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At least 703 records · Page 39Linked to original sources
PubMed1980

Low frequency sounds from sustained contraction of human skeletal muscle.

Low frequency audible vibrations are produced by human skeletal muscles undergoing sustained contraction. The effect is easily demonstrable with an electronic stethoscope which amplifies sound below 50 Hz. Autocorrelation analysis of the signal shows that it is periodic with a frequency 25 +/- 2.5 Hz. The quality of the sound is the same for all the skeletal muscles tested and is unaffected by changes in tension, ambient temperature, and blood flow. Electrically-stimulated contraction produces a sound which is indistinguishable from voluntary contraction. The amplitude of the sound increases linearly with tension. The sound signals are uncorrelated both in frequency and phase with electromyographic signals obtained simultaneously while the muscle is contacted. Arguments are presented to show that the sounds may be an intrinsic property of muscle contraction.

Humans↗
PubMed1983

Comparison of Doppler examination and retrograde spermatic venography in the diagnosis of varicocele.

The accuracy of the Doppler stethoscope is compared with that of retrograde spermatic venography in the diagnosis of varicocele in 39 subfertile men. In the 38 cases in which left-sided venography was successful, there was a good correlation between the radiographic and Doppler results in 33 cases (87%). The five failures were all false-negative results in patients without clinically diagnosed varicoceles. In the 33 cases in which right-sided venography was successful, there was a good correlation between the radiographic and Doppler results in 17 patients (52%). This low sensitivity on the right side appears to be a minor drawback, because right-sided reflux almost always occurs in conjunction with left-sided reflux, and therefore varicocele would be diagnosed in these patients despite the false-negative Doppler finding. Unlike venography, the Doppler study is noninvasive, inexpensive, and easy to perform. We conclude that it should be part of all studies of varicocele and infertility and that it may prove sufficiently accurate for use in controlled studies of the effectiveness of varicocelectomy and the role of subclinical varicocele in the pathogenesis of infertility.

Humans↗
PubMed1987

What is the incidence of varicocele in a fertile population?

One hundred men with proven fertility who presented for vasectomy consultation were examined for testicular size and presence of a varicocele, including examination with the Doppler stethoscope for the presence of subclinical varicocele. A diagnosis of varicocele was established in 61%. In 17 patients, the varicocele was evident clinically, whereas in 44 patients it was subclinical (8 bilateral). There was a discrepancy in testicular size in 22 patients, but this group included 8 men without varicoceles and 7 with subclinical varicoceles. It is apparent that varicoceles, especially subclinical varicoceles, are an extremely common finding, even in a group of fertile men. The results suggest that subclinical varicoceles have no role in male infertility.

Adult↗
PubMed1978

Ventriculoperitoneal (VP) shunt migration causing an acute scrotum: a case report of Doppler evaluation.

The diagnosis and management of a scrotal complication of a ventriculoperitoneal shunt simulating testicular torsion in a neonate is outlined. Radiologic evaluation determined the location of the shunt tube and adequate blood flow to the testicle was confirmed by use of the Doppler stethoscope, allowing for definitive therapy by extraperitoneal shortening of the shunt catheter. Surgery to the scrotum was, thus, avoided.

Cerebrospinal Fluid Shunts↗
PubMed1978

Sphygmomanometry in the pediatric patient.

The indirect measurement of blood pressure in the pediatric population is often difficult or impossible to perform and when values are obtained, they are often unreliable or inaccurate. An accurate measurement of arterial systolic pressure in the upper extremity is obtainable with a properly designed and sized occluding cuff and an ultrasonic device to detect the first Korotoff sound. For the detection of the first Korotkoff sound ultrasonic Doppler devices are superior to the stethoscope. When wider occluding cuffs than usual are applied to the upper extremity, the error of measurement is minimized. A method for accurately measuring end diastolic pressure has yet to be described despite assertions to the contrary.

Adolescent↗
PubMed1992

Arteriovenous malformation of scrotum: a case report.

