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PubMedDate not supplied

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

PURPOSE: The purpose of our study was to clarify the correlation between respiratory sounds and the high-resolution CT (HRCT) findings of lung diseases. MATERIALS AND METHODS: 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. RESULTS: 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. CONCLUSION: Abnormal respiratory sounds were correlated with some HRCT findings.

Aged↗
PubMed1992

Malocclusion, body posture, and temporomandibular disorder in children with primary and mixed dentition.

Occlusal factors, body posture and TM disorders were examined in forty children with primary dentition and forty children with mixed dentition. The purpose of the study was to test the hypothesis that there is a relationship between TM disorders and malocclusion, as well as that there is a relationship between body posture and TM disorders in the examined population. Clinical examination was done by two investigators, who used a stethoscope to detect TMJ sounds. The results showed that forward head position had a significant relationship to TM disorders in the mixed dentition. Also many of the occlusal factors were closely related to TM disorders in the population examined. The prevalence of TM disorders in primary dentition was 2.5% and in the mixed dentition it was 90% in the population studied.

Bruxism↗
PubMedDate not supplied

Effect of submucosal midazolam on behavior and physiologic response when combined with oral chloral hydrate and nitrous oxide sedation.

PURPOSE: This study was designed to examine the efficacy and safety of submucosal (SM) midazolam and oral chloral hydrate (CH) when used for pediatric conscious sedation in a clinical dental environment. METHODS: Twenty children ages 32 to 63 months participated in this institutionally approved study. Selection criteria included good health (ASA I), 2 to 5 years of age, uncooperative behavior, and the need for multiple restorative visits. In a double-blind crossover design, patients were randomly assigned to receive either oral CH (50 mg/kg) and SM midazolam (0.2 mg/kg), or oral CH (50 mg/kg) and SM saline placebo on their first sedation visit. On the second sedation visit, the patient received the opposite drug regimen than the first visit. Nitrous oxide (50%) was used during each sedation visit. Behavior response was rated as quiet (Q), crying (C), movement (M), or struggling (S) every 2.5 minutes through 40 minutes of operative procedures. Sedations were monitored using a capnograph, pulse oximeter, an automated blood pressure cuff, and precordial stethoscope. Respiratory rate (RR), heart rate (HR), and blood pressure (BP) were evaluated for each procedure. Data was analyzed using ANOVA and multinomial repeated-measures logistic regression. RESULTS: Analysis showed a significant difference in behavior during sedation across drug regimen (chi-square = 55.6, df = 3, P < .0001). Patients given SM midazolam in addition to oral CH showed increased Q rating and decreased C, M, and S ratings. RR, BP, and HR for both groups remained within the normal values for 2- to 5-year-olds. CONCLUSIONS: SM midazolam improved the quality of sedation without compromising safety. Quiet behavior was increased and struggling behavior was decreased. In addition, mean HR, RR, and BP analysis did not deviate from the norm for this age group.

Anesthesia, Dental↗
PubMed1992

[Pneumomediastinum].

Pneumomediastinum is a rare pathological condition with air in the mediastinum outside the trachea and oesophagus. The etiology may be spontaneous/resulting from exertion, traumatic, iatrogenic or it may be due to inflammation, neoplasm or perforation of a hollow abdominal organ. In pneumomediastinum resulting from exertion, a pressure gradient occurs and this causes rupture of marginally situated pulmonary alveoli. Air escapes from the alveoli into the perivascular adventitia and dissects its way along the vessels to the mediastinum. The commonest symptoms are pain in the thorax in 80-90% of the patients, followed by sensation of oppression and dysphagia. Stethoscopic examination reveals crepitation synchronous with pulse and respiration in half of the cases. The diagnosis is verified by radiographic examination of the thorax where air can be seen as vertical radio-translucent regions in the mediastinum and along the borders of the heart. Patients with pneumomediastinum should be admitted to hospital for investigation as treatment of a possible basic condition, e.g. rupture of the oesophagus or bronchus, is important. In uncomplicated cases, the mediastinal emphysema disappears in the course of a week. Mediastinotomy with incisions for relief of pressure may prove necessary.

