulating red cell pool, 20 mCi. of 99m-technetium were administered in an intravenous bolus injection. The isotope binds to the pyrophosphate thus tagging the red blood cells and creating a blood-pooling agent with a relatively short half-life (six hours). Perfusion studies as well as static views of the scrotal contents, both in the supine and erect position, with and without Valsalva maneuver, were obtained using a gamma camera. The activity in each hemiscrotum then was quantitated using a digital computer. It is proposed that quantitation of this differential blood pool will make the identification of even subclinical varicoceles a potentially objective determination.

Humans↗
PubMed1987

Haemodynamic dose-response actions of cicloprolol in left ventricular dysfunction due to ischaemic heart disease.

Cicloprolol is a cardioselective beta-1 partial agonist; its haemodynamic and radionuclide (nuclear stethoscope) effects were determined in 22 patients with impaired left ventricular function due to coronary artery disease. Following a 20 min stable control period, the effects of four doses of cicloprolol (0.025, 0.025, 0.05 and 0.1 mg/kg at 10 min intervals) were measured at rest 5-10 min after each intravenous injection. The effects of the cumulative 0.2 mg/kg dosage were assessed during supine bicycle exercise and compared with a control exercise period. At rest there were significant increases in systolic arterial without change in mean blood pressure. The heart rate and cardiac index were unchanged. There was a significant increase in left ventricular ejection fraction with a reduction in filling pressure and volume. Patients with resting heart rate below 75 beats/min and with ejection fraction greater than 35% showed the greatest improvement. During supine bicycle exercise, ejection fraction was increased compared to control (31 +/- 2 to 36 +/- 2; P less than 0.01), cardiac volume reduced and exercise tachycardia attenuated. These data suggest that cicloprolol may be of value where beta-blockade is considered in the presence of underlying left ventricular dysfunction due to ischaemic heart disease.

Adrenergic beta-Antagonists↗
PubMed1993

Minimal tourniquet pressure to maintain arterial closure in upper limb surgery.

Complications of the pneumatic tourniquet used during limb surgery result from excessive direct pressure. Traditional recommendations suggests parameters for maximum pressure and time limits rather than the minimal effective pressure to achieve a bloodless field. A clinical study was undertaken to evaluate the pneumatic tourniquet setting required for adequate haemostasis in the upper limb. The correlations between several possible influencing parameters (age, sex, arm fat thickness, extremity length, systolic, diastolic, and mean blood pressures) and the minimal pneumatic tourniquet pressure at which the peripheral pulse reappeared were studied in 50 patients undergoing surgery, using a Doppler stethoscope. The average Doppler Opening Pressure was 168.5 +/- 42.7 mmHg and the only significant clinical variable was the mean blood pressure. From these results an equation was derived to predict the minimal effective tourniquet pressure. The mean calculated tourniquet pressure was 202.3 +/- 34.2 mmHg, well below the 250 to 300 mmHg previously recommended. The technique consisted of inflating the tourniquet to a pressure of 300 mmHg, then reducing it to the calculated value. A bloodless field was maintained in all patients.

Adolescent↗
PubMed1986

Media images of physicians and nurses in the United States.

This paper analyzes images of physicians and nurses presented in advertisements in the medical and nursing journals JAMA (Journal of the American Medical Association) and AJN (American Journal of Nursing). Advertisements are viewed as hyper-ritualized displays of symbols and rituals associated with medical and nursing practice, both reflecting and reaffirming stereotypes and beliefs that are widely held in the society at large. Trends over the past few decades show that medical advertisements are dropping some traditional symbols (such as the white coat and stethoscope) in favor of depicting science-in-action and high technology. Nursing advertisements, however, are more frequently utilizing the symbols formerly reserved for physicians. Both physicians and nurses are depicted in their respective journals as existing largely independent of one another. While these advertisements clearly do not depict social reality, they present a fictionalized version which reflects and reproduces some of the expressed ideals in medical and nursing practice.

Advertising↗
PubMed1993

Maternal perceptions of pneumonia and pneumonia signs in Pakistani children.