Arteriovenous malformations of the scrotum are rare. We report a case of arteriovenous malformation involving the scrotal vessels. The patient presented with painful scrotal swelling, which was mainly in the skin and the Dartos layers. Vascular lesions of the scrotum are rare. By far the most common condition is varicocele. Our patient was examined by 2 other urologists before us and no one made the diagnosis of arteriovenous malformation on clinical examination. Diagnosis was made by auscultation with the Doppler stethoscope. We suggest that the possibility of a scrotal arteriovenous malformation and hemangiomas should be entertained in patients with unilateral scrotal swelling.

Arteriovenous Malformations↗
PubMed1992

Laparoscopic varicocelectomy: a simple technique for clip ligation of the spermatic vessels.

Less invasive laparoscopic surgery is replacing the conventional open operation for the treatment of several conditions. We performed laparoscopic clamping of the internal spermatic vessels in 12 subfertile patients to treat varicocele of the testis. Seven operations were performed with the patient under general anesthesia, whereas a local anesthetic was used in the 5 most recent patients. The internal spermatic vessels were successfully clipped in all 12 patients. Postoperative physical examination with a Doppler stethoscope showed that the venous reflux had disappeared in all patients. Semen quality was improved in 7 patients with a followup of 3 to 10 months. Neither hydrocele nor testicular atrophy was observed postoperatively. Laparoscopic varicocelectomy was effective and minimally invasive, especially when performed with the patient under local anesthesia.

Adult↗
PubMed1979

Epididymitis in infancy.

The occurrence of epididymitis in infants suggests the presence of urinary infection and the likelihood of an associated structural genitourinary abnormality, requiring complete urologic investigation. The advent of testicular scanning and the ultrasonic stethoscope, coupled with an increased index of suspicion, makes possible the non-operative diagnosis and management of a condition usually made by surgical exploration.

Epididymitis↗
PubMed1994

Ensuring the accuracy of digital sphygmomanometers for home use.

OBJECTIVE: To describe the techniques for assessing the accuracy of digital sphygmomanometers. DESIGN: The necessary equipment and the recommended procedures for determining the accuracy of digital units by comparison with a mercury sphygmomanometer were reviewed. RESULTS: Evaluation of the accuracy of digital sphygmomanometers is a simple two-phase process: (1) comparison of the pressure sensors against a mercury column and (2) assessment of the ability to detect Korotkoff sounds. The only equipment needed is a mercury column, a Y tubing, a "dummy" arm, two male-female adapters, and a stethoscope. The two short ends of the Y tubing are used to connect the mercury sphygmomanometer and the digital unit, and the long end of the Y tubing is attached to the cuff of the digital unit. The inflation mechanism of the digital unit (manual or automatic) influences the approach used for comparing the two units. For both manually and automatically inflatable digital units, the digital display should be within +/- 4 mm Hg of the mercury level; likewise, a properly functioning digital unit should detect Korotkoff sounds (both systolic and diastolic readings) within +/- 4 mm Hg of the auscultated blood pressure measurements. If the digital sphygmomanometer is judged to be accurate, 6-month reevaluations are suggested. CONCLUSION: With use of minimal equipment, digital sphygmomanometers (except the new finger blood pressure monitors) can easily be assessed for accuracy by comparing the pressure sensors against a mercury unit and testing the sensitivity for detecting Korotkoff sounds. Self-monitoring of the blood pressure is helpful in assessing blood pressure changes over time and in evaluating antihypertensive therapy.

Blood Pressure Monitors↗
PubMed1990

Value and limitations of auscultation in the management of congenital heart disease.

With advances in technology, especially that of ultrasonography, the art and science of auscultation could become relegated to that of an obsolete technique. Physicians in a cardiovascular training program involved in learning modern instrumentation diagnostic techniques often become expert in these areas before they have mastered the use of the stethoscope. Although the technology of ultrasonic examination, cardiac catheterization, and angiocardiography must be learned, the value of auscultation of the heart cannot be ignored. Many highly competent physicians who are responsible for diagnosis and treatment of the pediatric patient, including some pediatric cardiologists, may not be aware that they have not yet become experts at auscultation. The skill of auscultation of the heart must be learned by supervised experience with patients in whom a wide variety of normal and abnormal heart sounds and murmurs can be heard. Once learned, the skill can be maintained only by frequent practice in hearing and evaluating both subtle and obvious sounds emanating from the heart and from the pulmonary and systemic blood vessels.