Adolescent↗
PubMed2003

[Portable echocardiographs: useful or futile?].

Echocardiographic systems which are the size of a laptop computer are currently available. These hand-held ultrasound units are very easy to use at patient bedside in various clinical settings. According to the miniaturized devices, spectral Doppler may not be available and power Doppler may replace true color Doppler. Validation studies of hand-held echocardiography have been conducted in critically ill patients, in patients hospitalized in ward, but also in outpatients and as a screening tool for the detection of cardiac abnormalities in the community. Hand-held echocardiography appears to have important limitations in specific clinical settings, such as shock, pulmonary hypertension, assessment of valvulopathy or valvular prosthesis, dynamic left outflow tract obstruction, left ventricular restriction or construction. The miniaturized system with spectral Doppler capability has not yet been properly validated in these indications. At its present stage of development, hand-carried ultrasound units do not allow to perform a comprehensive examination which relies on the use of a full-feature system, especially when a precise hemodynamic evaluation is required. Diagnostic ability of hand-held echocardiography is similar to that of upper-end platforms for diagnoses based on two-dimensional imaging: left ventricular systolic function, detection of wall motion abnormalities, size of cardiac chambers, identification of pericardial or pleural effusions. Hand-carried ultrasound devices may be considered as a "visual stethoscope" which provides an extension of the physical examination, but not as a potential alternative to standard transthoracic echocardiography. Its large potential clinical field of use raises the concern of taylored training programs to intensivists which could be focused on goal-directed echocardiographic examinations.

Clinical Trials as Topic↗
PubMed2004

[Fasting and postprandial analysis of bowel sounds and plasma 5-hydroxytryptamine level].

BACKGROUND/AIMS: Auscultation of bowel sounds is a traditional technique for evaluating patients with abdominal symptoms. It is, however, subjective and qualitative method in general. Recently, analysis of bowel sounds becomes possible. We analyzed bowel sounds in healthy volunteers and measured platelet depleted plasma 5-hydroxytryptamine (5-HT) that may be associated with postprandial symptoms in irritable bowel syndrome. METHODS: We recorded both fasting and postprandial bowel sounds for 30 minutes in 16 healthy volunteers with a sensitive electronic stethoscope attached to a digital recorder. The files were saved in computer as wav files and analyzed with a specialized program. Blood samples were also taken before and 1 hour after meal for 5-HT analysis. RESULTS: Meal challenge made no statistically significant changes in the 5-HT concentrations and all the sound parameters including sound to sound interval, sounds/minute, average of sound amplitudes, sound length, percentage of bowel sounds representing sound clustering and dominant frequency of sounds. CONCLUSIONS: Postprandial changes in bowel sounds and plasma 5-HT were insignificant in healthy Korean volunteers.

Adolescent↗
PubMed2004

Bringing magic to the nursing workforce of the future.

How can nursing education respond to the ominous signs of a serious shortage of nurses in the future? One answer to this question is a focus on reclaiming nurses' stories of the "real-world" of nursing practice. In the process of creating a childrens book, The Magic Stethoscope, a group of nurse authors found a new appreciation for the stories of their practice and the need to share these stories with children. The authors hope that these stories will inspire children to consider the exciting career opportunities for the nursing workforce of the future.

Attitude to Health↗
PubMed1978

Monitoring ventilation during anesthesia.

