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PubMed1981

Office Doppler techniques in vascular disease.

The Doppler ultrasonic velocity detector is the least expensive and most versatile instrument used to screen patients for peripheral arterial, cerebrovascular, and venous disease. The Doppler detector provides qualitative and quantitative estimates of arterial and venous flow velocity and segmental arterial pressure measurements. The device can become as clinically useful as the stethoscope to screen patients for vascular disorders. New audiovisual instructional aids may make this technique a routine complement to the clinician's diagnostic resources.

Arterial Occlusive Diseases↗
PubMed1981

[Guidelines towards examination of the lung function in children (author's transl)].

Examination of the lung function in school children is complicated and necessitates a considerable amount of technical equipment. The general practitioner carrying out the examination should not forget that a detailed clinical examination and a good stethoscope can provide important information for the diagnosis, differential diagnosis and further therapy of the child. The range of so-called simple electronic spirometers with a print-out of data tempts practitioner to use them in the diagnostics of the functioning of the lung. There is, however, considerable danger that these instruments lead more often in wrong results. A simple bell spirograph with a recording unit together with a helium analysis instrument allows the doctor to make a complete spirogram which gives exact information. In addition, the doctor requires a special lung laboratory to which to transfer children for a period of supervision and larger. The doctor should be aware that an absence of clinical symptoms, proved in practice, does not necessarily mean that the lung is working normally. Indication of an extended examination of the lungs can be deduced from a blood gas analysis, which can, with some practice be determined in the office. A reduced pO2 or an increased pCO2 can indeed indicate a disorder even when the child appears on examination to be clinically healthy. Instruments new commonly in use for analyzing the blood gas with capillary blood can also be introduced into the office.

Body Height↗
PubMed1980

Hemodilution and induced hypotension for insertion of a Harrington rod in a Jehovah's Witness patient.

The case of a 28-year-old Jehovah's Witness illustrates the feasibility of using a combined technique of induced hypotension and hemodilution to minimize the surgical loss of red blood cells during the insertion of a Harrington rod. A Swan-Ganz catheter with thermister tip was inserted to measure pulmonary arterial pressure, pulmonary arterial wedge pressure and cardiac output. Other intraoperative monitoring included continuous arterial pressure, electrocardiography, oropharyngeal temperature, esophageal stethoscope, arm-cuff blood pressure and urinary output from an indwelling Foley catheter. A total of 10 L of crystalloid was infused over a 2 1/2-hour period while hypotension was induced by intravenous nitroprusside and enflurane anesthesia. Hematocrit was diluted from 46% to 26% intraoperatively with an estimated surgical blood loss of 2,740 ml. The 24-hour postoperative hematocrit was 30% and recovery was uneventful. This method may be useful in any orthopedic procedure in which heavy blood loss is anticipated and the patient refuses transfusion of blood or blood products. However, the patient must be in good health and have an uncompromised cardiopulmonary system.

Adult↗
PubMed1995

Self-measurement of blood pressure: assessment of equipment. Canadian Coalition for High Blood Pressure Prevention and Control.

Equipment for the self-measurement of blood pressure is readily available to consumers. These devices use one or more surrogate (indirect) measures of pressure to estimate systolic and diastolic blood pressure. Manual auscultatory devices using stethoscope and sphygmomanometer have been adapted for home use, but a variety of automated devices based on auscultation, oscillometry, and other techniques are available and may be more suitable for individuals who have limited vision, hearing or dexterity. Despite the existence of voluntary evaluation protocols and mandatory manufacturing standards, blood pressure readings from some automatic devices may not be accurate. Some devices are packaged with insufficient information to ensure proper use, and most individuals need some form of guidance in their use and calibration testing. If self-measurement of blood pressure is to be of benefit, the health care professional must recommend only those devices that are accurate and suitable to the patient or client. The Canadian Coalition for High Blood Pressure Prevention and Control will endeavour to develop a regular means by which health care professionals can keep informed of available devices for blood pressure self-measurement.

Blood Pressure Determination↗
PubMed1995

A curriculum for the training and certification of blood pressure measurement for health care providers.

Blood pressure measurement in clinical practice is almost never performed according to accepted guidelines. This is likely to be a result of inadequate training. We describe a standardized training program for teaching blood pressure measurement to health care students, practitioners and clinical investigators as well as lay personnel. The goal is to have the student understand the rationale and be able to perform accurate blood pressure measurements. Students must master the knowledge of proper blood pressure measurement technique, document their accuracy on standardized video tests and demonstrate their performance of proper technique. In addition the program reviews key historical and physiological aspects of blood pressure measurement and the cardiovascular complications of high blood pressure. The operation and maintenance of sphygmomanometers and the stethoscope, and monitoring for biases in blood pressure measurements in clinical practice, are also covered. The curriculum time requires a minimum of 7 h and biannual recertification is recommended. With training of instructors, the program can be easily replicated and should be considered in any setting in which blood pressure measurement is taught.

