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At least 937 records · Page 52Linked to original sources
PubMedDate not supplied

[Femoral artery compression test: a non-invasive method for detection of obstructive injury of the internal iliac artery].

For non-invasive detection of obstructive disease in the internal iliac artery, the femoral compression test was devised. This test consists in the compression of the inguinal arcade of the patient with the examiner's thumb, until the disappearance of the arterial beats in this region and peripherically in the correspondent lower limb, while one auscultates the sound in the dorsal penial artery with ultrasonic stethoscope and measures the penial pressure. The test was considered positive when there was abolition of sound in the penial artery, or reduction superior to 15% in the penial pressure. The test was negative when there was no abolition or reduction of sound and pressure, as referred respectively. In 15 normal individuals the 30 tests, one for each inguinal region, were negative. In 23 patients with ischemia of lower limbs registered by the analysis of angiographies to which they were submitted, there were 39 tests, one in each inguinal region, in which there was femoral pulsation. There was abolition of sound in the penial dorsal artery in 20 of 22 tests in which the arteriography showed obstruction of the homolateral internal iliac artery. In 15 tests, in which there was reduction of penial pressure, the arteriography showed presence of unique or multiple stenosis in the internal homolateral iliac artery. In two cases of patency of the internal homolateral iliac artery, the test was negative. The positivity of the test was significantly higher in patients with obstructive lesions of internal iliac artery when compared to normal individuals (p < 0.001, chi-square test).(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1991

Patients go home for care. But do their doctors make house calls?

Caring for a patient at home no longer consists simply of a black bag and a stethoscope warmed in the physician's palm. No longer is it a quarantine sign the physician tacked up on the front door, or a thermometer and an injection of penicillin. Today, taking care of a patient at home often involves sophisticated equipment, a highly trained staff of nurses and allied professionals, and a set of skills and a body of knowledge with which many physicians are neither familiar nor comfortable.

Home Care Services↗
PubMed1991

Utilizing lung sounds analysis for the evaluation of acute asthma in small children.

One of the most difficult aspects of management of acute asthma in the small child is the clinician's inability to quantitate the response or lack of response to bronchodilator agents because of the inability of a child this age to perform objective lung measurements in the acute state. The present study was designed to evaluate bronchodilator responsiveness in children between 2 and 6 years of age with wheezing by means of a computerized lung sound analysis, computer digitized airway phonopneumonography. Children between ages 2 and 6 who were experiencing acute exacerbations of asthma were included in this study population. The 43 children were evaluated by physical examination, pulmonary function testing, if possible, by use of (spirometry or peak flow meter) and transmission of lung sounds to a computer using an electronic stethoscope to obtain a phonopneumograph with sound intensity level determinations during tidal breathing. A control group of 20 known asthmatic patients between the ages of 8 and 52 years who also presented to the office with acute asthma were evaluated similarly. In each of these individuals, a physical examination was followed by complete spirometry as well as computer digitized airway phonopneumonography recordings. Following initial measurements, all patients were treated with nebulized albuterol (0.25 mL in 2 mL of saline). Five minutes after completion of the nebulization all patients were reexamined and repeat pulmonary function tests were performed followed by CDAP recordings. In the study group of children, the mean pretreatment sound intensity level was 1,694 (range 557 to 4,950 SD +/- 745).(ABSTRACT TRUNCATED AT 250 WORDS)

Acute Disease↗
PubMedDate not supplied

[Nuclear stethoscopy. The clinical technic, methods and applications].

The paper reports on a new way of cardiological, radionuclidic investigation of the patients, a technique used for the first time in Romania. The technique and investigation method are presented in detail, with emphasis on some more important stages. As resulting from the description of the methodology, the performances of the left ventricle consist of three types of radioactivity/time curves at: first passage, beat by beat, and their summation. Of the advantages offered by the nuclear stethoscope, mention should be made that, besides the evaluation of systolic and diastolic parameters, it monitors the left ventricle functions in the rhythm disturbances, beat by beat, and being mobile, it permits the investigation at the patient's bed. Finally, the paper presents several cases investigated by the authors, and their special clinical applicability.

Coronary Disease↗
PubMedDate not supplied

An evaluation of three blood pressure methods in a stabilized acute trauma population.