In patients under anesthesia, ventilation is often monitored less adequately than circulation. A simple method, neglected in adults, is the use of a precordial or oesophageal stethoscope. Respiratory volumes may be measured directly, or inferred from flowrates or pressure changes. A rough measurement of inspired volumes may be made using a nonrebreathing valve, and controlling fresh gas input to maintain a constant underfilled reservoir bag. Spirometry of expired volumes is difficult and requires sophisticated apparatus. Respiratory volumes are easily inferred from flowrates using the Wright or Dräger respirometers. Flowrates may also be inferred from pressure changes, which are easy to record, as in the pneumotachorgraph. Accurate measurements require attention to many details, such as linearity of the transducer response over the flowrates measured. Calibration should be with the anesthetic gases used, at controlled temperature and humidity. Positive pressure ventilation peaks give a high flow artefact, and electronic drift requires regular recalibration. Electrical impedance changes may also be used to infer and record respiratory volumes, with reasonable accuracy if individual calibration is carried out. Anesthesia offers excellent opportunities to measure compliance and resistance, but itself changes these values, so that relation to normal values or changes due to pathology is difficult. Occlusion pressure is also readily measured during anesthesia, as an indication of respiratory drive, but rigid control of all other factors affecting respiratory muscle tensions is necessary.

Airway Resistance↗
PubMed2005

Factors influencing cardiac auscultation proficiency in physician trainees.

INTRODUCTION: We assessed the accuracy of physician trainees in identifying different cardiac sounds and examined the factors influencing their cardiac auscultation proficiency. METHODS: A total of 106 physicians in the Family Medicine Training Programme were asked to identify 10 cardiac sounds played sequentially on the Littmann electronic stethoscope, which functioned as a surrogate patient. Their auscultation accuracy was scored numerically out of a maximum of 10. Demographical data of the physicians was collected prospectively. RESULTS: The mean (+/-SD) auscultation proficiency score of the study population was 4.0 +/- 1.7. Physicians who graduated in 1994 or earlier fared significantly poorer than those who obtained their Bachelor of Medicine and Bachelor of Surgery degrees between 1995 and 2000 (p-value equals 0.02). Auscultation proficiency was not related to current practice, previous years of primary care, cardiology, internal medicine or paediatric medicine postings, or cumulative years of postings. Normal heart sounds were most accurately identified. Prosthetic cardiac sounds were better identified than other extra-cardiac sounds while systolic murmurs were more accurately identified than diastolic murmurs. Tachycardia had the lowest identification rate. CONCLUSION: Our data suggest that cardiac auscultation skill declined with time, being significantly impaired eight years after graduation. We suggest that there is a need for retraining in the form of continuing medical education to address not only new knowledge and skills, but also basic skill competency.

Adult↗
PubMed2004

Reliability and validity of cervical auscultation: a controlled comparison using videofluoroscopy.

Cervical auscultation is experiencing a renaissance as an adjunct to the clinical swallowing assessment. It is a controversial technique with a small evidence base. We have aimed to establish whether cervical auscultation interpretation is based on the actual sounds heard or, in practice, influenced by information gleaned from other aspects of the clinical assessment, medical notes, or previous knowledge. We sought to determine (a) rater reliability and its impact on the clinical value of cervical auscultation and (b) how judgments compare with the "gold standard": videofluoroscopy. Swallow sounds were computer recorded via a Littmann stethoscope. Sounds were sampled from 10 healthy control swallows with no aspiration/penetration and 10 patient swallows with aspiration/penetration, all recorded during simultaneous videofluoroscopy. The system generated sound quality similar to "live" bedside listening, a feature rarely seen in cervical auscultation studies. The 20 sound clips were classified as "normal" or "abnormal" by 19 volunteer speech-language pathologists with experience in cervical auscultation. After at least four weeks, 11 of these judges rated the sounds rerandomized on a new CD. Intrarater reliability kappa ranged from -0.12 to 0.71. Individual reliability did not correlate with years of experience, practice pattern, or frequency of use. Interrater reliability kappa = 0.17. Comparison with radiologically defined aspiration/penetration yielded 66% specificity, 62% sensitivity, and majority consensus gave 90% specificity, 80% sensitivity. There was a significant relationship between individual reliability and true positive rate (r(s) = 0.623, p = 0.040). The reliability of individual judges varied widely and thus, inevitably, agreement between judges was poor. Validity is dependent upon reliability: Improving the poor raters would improve the overall accuracy of this technique in predicting abnormality in swallowing. The group consensus correctly identified 17 of the 20 clips so we may speculate that the swallow sound contains audible cues that should in principle permit reliable classification.