Cardiac Catheterization↗
PubMed1990

Physician-patient communication about breast cancer. A challenge for the 1990s.

Rose Kushner, a well-known breast cancer patient advocate and medical journalist who contributed immeasurably to the changes that have taken place in breast cancer management today, summed up the communication dilemma succinctly. She stressed the importance of communication from physician to patient and from patient to physician. "In order for it to work [well]," she said, "it has to go both ways." The essence of a mutually cooperative endeavor in health care assumes that reactions from both parties affect the nature and outcome of the interaction. Therefore, it is mandatory to examine the reciprocal flow of factors that shape the physician-patient interaction. Although public testimony often conveys the conviction that physician communications are limited or altered in an attempt to protect patients from emotional upset and that withholding information is in their best interest, a literature review demonstrated that this was not so. Interestingly, today, a contrary trend may be emerging, where some physicians are so forthright and blunt in their disclosure that the impact of a guarded prognosis is felt as an assault and carries with it a connotation of certainty for disaster. As was stated earlier in this article, a most useful beacon to guide the physician in this dimly lit path is the notion that "congruence not candor" direct the disclosure. The physician-patient interaction is a unique and somewhat fragile connection that must be viewed as more than an implicit service contract. It is a special collaborative effort that requires continuous monitoring and assessment in order to maximize gratification for both parties. Individuals on both sides of the stethoscope have feelings and needs that can operate to enhance or sabotage optimal physician-patient relations.

Breast Neoplasms↗
PubMed1997

Muscle sounds in Parkinson's disease.

BACKGROUND: A sound with a frequency of around 40 Hz can be heard, with a stethoscope, in the muscles of the hand and forearm during tonic contraction or movement. This sound is the acoustic correlate of the Piper rhythm seen in electromyographic records of muscle activity. The way in which motor activity is organised at the cortical level may determine the frequency of the sound heard. METHODS: The wrist extensor muscles in the forearm of seven patients with idiopathic Parkinson's disease, studied with and without antiparkinsonian treatment, and a control group of seven healthy men were auscultated during very strong extension of the wrist and during repeated slow flexion and extension of this joint. FINDINGS: In healthy people, the Piper-band sound made by muscle activity is 40-50 Hz. In all seven parkinsonian patients, when off medication, the normal Piper-band sound was replaced by a pulsatile muscle activity of 10 Hz during strong wrist extension, and in four patients during repeated flexion and extension of the wrist. After treatment with dopaminergic drugs, the Piper mode of muscle discharge was restored and motor performance was improved. INTERPRETATION: The Piper mode of muscle discharge is dependent on the normal functioning of pallidal projections to the motor areas of the cortex. In abnormal function a muscle discharge of 10 Hz dominates, which is suboptimal when fast or powerful contractions are necessary.

Adult↗
PubMed1999

Reduced tolerance and cardiovascular response to ischemic pain in minor depression.

BACKGROUND: A paradoxical association between a higher prevalence of clinical pain and a reduced sensitivity to brief experimental pain seems to exist during depression. METHODS: We assessed the responses to sustained ischemic pain produced by a maximal effort tourniquet procedure in 32 controls and 11 individuals with minor depression (Zung autoscale > or =50). Stethoscopic blood pressures and heart rates were monitored throughout the procedure. RESULTS: Measures of pain threshold, and measures of pain intensity and pain unpleasantness during the ischemic procedure were similar in depressed and control subjects. Yet, the overall numerical ratings of ischemic pain during the procedure was 28% higher and pain tolerance was 44% lower in depressed compared to control subjects. Clinical pain complaints were reported by 91% of depressed but only by 41% of control subjects (P = 0.01). Sustained ischemic pain induced significant elevations of systolic and mean arterial blood pressures in controls but not in depressed subjects. LIMITATIONS: The main limitation of the present study was the preponderance of females in the depressed group. Yet, we did not find significant gender differences in the sensory-affective and autonomic responses to ischemic pain in our sample. CONCLUSIONS: These findings suggest alterations in the sensory and autonomic nervous systems during minor depression.