Blood Pressure Determination↗
PubMed1995

Patients achieve accurate home blood pressure measurement following instruction.

This study evaluates the effects of an instruction program conducted by registered nurses on subjects' ability to achieve three blood pressure measurements that were within 2 mmHg of simultaneous readings taken by an instructor listening through a dual headed stethoscope. The sample comprised 30 subjects aged between 22 and 76 years who were referred to a Hypertension Unit over a two month period for home blood pressure instruction. After approximately 45 minutes of individual instruction and practice in the use of an aneroid home blood pressure machine, subjects' ability to measure their blood pressure was assessed by the accuracy of their readings, their responses to a multiple choice knowledge questionnaire, their self-reported confidence in their ability to measure their blood pressure at home and an instructor's evaluation of their technique. Twenty seven percent of subjects achieved three measurements that were the same as those of their instructor, 57% and 17% obtained readings that were within 2 mmHg and 4 mmHg of an instructor respectively. Ninety percent of subjects obtained perfect scores in the knowledge questionnaire, 93% obtained perfect scores in the technique competency checklist and 100% of subjects either strongly agreed or agreed with the statement 'I feel confident enough to measure my blood pressure at home'. The study demonstrates that patients can be taught to accurately measure their blood pressure at home and, herefore, to provide reliable data to assist in the diagnosis and treatment of hypertension and hypotension.

Adult↗
PubMedDate not supplied

[Lung auscultation: an old skill with new interpretation and terminology].

The lung sound auscultation is a part of everyday practice of most physicians. This skill used to be in practice in antique times, but it did not gain any particular attention until the beginning of the 19th century when Laennec systematized his observations, so that the method became generally accepted as the means of examining the patient. Today the stethoscope has almost become the symbol of medical profession, and without it no worthy caricature on behalf of a physician is possible. In this article except short historical review of the lung auscultation, the new technical innovations, including the use of computers which have led to new insights into the characteristics of the lung sounds in health and disease have been shown. Indeed, the technical innovations have insured more accurate measurement of all characteristics of lung sounds, and in connection with this enabled the coining of new terms, especially for adventitious lung sounds. As the whole civilized world has agreed upon the terminology, in the radiance of the above mentioned we are also proposing new terminology for adventitious lung sounds.

Auscultation↗
PubMed1995

[Mycoplasma pneumonia found by the occurrence of atelectasis during the induction of anesthesia in a child with tetralogy of Fallot].

A 3-yr-old girl was scheduled to undergo surgical repair of tetralogy of Fallot. She had no sign or data indicating an infectious disease, other than a slight dry cough for a few days prior to the proposed operation. During the induction of anesthesia with nitrous oxide, oxygen and sevoflurane, transient moist rale was noticed with a precordial stethoscope. Her trachea was intubated without any difficulty after the administration of pancuronium, followed by a chest auscultation, which revealed vesicular sound bilaterally but no rale. However, a chest X-ray taken after the right subclavian vein catheterization showed a massive hypoaeration in the upper left pulmonary region. The presence of the right-to-left intracardiac shunt made it impossible to detect the occurrence of atelectasis by a decrease in SpO2. Fiberoptic bronchoscopy showed no obstruction of the bronchus and no hypersecretion initially, but physical therapy and humidification made it possible to aspirate intratracheal sputum. Because there seemed to be an imbalance between the relatively uneventful induction of anesthesia and the relative resistance of atelectasis to authentic therapies, the operation was postponed, and the antibody to mycoplasma pneumoniae was titrated. The titer in the serum was 1:80, and increased to 1:560 6 days later. Chest X-rays revealed normal lung condition 3 days later, and she was given erythromycin, 800 mg.day-1 for 2 weeks. We conclude that we should be alert to possible asymptomatic mycoplasma infection, which potentially makes patients susceptible to atelectasis during the perioperative period.

Anesthesia, Inhalation↗
PubMed1994

An experience with trial of scar in 66 Ethiopian women.