Aged↗
PubMed2005

[Bilateral recurrent laryngeal nerve paralysis in a child following a neurosurgical operation].

We experienced a case of 7-year-old boy who developed bilateral recurrent laryngeal nerve paralysis following an elective neurosurgical operation under oxygen-nitrous oxide-isoflurane anesthesia. He underwent a removal of brain tumor in the supratentorial region on supine position. After the removal of the endotracheal tube in the intensive care unit, he developed marked respiratory effort and inspiratory stridor. A diagnosis of bilateral recurrent laryngeal nerve paralysis was made by a direct diagnostic laryngoscopy. The patient needed continuous care for his airway patency with tracheotomy tube in place, and his normal vocal cord mobility recovered on the 23 rd postoperative day. Common cause of recurrent nerve injury following general anesthesia is either the procedure of endotracheal intubation itself or trauma due to surgical manipulation. In the present case, an endotracheal tube, a transesophageal stethoscope and a nasogastric tube inserted into the narrow laryngeal space might have been a cause of this complication. Moreover, accidental extreme flexion of his neck which occurred during the surgery might also be an additional cause. This case suggests that recurrent laryngeal nerve paralysis due to anesthetic instruments around the larynx is a possible cause of complications during general anesthesia in pediatric patients.

Anesthesia, General↗
PubMed2006

BpTRU(tm) blood pressure monitor for use in a physician's office.

The BpTRU(tm) is an automated device that takes serial blood pressure (BP) measurements in a physician's office. (1) Preliminary data from non-randomized, uncontrolled trials suggest that the average of five BpTRU measurements, taken while the patient is alone, more reliably reflects "resting" BP compared to manual measurements taken with a stethoscope and sphygmomanometer. (2) BpTRU helps reduce the overestimation of BP due to improper measurement technique, or due to a patient's anxiety in a physician's presence ("white coat" effect). (3) The BpTRU device can improve hypertension management by replacing conventional manual BP measurements, which are often poorly performed and inaccurate. (4) BpTRU is more expensive than the manual manometers used in a physician's office. The serial measurement, taken in a private examining room, requires an average of six to 12 minutes, which could increase the duration of a patient's visit.

Automation↗
PubMed2006

[Telemedicine consultations in Iceland].

OBJECTIVE: A Telemedicine project was initiated to evaluate the usefulness of medical teleconsultations in Iceland and to gain experience for further planning of Telemedicine in the country. MATERIAL AND METHODS: The consultations were based on videoconference and store and forward method. Electronic stethoscope, spirometry, otoendoscope and digital pictures were used along with conventional videoconsultations. Doctors in six specialties in Landspitali University Hospital and one in private practice and Primary Care Physicians from five Health Care Centers in Iceland participated in the project. RESULTS: The results show that the Telemedicine consultations is practical and can be very useful. The doctors were content with the use of Telemedicine and the patients were pleased with the technique and the consults in general. All patients for example said that the consultation was just as or even better as if the specialist was in the room in person. The use of Telemedicine was helpful in almost all of the cases. Attention must be paid to organization of the consultations, payment, technical details and knowledge. CONCLUSION: Telemedicine have a role for Icelandic healthcare and may prove to be very useful. There are a number of factors who need preparation before the implementation of a Telemedicine service.

Humans↗
PubMed2006

Early detection of pulmonary hypertension with heart sounds analysis pilot study.

