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At least 955 records · Page 53Linked to original sources
PubMed1989

[Evaluation of reserve potentials of the heart in diseases of the abdominal aorta in middle aged and elderly patients].

By the method of radionuclide ventriculography on the nuclear stethoscope, 106 patients at the age of 60-84 years with occlusive lesions (64) and abdominal aortic aneurysm (42) were examined. After preoperative therapy, 48 patients underwent resection of the abdominal aortic aneurysm with grafting, 41--aortofemoral shunting. Three (7.5%) patients developed myocardial infarction after the operation, one patient died.

Age Factors↗
PubMed1988

[Evaluation of pump function of the heart in patients with occlusive diseases of the abdominal aorta and ischemic heart disease based on radionuclide ventriculography].

Altogether 56 patients with occlusive abdominal aortic lesions and concomitant CHD were examined by radionuclide ventriculography on a nuclear stethoscope. Suppression of left ventricular systolic and diastolic function was noted in the patients with CHD and arterial hypertension. Investigations of cardiohemodynamics using the above method made it possible to identify patients with limited functional cardiac reserve, to predict possible myocardial complications, and to take preventive measures before, during and after reconstructive interventions on the abdominal aorta.

Adult↗
PubMedDate not supplied

A quantitative method of determining the pneumatic ankle tourniquet setting.

Pneumatic ankle tourniquets are currently used in podiatry for maintaining hemostasis during foot surgery. The literature is limited concerning the safest pressure to use with this device. This study was undertaken to develop a simple and reliable method of deriving a proper pressure setting that would be safe and efficacious. Using a Doppler stethoscope, the minimum effective tourniquet pressure was established on 54 limbs from 35 patients undergoing foot surgery at our institution. The average pressure needed to obtain a "bloodless field" was 218.6 +/- 34.6 mm. Hg. However, in the younger, normotensive patients the average pressure utilized was 203.9 +/- 22.3 mm. Hg. The lower pressures used were felt to be safer and better tolerated by the patients. The authors concluded that the minimum effective pressure should be determined for each patient preoperatively and the routine use of a maximum safe pressure of 250 mm. Hg should be discouraged.

Adolescent↗
PubMed1986

[Intraoperative monitoring in artificial respiration of premature and newborn infants. I. Monitoring of respiratory parameters and alveolar ventilation].

Monitoring of ventilation serves to ensure adequate alveolar ventilation and arterial oxygenation, and to avoid pulmonary damage due to mechanical ventilation. Basic clinical monitoring, i.e., inspection, auscultation (including precordial or oesophageal stethoscope) and monitoring of heart rate and blood pressure, is mandatory. Mechanical ventilation is monitored by ventilation pressures (peak pressure, plateau pressure and endexpiratory pressure), ventilation volumes (measured at the in/expiratory valve of the respirator and by hot-wire anemometry at the tube connector), ventilation rate, and inspiratory oxygen concentration (FiO2). Alveolar ventilation should be continuously and indirectly recorded by capnometry (pECO2) and by measurement of transcutaneous pCO2 (tcpCO2), whereas oxygenation is determined via measurement of transcutaneous pO2 (tcpO2). Invasive monitoring of gas exchange is essential in prolonged or intrathoracic interventions as well as in neonates with cardiopulmonary problems. paCO2 may be estimated by capillary or venous blood gas analysis; arterial blood gas analysis is required for exact determination of paCO2 as well as arteriocutaneous pCO2 (atcDCO2) and arterio-end-expiratory (aEDCO2) gradients.

Acid-Base Equilibrium↗
PubMed1988

Pulse oximeter in the ambulatory aesthetic surgical facility.

One-hundred consecutive patients undergoing aesthetic surgical procedures with adjunctive intravenous sedation in an office-based ambulatory surgical facility were monitored by an anesthesiologist with an ECG, stethoscope, automatic sphygmomanometer, and pulse oximeter. The pulse oximeter detected hypoxemia occurring intraoperatively and in the recovery room earlier than the traditional methods of monitoring. By detecting early drops in the SAO2 with the pulse oximeter, appropriate corrective measures could be instituted and titration of intravenous anesthetics adjusted, avoiding progression to more profound hypoxemia and thus resulting in the safer delivery of anesthesia. The pulse oximeter is a useful and recommended adjunct to the traditional methods of monitoring in an office-based ambulatory surgical facility.

Adolescent↗
PubMed1988

[Evaluation of peak filling rate for the early identification of daunorubicin cardiotoxicity].