Adult↗
PubMed1999

Extrauterine pelvic arteriovenous malformation mimicking the clinical presentation of structural heart disease.

A case is reported of an extrauterine pelvic arteriovenous malformation involving branches of the internal iliac arteries. Cardiomegaly and a rough cardiac murmur were the clinical presentations mimicking a structural heart disease. A continuous bruit could only be detected by the diaphragm of the stethoscope applied firmly to the left lower abdomen. Multiple blood samplings from inferior vena cava, and iliac and femoral veins for determination of oxygen saturation may be necessary for suspected cases. However, selective arteriography remains the best method for diagnosing the presence, extent, and multiplicity of the lesions before surgery or percutaneous arterial embolization.

Arteriovenous Malformations↗
PubMed1984

Doppler ultrasound failure in testicular torsion.

Eighty adult patients with acute scrotal pain were evaluated during a one-year period using the Doppler ultrasonic stethoscope. Among the 16 patients with spermatic cord torsion, the Doppler examination was correct in seven (44%), indeterminate in four (25%), and falsely negative in five (31%), despite use of the funicular compression test. The mean duration of torsion was substantially different in the correct (15 hours), indeterminate (70 hours), and false-negative (50 hours) groups, although the correlation between Doppler result and torsion duration was not significant (P = .14). The large number of false-negative examinations makes the Doppler unsuitable for excluding the diagnosis of testicular torsion.

Adult↗
PubMed1985

Differential auscultation of the acutely ill patient.

The differential stethoscope is a unique instrument that assists in rapid evaluation of pulmonary problems in the acutely ill patient. Simultaneous auscultation of homologous lung segments eliminates the problem of variability of breathing rate and pattern that must be confronted in conventional auscultation.

Auscultation↗
PubMed1987

Medical emergencies aboard commercial aircraft.

The Federal Aviation Administration has recently ordered a physician's kit be installed aboard all commercial aircraft in the United States. The kit includes epinephrine, diphenhydramine HCl, nitroglycerin tablets, 50% dextrose injection, oropharyngeal airways, stethoscope, and sphygmomanometer. The addition of the kit prompts an examination of medical problems while aloft. We review the incidence of inflight medical emergencies, the equipment available for treating such incidents, and first aid training of the cabin crew. Ongoing issues such as the legal status of physician volunteers and the security of first aid supplies aboard an aircraft are discussed. The most effective step to prevent further inflight medical incidents would be to initiate an educational program in both medical and aviation circles detailing the hazards and contraindications to flight.

Aerospace Medicine↗
PubMed1988

Clinical use of the olecranon-manubrium percussion sign in shoulder trauma.

We conducted a study to assess the efficacy of the use of osteophony in the evaluation of shoulder trauma. Evaluation of the shoulder includes the physical examination and often a radiographic series. We studied the usefulness of the olecranon-manubrium percussion (OMP) test, a physical diagnostic procedure performed in shoulder trauma. The bell of the stethoscope is placed over the manubrium, both elbows are flexed at 90 degrees, and the olecranon is percussed. In the normal examination with no disruption of bony conduction, both sides should produce a crisp equal sound. In the event of a dislocation or fracture with disruption of bony conduction, the affected side should be duller in pitch and intensity. We evaluated the utilization of the OMP test to assess its accuracy when used as a screening test for radiographs in conjunction with the physical examination and radiographic examination. Ninety-six patients were prospectively evaluated by the OMP test and also received radiographs. In those patients who had radiographic abnormalities, 40 of 47 (85.1%) had an abnormal OMP sign. In those patients without radiographic abnormalities, none had an abnormal OMP sign. In assessing anterior shoulder dislocations, 11 of 13 (84.6%) had an abnormal OMP sign (P less than .02). After relocation, 100% had a normal OMP sign. Of those with clavicular fractures, nine of nine (100%) had abnormal OMP signs (P less than .005). Of those with a fracture of the humerus, 16 of 20 (80%) revealed an abnormal OMP test (P less than .01). The test was not significant in assessing acromio-clavicular joint abnormalities.(ABSTRACT TRUNCATED AT 250 WORDS)

Emergencies↗