There are strong evidences to support that the modification of the characteristics of the second heart sound has a high correlation with the pulmonary arterial pressure (PAP). It is hence postulated that a specific heart sound spectrum for this disease group could be generated as a decision support system to help healthcare workers for the early detection of pulmonary hypertension. This paper described the design of a case-control study on identifying the heart sound pattern of people with pulmonary hypertension. In the proposed study, the heart sound of patients having pulmonary hypertension will be captured by an electronic stethoscope and processed into digital sound spectra which will be analysed to identify a specific heart sound pattern. In the future, an intelligent device will be developed based on the identified pattern to identify and diagnose early stage of pulmonary hypertension.

Decision Support Systems, Clinical↗
PubMed1992

[Self measurement of blood pressure: automation and management problems].

In the Federal Republic of Germany, the introduction of clinical testing of devices designed for the self-measurement of blood pressure resulted in an improvement of quality of these devices during the last ten years. Further progress seems to be possible by more restrictive administrative prescriptions. Now, electronic devices have the same accuracy as stethoscope devices. They facilitate self-measurement especially in handicapped persons. Devices working by the oscillometric method do not measure blood pressure more accurately than Korotkow devices, but they are a bit less sensitive for wrong placing of the bladder. In most devices automation of the prescribed deflation rate (2 to 3 mmHg/s) was successful.

Blood Pressure Determination↗
PubMed1991

[Diagnosis and treatment of inhalation injury (a report of 62 cases)].

62 cases with inhalation injury are included in this paper. 19 patients died, constituting a mortality of 30.7%. Among the symptoms, there is a characteristic high-pitched laryngotracheal respiratory sound, which is produced by narrowing of the laryngo-tracheal tract due to edema after the injury. It can be heard in the middle of the neck with a stethoscope. It can be regarded both as a diagnostic sign of inhalation injury and an indication for tracheotomy. The pressure exerted by the eschar in the neck can be released by incising the eschar. Tracheotomy can be avoided in some patients after the releasing incisions. Other problems such as artificial ventilation, liquid resuscitation etc. are also discussed.

Adolescent↗
PubMed1991

[24-hour blood pressure monitoring. Validation of a new automatic device].

To validate a new miniaturized 24-h blood pressure measuring device, 42 monitorings were carried out in 20 patients in the following manner: simultaneously with the automatic measurement, the physician involved measured the blood pressure in the usual manner with stethoscope and sphygmomanometer. The following very close agreement was found: Systolic: mean values 148 +/- 18/147 +/- 18 mmHg (Rxy = 0.98); diastolic: mean values 78 +/- 11/80 +/- 10 mmHg (Rxy = 0.96). These small differences show that, on account of its very high sensitivity, the Accutracker II recognizes the onset of the systolic k sound earlier on, and is capable of still detecting k sounds down to the lower diastolic pressures. These data, together with the good handling of the miniaturized device reveal it to be very well suited for the monitoring of anti-hypertensive treatment, thus helping to avoid unnecessary medication.

Blood Pressure Determination↗
PubMed1991

Techniques for measuring arterial pressure in the postoperative cardiac surgery patient.

Blood pressure measurement and management of the cardiac surgical patient do not appear to be simple processes. The critical care nurse needs to understand thoroughly the many technical and physiologic variables pertaining to the equipment used (i.e., cuff size, stethoscope placement, automated device cycling patterns, and monitoring system accuracy and reliability); the patient (i.e., cardiac output, PVR, hypothermia, and placement site and length of the intra-arterial catheter); and the relationship of indirect to direct measurement. The choice of therapy, i.e., volume or drug therapy (vasodilator or vasopressor), should be based on a thorough understanding of the technical and physiologic factors influencing the readings and their relationship to indirect and direct measurement of the blood pressure. Once the nurse understands the correlation of the indirect and direct blood pressure readings, choosing the pressure reading that one "likes" will no longer be an issue.

Blood Pressure Monitors↗