UNLABELLED: Anthracyclines are potent anticancer agents and their use is limited because of their cardiotoxicity which differs from one patient to another and is also dependent on other concurring risk factors. The radionuclide ventriculography is the non-invasive trasteale method used to detect early variations in the Left Ventricular Function (LVF) using Anthracyclines. The LVF in 13 pts, with acute non lymphoblastic leukaemia, was analyzed using a Nuclear Stethoscope before and after induction therapy with daunorubicin (DNR) at the total dosage of 135 mg/m2. The mean age of this group was 59 +/- 5 years; 4 of these were female and 9 were male. In all pts the Ejection Fraction (EF) for the systolic phase and the Peak Filling Rate (PFR) for the diastolic phase were evaluated. Results. Before therapy: 1) normal value of EF (74 +/- 4%) in all pts; 2) normal value of PFR in 10 pts and a slightly reduced value in 3 pts (PFR middle 3.30 +/- 0.74 EDV/sec). After therapy: 1) no significant changes in EF (72 +/- 4%); 2) significant reduction of PFR values in all pts (PFR middle 2.71 +/- 0.48 EDV/sec; p less than 0.05). CONCLUSIONS: the results show an early involvement of the diastolic phase (reduction of PFR) in patients who underwent DNR induction therapy. This is also evident from the normal EF values.

Acute Disease↗
PubMed1988

Effects of bell versus diaphragm on indirect blood pressure measurement.

The purpose of this study was to determine the effects of using the bell versus the diaphragm of the stethoscope on indirect blood pressure (BP) measurement. The design was experimental. Data were collected from 56 subjects randomly selected from 255 young women. Systolic (S1), fourth phase diastolic (D4), and fifth phase diastolic (D5) values were the dependent variables. Three research hypotheses were tested. Data were analyzed by using a one-tailed t test for dependent means. Hypotheses 1 and 2 predicted that use of the bell would result in higher S1 and D4 readings, respectively, than use of the diaphragm. Hypothesis 1 was supported whereas hypothesis 2 was not. Hypothesis 3, which stated that using the bell would produce a lower D5 reading than using the diaphragm, was supported. Implications of these findings as well as suggestions for future research are discussed.

Adult↗
PubMed1987

[Ventricular function in patients with silent myocardial ischemia before and following aortocoronary bypass operation].

In 12 patients with silent myocardial ischemia (fall of the ejection fraction (EF) greater than or equal to 5%, without angina pectoris) and in 15 symptomatic patients with coronary heart disease (fall of the EF during exercise EF greater than or equal to 5%, with angina pectoris), the left ventricular ejection fraction and the diastolic function (Peak Filling Rate, PFR; Time to Peak Filling Rate, TPFR) were evaluated before coronary artery bypass surgery and afterwards by the aid of the Nuclear Stethoscope. Our results showed a slight insignificant improvement in the EF from 60 +/- 8.3 per cent at rest to 66 +/- 7.9 per cent vs. 57 +/- 12 per cent to 62.6 +/- 9 per cent in patients with silent ischemia and in patients with angina pectoris after surgery. In contrast to this the EF increased significantly during exercise both in patients with silent ischemia from 52.0 +/- 15.2 per cent to 70.1 +/- 7.9 per cent and in symptomatic patients after revascularisation from, 49 +/- 11.7 per cent on to 64.2 +/- 8.4 per cent (both p less than 0.0001). There was also a similar significant improvement in the diastolic function, whereby the PFR was enhanced from 2.52 +/- 0.54 EDV/sec to 3.31 +/- 0.87 EDV/sec (p less than 0.02) in patients with silent myocardial ischemia and from 2.55 +/- 0.86 EDV/sec to 3.40 +/- 0.98 EDV/sec (p less than 0.02) in symptomatic patients. The TPFR showed a similar improvement.

Angina Pectoris↗
PubMedDate not supplied

Laënnec and the discovery of auscultation.

René Théophile Hyacinthe Lënnec is famous chiefly for the invention of the stethoscope. In addition to this, he was also one of the pioneers of accurate clinical observation together with postmortem correlation of physical signs. One hundred and sixty years after his death, he is still considered to be one of the greatest clinicians of all time.

Auscultation↗
PubMed1987

Pathophysiological significance of the global and regional left-ventricular ejection fraction (LV-EF) on ischaemic heart disease patients at rest and during ergometric exercise load (from radiocardio-cyclography (RKG-RCG) to parametric amplitude and phase scan).