The purpose of this study was to determine the circumstances in which trial of scar is conducted in the obstetric unit of Tikur Anbessa Hospital, Addis Ababa, Ethiopia, and evaluate the safety of the undertaking in terms of maternal and perinatal morbidity and mortality. Between 11 September, 1991 to 10 September, 1992, 66 women with previous caesarean section were given a trial of scar. The main pre-requests to allow a trial of scar were: only one previous lower uterine segment section, a cephalic presentation with no disproportion in the current labour and, the presence of a functional operating theatre. Labour was being monitored by checking the uterine contractions by fundal palpation and counting the Foetal heart rate (FHR) using the Pinnard Stethoscope. Compatible blood was prior prepared in only 7 (10.6%) labours. Forty seven (71.2%) parturients delivered vaginally. In 19 (28.2%) an emergency repeat section was done for failure of progress in labour. In one (1.5%) patient, a uterine scar dehiscence was detected. The 5th minute APGAR score was 7/10 or more in 64 (94.1%) and 6/10 in 3 (4.5%) of 68 neonates. There was one prepartum intra-uterine foetal death and one neonatal death of a preterm baby making the perinatal mortality rate (PNMR) of 29.4 per thousand. There was no maternal death. In conclusion, this study demonstrates that a trial of scar was a safe procedure.

Apgar Score↗
PubMed1994

[Bilateral varicocele: diagnostic implications].

If a varicocele is appreciated on the clinical examination, its presence may then be confirmed by Doppler examination. A pencil-probe Doppler stethoscope is utilized with ultrasonic conduction gel. The patient is examined in the upright position, and conducting medium is applied to the upper aspect of the scrotum. It is important that there is complete acoustic silence prior to having the patient perform the Valsalva maneuver. However, if a clinical varicocele is found on either the left or right side, the opposite side is evaluated for the presence of a "subclinical" varicocele by Doppler examination. When a "subclinical" varicocele is associated with a controlateral clinical varicocele, it is treated at the same time as the coexistent clinical varicocele. Venography is employed for the diagnosis of varicoceles only for patients in whom physical examination and Doppler studies are equivocal but highly suggestive of the presence of a varicocele. In that situation, rather than subjecting the patient to an unnecessary surgical procedure, venography may be employed to confirm the varicocele. Nowadays another diagnostic procedure is successfully used, that consists in a color ultrasound of the scrotum associated with Doppler velocimetry of the spermatic cord.

Humans↗
PubMedDate not supplied

Telehygiene system for preventive chronopharmacology in space and remote areas on earth.

A chronobiologic computerized modular health care (telehygiene) system for humans in extraterrestrial space 1) monitors and analyzes physiologic blood pressure, heart rate and other variation, including that in tumor markers; 2) recognizes earliest risk elevation by dynamic changes in the 'usual value' range (trend and rhythm alteration); 3) prompts timely and timed treatment for cardiovascular and emotional disease and malignancy prevention, and 4) serves for health improvement; the information from the system can also help optimize shift-work schedules for peak performance and provides endpoints of interest in basic science. The system exploits the chronome, a genetically anchored, habitat-synchronized structure of multifrequency rhythms and trends which is now documented (by longitudinal data series) to respond to magnetic disturbance in the solar system, with consequences expressed in catastrophic illness that is best prevented. Such a system, rated by peers as being of highest priority, could complement classical tools such as the stethoscope, proposed by the U.S. Johnson Space Center representative for use on the moon.

Aerospace Medicine↗
PubMed1993

[Radionuclide ventriculography for evaluating left ventricular myocardial contractility in patients with implanted pacemaker].

An EKC-500 pacemaker was implanted in 16 patients with coronary heart disease (CHD) and 14 idiopathic conduction disturbance for complete atrioventricular block. After surgery, the patients underwent equilibrium radionuclide ventriculography by using a nuclear stethoscope at rest and during exercise at different stimulation rates with the aim of choosing their optimal values. It was established that patients with idiopathic conduction disturbances showed improved left ventricular contractility at all stimulation rates and their optimal values ranged 60-70 per minute. In patients with CHD, the stimulation rate of 60 impulses/min was optimal at rest, and with this, exercise resulted in a significant deterioration of myocardial contractility, but only the stimulation rate of 80 impulses/min led to a slight improvement, which was due to accessory mechanisms of contractility enhancement. The peak ejection rate was the most sensitive to progressive myocardial dysfunction, yet the basic contractility index was the mean ejection rate.

Arrhythmias, Cardiac↗
PubMed1993

Informatics in medical practice: billing systems survey by the Hawaii Medical Association.

The Information Age has arrived! Our offices are quickly integrating information machines for the business part of our profession, just as the stethoscope and scalpel are requisites for the practice of medicine and surgery. The mission of the HMA Computer Committee is to provide guidance in the direction of medical informatics for its members. We hope to assist the membership in the selection, evaluation and use of the products relating to the processing of information in the modern practice of medicine.