Blood pressure values were evaluated in 30 acute adult trauma patients using two indirect methods, the bell and diaphragm components of the stethoscope, and one direct arterial method. K1, K4, and K5 measurements were taken 4 to 72 hours (M = 30) after admission when vital signs had stabilized. Data were collected using a random-zero (RZ) sphygmomanometer for indirect blood pressure and radial intraarterial cannula for direct blood pressure. The sequence of measurement was randomized and variables shown to alter blood pressure values were controlled. There was no overall significant difference in K1, K4, and K5 blood pressures among the three methods. These results suggest that when clinicians monitor variables such as the frequency response of arterial lines and peripheral vascular resistance, indirect blood pressure methods are reliable for use with stabilized trauma patients.

Adolescent↗
PubMed1991

[Venous air embolism following repositioning from sitting to supine].

We have experienced a patient in whom venous air embolism reoccurred, when the patient's position was changed from sitting to supine. A 40 year old male with Arnold-Chiari malformation underwent suboccipital decompression and cervical laminectomy under the sitting position. During surgery, three episodes of venous air embolism were detected by high pitched sound through precordial ultrasound Doppler stethoscope, an abrupt increase in pulmonary arterial pressure, a decrease in end-tidal carbon dioxide concentration; and a small amount of bubbled air was removed from the central venous catheter. At the end of surgery when the patient was turned to supine position, the signs of venous air embolism reappeared and 3 ml of bubbled air was also removed. This case suggests that there is some remaining air in the large veins of the upper part of the body once the air embolism has occurred during sitting position and thus we need to confirm that no air is left in the large veins before repositioning. We should be cautious of reoccurrence of venous air embolism whenever patient's position is changed.

Adult↗
PubMed1991

Antihypertensive effect of tiapamil from ambulatory and clinic methods.

Tiapamil (T), a calcium antagonist, was studied in hypertensive patients by 1) automatic monitor of blood pressure (AMBP), and 2) cuff and stethoscope clinic blood pressure (CBP). Systolic (SBP), diastolic (DBP) pressures and heart rate were measured. Patients (n = 58) received four weeks of placebos given twice daily. Baseline 24 h AMBP (wk 4), 147 +/- 18 (SBP) and 91 +/- 8 (DBP) mmHg; and CBP (wk 3 and 4), 152 +/- 16 (SBP) and 102 +/- 9 (DBP) were established. Then, patients received double-blinded therapy (wk 5-10) of twice daily tablets of placebo (n = 9); Level I T, 150-300 mg (n = 24); or Level II T, 450-600 mg (n = 25): i.e. 0 to 1,200 mg T/d. Significant responses, measured by AMBP (wk 10), were noted only at Level II T: SBP (-10.5 +/- 12.4) and DBP (-5.6 +/- 7.8) mmHg. However, CBP (wk 9 and 10) responded at Level I T (SBP, -7.7 +/- 12.4/DBP, -5.8 +/- 6.4) and Level II T (SBP, -8.8 +/- 9.4/DBP, -9.7 +/- 7.8 mmHg). There was minimal correlation (r = 0.16) of pressure responses to T measured by 24-h AMBP versus CBP methods. Therefore, T effectively lowered SBP and DBP, but individual responses measured by AMBP did not predict those measured by CBP. There was no effect of T on heart rate. Dizziness was noted in 12 percent of patients on T.

Adolescent↗
PubMed1991

[Hygiene barriers in the hospital--psychological aspects].

This study was made necessary due to the great extent of hospital infections (720,000 cases) in the Federal Republic of Germany and the fact that the nosocomial infection is the most common infectious disease. Starting with a theoretical explanatory model of hygiene behaviour in clinics, 25 senior physicians, 38 assistant doctors, 31 members of the nursing staff and 20 members of the cleaning personnel and domestic staff in university clinics (surgery, orthopaedics, anaesthesia, gynaecology, paediatrics) were examined in a two-stage sociopsychological investigation. To be checked was the hypothesis that the quality and intensity of hygiene behaviour in clinics rises with the extent of personal hygiene sensitivity, knowledge about hygiene essentials, hygiene risks, causes of infection and possibilities of prophylaxis, exemplary and supervisory behaviour on the part of principals and staff in the clinic, as well as the absoluteness, succinctness, clinic-specificity and compulsoriness of rules of hygiene. General findings: (1) During training hygiene was a subject which did not arouse much interest; 57% admit big deficiencies in training; 60.4% of all those asked saw a big lack of information concerning basic knowledge of hospital hygiene, use of non-reusable materials, disinfection of endoscopes, laser probes etc., antibiotic therapy and strategy, development of resistant germs and their disinfection, ways and chains of infection, asepsis in the operating theatre, disposal of contaminated material, rules of hygiene in dealing with HIV-patients, sterilization of implants etc. (2) Doctors and nursing staff assume a relatively high incidence of hospital infections in their own clinic and in their wake an increase in psychological strain on the part of the patients, as well as higher costs in the health service. The most common hygiene deficiencies are lack of space and storage rooms, no separation of septic and aseptic patients, deficiencies in toilets and bathrooms, inadequate personal hygiene behaviour of staff, lack of protective clothing or no regular change of clothing, shortcomings in disinfection, incorrect use of syringes, stethoscopes, etc., no sterile dressings for wounds, no systematic hygiene control and no official consequences for wrong behaviour.(ABSTRACT TRUNCATED AT 400 WORDS)