As early as in the graphical RKG-RCG period a close inverse correlation could be established between the LV-EF and the serum myoglobin level during the acute course of myocardial infarction, in 10 patients in repeated follow up examinations. Corr. coeff. -0.91, p less than 0.01. In the mid seventies it could be shown by RKG-RCG, in 15 IHD patients with angina pectoris that the decrease of the basal LV-EF during ergometric load reflected the severity of IHD, compared with the increasing LV-EF tendency of 15 normal subjects. This fact could be verified on 19 middle age males (mean age, 41 years) by 99mTc RBC gamma camera ventriculography, i.e. that under modest load (100 W ergometry) a more than 10% decrease was a non-specific sign of main branch or three-vessel coronary heart disease. So in this extreme case our nuclear stethoscope-like RKG-RCG method alone may be satisfactory for staging and screening of coronary ischaemic heart disease (IHD) patients. All the 11 normal subjects belonged to the load-reaction group with more than 5% LV-EF increase, while the extensive anterior and inferior scar patients reacted without exception with more than 10% deficit (their basal LV-EF value was already under 45%). Supported by data in the literature in the comparison of load ECG and coronarography and two-step load, we could gain more refined data, but in accordance with the one-step load on the same patients. As regards the reproducibility of our global LV-EF investigations with gamma camera computer program Supersegams, it was within 5%.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗
PubMed1987

The lung exam.

Accurate diagnosis is essential for effective treatment. After history-taking, the physical examination is second in importance in assessing a pulmonary patient. The time-honored sequence of inspection, palpation, percussion, and auscultation is appropriate. Diagnostic tests are becoming more complex, more expensive, and more inclined to separate the patient and physician. The stethoscope is still the more commonly used diagnostic medical instrument, but it is not always used to best advantage. It is familiar, harmless, portable, and inexpensive. Its appropriate use improves medical practice and reduces costs. Improvements in sound recording and analysis techniques have spurred a renewed interest in lung sounds and their meaning. This is likely to lead to better understanding of what we hear, and perhaps to the development of new noninvasive diagnostic and monitoring techniques.

Auscultation↗
PubMed1987

Circadian rhythm of blood pressure in hypertensive adult patients: implications for blood pressure determination.

To determine whether traditionally timed (0800, 1600, and 2400 hr) blood pressure assessments by nurses reflect circadian peaks and troughs, blood pressure was measured indirectly every 2 hr for 24 hr with a mercury sphygmomanometer and a Sprague-Rapaport stethoscope in a sample of 31 hypertensive adult patients in a university hospital. Pooled mean systolic and diastolic readings portrayed a circadian rhythm with the peak occurring most frequently at 1600 and the trough at 0400 hr. The mean range of variability was 29.54 mm Hg for systolic pressure and 21.54 mm Hg for diastolic pressure. Two-tailed t tests demonstrated statistically significant (P less than .001) differences between peak and 0800 systolic pressure, peak and 2400 systolic pressure, peak and 0800 diastolic pressure, and peak and 2400 diastolic pressure. No significant differences were found between peak and 1600 systolic and diastolic assessments. There were statistically significant (P less than .001) t test differences between trough systolic and diastolic pressure and traditionally timed blood pressure readings. These findings have clinical nursing implications for the timing of blood pressure assessments of hospitalized hypertensive adult patients.

Adult↗
PubMed1987

[From phonocardiography to phonoanalysis].

We report on a new system for the examination and presentation of heart sounds, the phonoanalysis (PHA). It gives automatically a complete, objective physically founded picture of heart sounds and murmurs by registering the frequency spectrum graphically, as well as presenting in a numeric format, as a whole and as a function of time; in addition, the usual phonocardiographic and electrocardiographic leads may be obtained. A further function is to measure--probably for the first time--quantitatively the "roughness" of heart murmurs. This factor is also essential for the quality of murmurs and independent of the pitch. Therefore, the quantitative assessment of roughness has been proposed as an essential part of the physically founded description of heart murmurs in the auscultation, in addition to the determination of the dominating frequency (pitch). The term 'roughness' should not been confined to the extremely rough low-pitched heart murmurs e.g. in typical aortic stenosis. The PHA gives a better insight into the hemodynamic basis of heart murmurs and discloses properties of murmurs not recognized by auscultation and phonocardiography. The PHA can also be used for the examination of vascular, lung, bronchial and abdominal murmurs and also in connection with a stethoscope using an airborne sound microphone.

Computers↗
PubMed1987

[Anesthesia for congenital diaphragmatic hernia].