Accounting↗
PubMed1993

Chronic mitral valve disease in cavalier King Charles spaniels: 95 cases (1987-1991)

Systolic heart murmurs caused by chronic mitral valve disease are particularly common in Cavalier King Charles Spaniels (CKCS) in Great Britain. To determine if American-bred CKCS have a similar high prevalence of chronic valve disease, results of stethoscopic examinations on 394 CKCS were analyzed. Left apical systolic heart murmurs were found in 22% of the dogs. The prevalence ranged from 9% in dogs < 1 year old to 100% in those > or = 10 years old; prevalence was 56% in dogs > or = 4 years old. Differences were not found in prevalence between sexes and among various coat colors. Reexamination of 79 dogs after 1 year revealed an incidence of new murmurs of 21%. Comparison of ages at initial examination in 128 referral hospital cases with chronic mitral valve disease revealed a mean age of 6.25 years in 17 CKCS, in contrast to a mean age of 12 years in other breeds. Echocardiographic and necropsy findings indicated that ruptured chordae tendineae and mitral valve prolapse are major components in the chronic valve disease process in CKCS.

Age Factors↗
PubMed1978

ECG monitoring of oral surgery patients receiving a local anesthetic.

Cardiac arrhythmias were observed on continuous electrocardiographic tracings in 36 of 225 patients who were having oral surgical procedures with local anesthesia only. The arrhythmias were serious enough in five patients to cause alteration of the treatment. A stethoscope taped to the chest of every patient for checking before and during every procedure might be just as effective as an electrocardioscope.

Adolescent↗
PubMed1994

[Sound frequency analysis for identification of venous air embolism].

Air emboli occurring during surgery are considered to be life-threatening incidents. With the aim of achieving acoustic identification of venous air emboli, a frequency analysis of the sounds induced by an air embolism (millwheel murmurs) as well as of all other unusual sounds, was undertaken during 20 operations, and in experiments with animals. The frequency spectra of the sounds induced by air emboli are characterised by an increase in the amplitudes in the frequency range 1,100 to 3,000 Hz, while the amplitudes of normal heart sounds continuously decrease with increasing frequency. The frequency spectrum was examined for characteristics using an electronic filter system. The sounds induced by air emboli can be clearly distinguished from normal heart sounds. During operations on patients, suction sounds occur, the frequency patterns of which are not easy to distinguish from those of embolus-induced sounds, although an acoustic distinction can be made via a stethoscope or a loudspeaker. With optimal adjustment of the filter system, 73 out of 81 (90%) embolism-related sounds were correctly identified in animal experiments. On no occasion were normal heart sounds wrongly identified as due to an embolus. However, an embolus sound was frequently mimicked by interfering sounds such as those produced by artificial respiration, and other ambiend sounds. By modifying the oesophageal catheter to achieve optimal suppression of interfering sounds, this filter system could be developed into an alarm.

Animals↗
PubMed1993

[Past and present--the roots of our modern concept of disease in 19th century clinical practice and science].

Historically speaking, our current clinical conceptions of disease are derived from 19th century science and clinical practice. In the early 19th century, large hospitals with hundreds of patients were erected for the first time. This provided "material" to which the physicians could apply their new diagnostic techniques and tools: percussion and auscultation, aided by the newly invented stethoscope. Eventually, what was found at the bedside was systematically compared with what was discovered on the autopsy table. This clinical research programme was challenged by, though later combined with, the experimental physiology and "laboratory medicine" of men like François Magendie and Claude Bernard. Their strong programme to introduce pure science, i.e. physics and chemistry, into medicine was paralleled by further developments in the old solidistic pathological tradition; an improved microscope and new techniques for preparing tissues for the microscope, led to the development of truly microscopic anatomy and cellular pathology. The idea that disease may be caused by microscopic living organisms was tested by means of strict experimental, scientific methods by men such as Louis Pasteur and Robert Koch; and our current conception of infectious disease is still very similar to that of the first microbiologists of the 1870s and 80s. The last 19th century root of our modern conceptions of disease discussed in the present essay is the visualization of the interior of the body--indeed, the visualization of disease--by X-rays.

Anatomy↗
PubMedDate not supplied

Pharmacologic patient management in pediatric dentistry: an update.

This paper reviews the issue of sedation in pediatric dentistry in the light of recent controversies and rapidly increasing legal, professional and governmental regulations. Consideration is given to "Guidelines for safe administration of pharmacologic agents in dental practice". The various avenues of drug administration are reviewed with specific comment on recent approaches. Many of the older pharmacologic agents used for pediatric sedation are falling into disfavor. Chloral hydrate, in particular, would seem to be heading toward its demise. The benzodiazepines appear to have a very promising future as sedative agents. When administered and monitored appropriately, they have a wide margin of safety. Consideration is given to research and development into agents that reverse the action of sedative drugs. It is emphasized that contemporary electronic monitoring equipment in no way diminishes the necessity for sound and expert clinical judgment, supplemented by such simple devices as the precordial stethoscope and observation and communication in the form of simple commands.

Anesthesia, Dental↗