Cross Infection↗
PubMed1990

Distress, jaw habits, and connective tissue laxity as predisposing factors to TMJ sounds in adolescents.

Immediately before a craniomandibular examination and measurement of wrist laxity, 96 adolescents answered a questionnaire about jaw habits, jaw activities, symptoms of stress, facial trauma, and TMJ sounds. The sample was divided into five subgroups on the basis of history and stethoscopically detected TMJ sounds. Some groups with TMJ sounds had significantly more jaw habits, jaw activities, and symptoms of stress than the control group (without history and clinically detected TMJ sounds). No significant differences emerged in angular measurement of wrist laxity between groups with TMJ sounds and the control group. This preliminary study indicates that an adolescent's distress may be associated with TMJ sounds. Further studies on subgroups of adolescents with different TMJ-related symptoms and signs are urged.

Adolescent↗
PubMed1990

The role of the Doppler in the differential diagnosis of lower extremity claudication syndromes.

Certain doppler procedures can be used as screening methods, and may be helpful in detecting and locating arterial occlusive disease in the patient with vertebrogenic sciatica or claudication syndromes of the lower extremities. The doppler has become popular in the office setting because it is quick, noninvasive and inexpensive. The procedures can be performed even with the simple stethoscope doppler. A review of the basic types of equipment as well as pertinent data interpretation are covered in this article. The methods applied are multisegmental pressures and audible doppler flow signals.

Adult↗
PubMed1990

[Severe first dose reaction after administration of captopril to patients with carotid artery stenosis].

During recent years, ACE inhibitors have been employed to an increasing extent in the long-term treatment of arterial hypertension. As part of the investigation of arterial hypertension, the captopril test, with administration of a small oral dose of captopril and registration of the blood pressure and pulse during the subsequent period, is employed. During this test, two cases of marked fall in blood pressure accompanied by symptoms of inadequate cerebral circulation were observed. Both of these patients were subsequently submitted to digital subtraction angiography of the vessels of the neck and both found to have unilateral stenosis of the carotid artery. It is concluded that, particularly in elderly hypertensive patients, ACE inhibitor treatment should always be initiated during controlled conditions. Stethoscopic examination of the carotid arteries should always be performed.

Aged↗
PubMed1990

Reliability of compact electronic blood pressure monitors for hypertensive pregnant women.

Self-monitoring of blood pressure is an asset to managing hypertensive pregnant women on an outpatient basis. Many brands of electronic blood pressure devices are now available for use during pregnancy. An investigation was undertaken to compare the relative accuracy and acceptability of four of the least expensive and most compact units (Sunbeam III, Norelco, Lumiscope and Marshall). The reliability of the devices was compared with simultaneous measurements using a Dinamap 845A monitor on 22 pregnant hypertensive women. All measurements were performed without difficulty by a skilled observer and the patients. The accuracy varied, but each electronic device was considered as accurate as a mechanical aneroid unit available at the same retail stores. The advantages of these electronic units were ease of application and readability of the measurements without the need for a stethoscope or an assistant.

Adult↗
PubMed1990

[Evaluation of abdominal motor blockade using surface integrated electromyography during bupivacaine spinal anesthesia].