Hypoplasia of the lungs is the cause of the high mortality of newborns with diaphragmatic hernia. Survival depends mainly on the development of the contralateral lung. Eighty percent of diaphragmatic hernias are postolateral hernias of the left side. The most serious postoperative complication is a relapse into fetal circulation with increased pulmonary vascular resistance and right-to-left shunting (Fig. 2). The clinical signs of diaphragmatic hernia are cyanosis and tachypnea. Intermittent suction via a nasogastric tube and early intubation without mask ventilation should be performed. The inspiratory pressure should not exceed 25 cm H2O to minimize the risk of pneumothorax. Survival of the baby is unlikely if the initial blood gas analysis shows pH less than 7.10, pO2 less than 50 mmHg, and pCO2 greater than 65 mmHg. Hypothermia should be strictly avoided because it leads to increased oxygen consumption. Intraoperative monitoring should include a precordial stethoscope, ECG, blood pressure, and rectal temperature. Anesthesia is maintained with fentanyl 0.02-0.03 mg/kg body wt. and pancuronium 0.08-0.1 mg/kg. One dose of atropine (0.02 mg/kg) is administered before fentanyl. Intraoperative ventilation is performed by hand or by use of a Siemens Servo ventilator. Thirty newborns were anesthetized for repair of a congenital diaphragmatic hernia with no intraoperative complication and an overall mortality of 27%.

Anesthesia↗
PubMed1986

[Nuclear medical determination of left ventricular diastolic function in coronary heart disease].

In 191 patients with confirmed coronary disease we determined the left ventricular diastolic function with the Nuclear Stethoscope by the aid of the Peak Filling Rate (PFR) and the Time to Peak Filling Rate (TPFR). Moreover we investigated the ejection fraction (EF). 123 patients had already suffered a myocardial infarction, of these 59 an anterior wall infarction and 64 an inferior wall infarction. The remaining 68 patients had a CAD without a history of myocardial infarction. The PFR was 2.20 +/- 0.64 EDV/sec in the 59 patients after anterior wall infarction and 2.64 +/- 0.82 EDV/sec in the 64 patients after inferior wall infarction and 2.83 +/- 0.84 EDV/sec in 68 patients with coronary artery disease without a history of myocardial infarction. The TPFR was 178 +/- 36.7 msec after anterior and 157 +/- 49.2 msec after inferior wall infarction and 156 +/- 47 msec in the patients with CAD without previous infarction. The left ventricular diastolic function (PFR and/or TPFR) was abnormal in 87% after anterior wall infarction and in 81% after inferior wall infarction. In comparison with this the ejection fraction was reduced in 66% in anterior and in 61% after inferior wall infarction at rest. These results indicate that the resting diastolic function appears to be more informative for evaluation of a left ventricular dysfunction than the systolic function at rest.

Adult↗
PubMed1986

Admission test: a screening test for fetal distress in labor.

The usefulness of a short electronic fetal heart rate recording at admission of patients in labor (admission test) was investigated in low-risk patients in two prospective studies. The admission test was done in a concealed manner, and the result of the test was evaluated after delivery so as not to influence the clinical management. In part I of the investigation, the test was performed in 130 patients monitored during labor with pH determinations in scalp blood and in cord blood at birth. Patients with reactive admission tests had a low rate of intrauterine asphyxia in labor (0.9%), whereas half of the patients with ominous traces had intrauterine fetal asphyxia with a low scalp blood pH and neonatal depression. Similar results were obtained in part II, when the admission test was used as a screening procedure involving 1041 patients. The test was reactive in 94.3%, and in this group fetal distress (cesarean section, or forceps on that indication, or an Apgar score less than 7 at five minutes) occurred in 1.3%. Ten patients (1.0%) had ominous tests; four of these had fetal distress, and one of these fetuses died in utero three hours after admission, during which time stethoscopic auscultation failed to detect the fetal compromise. It is concluded that the admission test can detect fetal distress already present at admission and unnecessary delay in intervention can be avoided in such a case. The test seems also to have some predictive value for the fetal well-being for the next few hours of labor. The test is simple and convenient for screening purposes.

Delivery, Obstetric↗
PubMed1985

A respiratory profile from a hand-held computer.

A pocket computer would be of great use to the clinician, both in and out of an intensive care unit setting. Specialized, smaller, less expensive calculators that are preprogrammed with cardiorespiratory and other profiles will appear on the market and may become as useful a clinical aid as the stethoscope. This article describes a simple respiratory profile that will help the clinician logically approach a respiratory problem.

Computers↗