Fifty mothers of children attending a hospital outpatient clinic with non-severe pneumonia (fast breathing but no chest indrawing) were interviewed in depth. Maternal perceptions and practices with clinical significance were documented. Results showed that most mothers initially tried "heat-producing" home remedies designed to counter the "coldness" of the disease, allowed only 2 days for any particular allopathic medicine to work, and did not go to the same practitioner twice. When mothers were asked what had alarmed them enough to come to the hospital, the symptoms named most frequently were persistent severe cough and high fever, inability to sleep and excessive crying. Fast breathing was spontaneously mentioned by only a few, although when questioned, 32/50 said that they had noticed it. The mothers who had prior experience with child pneumonia were more likely to notice fast breathing and also came to the hospital earlier than those who were inexperienced. Relatively higher levels of maternal education and income were suggestively associated with bringing a female child rather than a male child for pneumonia treatment. Fewer than half of the mothers knew where air goes when a person breathes in and where the lungs are located. Most held treatment preferences at odds with the protocols proposed for the national ARI program currently being initiated in Pakistan, e.g. they said that a doctor should use a stethoscope, should prescribe suspensions rather than tablets and should give injections. This study provides baseline data on attitudes and behaviors that can either be built on in that program or addressed through public education campaigns.

Attitude to Health↗
PubMed1990

French influence on the development of medicine in Louisiana.

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

Clinical Medicine↗
PubMed2005

Usefulness of a new sound spectral averaging technique to distinguish an innocent systolic murmur from that of aortic stenosis.

We present a new method to record and display heart sounds that uses a hand-held computer and stethoscopic recording device. It allows for rapid spectral and waveform displays of murmurs and provides a means for signal averaging of spectral frequency content. Compared with aortic stenosis, innocent murmurs primarily contain frequencies of <300 Hz and persist for a shorter duration at the upper-frequency levels. This method provides for rapid characterization of innocent murmurs, a means for comparison with other murmurs, and transmission of acoustic data to distant sites.

Adolescent↗
PubMed2004

Third heart sound: genesis and clinical importance.

Auscultation of third heart sound has been performed for more than a century, an interest that not only persists today, but also has experienced renewed emphasis. Sophisticated study of the third heart sound by current investigative techniques has underscored the value of clinical detection with the time-honored stethoscope. This review re-examines the mechanisms of genesis of third heart sound in regard to the hemodynamic and echocardiographic aspects, and its clinical importance.

Heart Auscultation↗
PubMed1994

Automated blood pressure measurement devices: a potential source of morbidity in preeclampsia?

OBJECTIVE: The purpose was to compare auscultatory and oscillometric techniques in the determination of maternal blood pressure in normotensive primigravid patients and primigravid patients with proteinuric preeclampsia (blood pressure > 140/90 on two occasions and proteinuria > 0.5 gm/L). STUDY DESIGN: A prospective comparison of systolic and diastolic blood pressure was made with an automated device using oscillometric principles and two observers using a double-headed stethoscope to determine auscultatory observations (phase I and phase IV of the vascular sounds) in normotensive primigravid patients (N = 40) and primigravid patients with proteinuric hypertension (N = 17). RESULTS: In patients with proteinuric preeclampsia the mean differences between auscultatory (phase I and phase IV) and oscillometric observations were 5.4 mm Hg (SEM 1.4 mm, p < 0.05) and 14.8 mm Hg (SEM 2.9 mm, p < 0.01) for systolic and diastolic observations, respectively. In normotensive patients the mean differences between auscultatory (phase I and phase IV) and oscillometric observations were 2.4 mm Hg (SEM 0.9 mm, p not significant) and 7.5 mm Hg (SEM 1.9 mm, p < 0.01) for systolic and diastolic observations, respectively. CONCLUSION: Automated devices using oscillometric principles "underrecord" systolic and diastolic blood pressure compared with auscultatory observations (phase I and phase IV) in patients with proteinuric preeclampsia. In some cases the difference between observations exceeds 30 mm Hg.

Adult↗