The study was undertaken to investigate abdominal motor blockade and compare sensory-motor differential blockade in bupivacaine spinal anesthesia by surface integrated electromyography (SIEMG). Seventeen physical status I adult male patients underwent lower limb surgery under spinal anesthesia were divided into two groups: hyperbaric bupivacaine (HB) group (n = 8) receiving 3 mL of 0.5% bupivacaine (8% glucose) and isobaric bupivacaine (IB) group (n = 9), 3 mL of 0.5% bupivacaine (glucose-free). Each patient was monitored with a blood pressure cuff, an ECG and a precordial stethoscope. Spinal anesthesia was performed at L3-4 interspace on the lateral position. Immediately following injection of bupivacaine, the patients were turned to the supine position and then simultaneous measurements of sensory blockade using pinprick, abdominal motor blockade at T6, T8, T10, T12 level using SIEMG and lower limb motor blockade using Bromage scale were made for 4 hours. Between two groups, there were no significant differences in terms of age, body weight, height as maximum level and mean times to maximum level of sensory blockade, abdominal motor blockade and lower limb motor blockade. The times of 2-segment regression of sensory blockade were 66.3 +/- 11.1 min in HB group and 115.6 +/- 31.3 min in IB group. The sensory-motor differential blockades were 4.6 +/- 0.5 segments and 4.8 +/- 2.1 segments in HB and IB groups, respectively. According to the linear regression analysis, the correlation between sensory blockade and abdominal motor blockade was better than the lower limb motor blockade and abdominal motor blockade. (Correlation coefficient (r): 0.893 vs 0.580 in HB group; 0.773 vs 0.366 in IB group).(ABSTRACT TRUNCATED AT 250 WORDS)

Abdomen↗
PubMed1985

[Left ventricular diastolic function and ventricular arrhythmias in coronary heart disease].

In 70 patients suffering from coronary heart disease, to a large extent after myocardial infarction, left ventricular diastolic function was examined with a nuclear stethoscope using Peak Filling Rate (PFR) and Time to Peak Filling Rate (TPFR). Ventricular arrhythmias were recorded by 24-hour ECG and the arrhythmias were analyzed according to the Lown classification. The parameters severing the ventricular arrhythmias were correlated with the previously mentioned parameters of diastolic left ventricular function. A correlation was found between PFR and TPFR and the severity of ventricular arrhythmias, whereby the difference in the PFR between Lown classes 0 and III and also between 0 and IVa was statistically significant. For TPFR a statistically significant distribution could be found only between Lown 0 and III.

Adult↗
PubMed1989

[ Self measurement of blood pressure. Equipment and comparison of equipment].

Precision is the primordial criterion for the evaluation of a blood pressure measuring device. While traditionally devices based on the auscultation technique have dominated semiautomatic devices have recently gained acceptance. The latter permit to reduce procedure-related errors. They are simpler to use and require less demanding instruction but are more expensive than stethoscopic devices.

Auscultation↗
PubMed1989

Response capability during civil air carrier inflight medical emergencies.

Expanded civil aircraft medical emergency kits have been mandated on U.S. carriers since August 1986. Airlines provided the Federal Aviation Agency reports on medical kit usage and outcomes of the associated medical emergencies; 1,016 inflight medical events during the period August 1, 1986, through July 31, 1987, were available for review. Physicians responded to the emergencies in over 63% of the occurrences; the two most prevalent presenting situations were chest pain and syncopal episodes. Nine passengers died on board aircraft, and at least three deaths occurred postlanding. A minimum of 89 of the total cases resulted in flight diversions. The sphygmomanometer (739 cases) and stethoscope (734 cases) were the most frequently used kit items; oropharyngeal airways were utilized in 14 cases. Since standardized reporting formats are not required, evaluation of response capability remains incomplete.

Aircraft↗
PubMed1989

AANA Journal course: new technologies in anesthesia: update for nurse anesthetists--monitoring depth of anesthesia using a reliable esophageal method. (continuing education credit)

Until recently, there had been no simple, accurate, and reliable technique for monitoring depth of anesthesia, but now a monitoring system that measures lower esophageal contractility (LEC) is available. The system consists of a monitor and a disposable esophageal stethoscope equipped with provoking and measuring balloons. Since the brain stem directly controls the motor function of the esophagus, LEC was postulated to reflect the anesthetic state of the patient. Multiple-center clinical studies have shown that LEC correlates significantly with administered levels of intravenous and inhalation anesthetic agents and patient responses to surgical stimulation. Monitoring LEC permits the clinician to administer the dose of drug needed without the complications associated with "too deep" or "too light" anesthesia.

Anesthesia, General↗
PubMed1989

Emergence of rheumatic fever in the nineteenth century.

How do we make sense of the process of disease definition when the tools for "framing" a pathophysiologic reality and the reality to be framed may have both been changing? The sudden emergence of rheumatic fever at the end of the eighteenth century was the result of distinct biological changes that led to cardiac damage. But the identification of the disease also depended on the ability of clinicians to diagnose it in the absence of easily observable cardiac symptoms. Clinicians were able to appreciate the alteration of rheumatism into rheumatic fever through assimilation of technological changes (the stethoscope and autopsy), refinements in clinical thinking (the "typical case"), and the concentration of patients in hospitals where they were treated by physicians who were medical leaders and educators.

History, 18th Century↗