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[Improved cardiac auscultation by polystethoscope].
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[The symballophone, an aid in auscultation].
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LECTRON-O-SCOPE accepted.
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A clinical application of the electrically represented breath sounds.
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[Diploskop, Pat. 42216 IXa/S30 a D].
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[The electronic polystethoscope].
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Cardiac auscultation skills of physicians in training.
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Microbiologic contamination and cleaning personal medical equipment.
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A piece of my mind: tactile.
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Continuous gastric suctioning decreases measured esophageal temperature during general anesthesia.
OBJECTIVE: This study sought to determine whether continuous gastric suctioning influences esophageal temperature measurements. METHODS: This study evaluated 21 patients scheduled for extremity or lower abdominal surgery. After induction of general endotracheal anesthesia, an orogastric tube, and esophageal and nasopharyngeal temperature probes were placed in functional positions. Baseline esophageal (Tes) and nasopharyngeal (Tnas) temperatures were recorded and the orogastric tube was placed on continuous suction. After the first 11 patients (Group I) were studied, 10 additional patients (Group II) were studied with more frequent data collection to improve the time resolution of temperature changes. Temperatures were recorded for patients in Group I at 2 and 10 min with suctioning and 10 min after cessation of suctioning. In Group II, temperatures were recorded at 1, 2, 5 and 10 min with suctioning and 10 min after cessation of suctioning. Analysis of data was performed using repeated measures analysis of variance and paired t-tests with the Bonferroni correction. RESULTS: In Group I, Tes decreased significantly from 35.9 +/- 0.2 degrees C (mean +/- SE) to 35.1 +/- 0.4 degrees C at 2 min and 34.8 +/- 0.3 degrees C at 10 min of suctioning (p < 0.01). Ten minutes after cessation of suctioning, Tes was not significantly different from the baseline measurement. Tnas did not change significantly over the 20 min observation period. In Group II, Tes continually decreased from 36.2 +/- 0.1 degrees C to 34.8 +/- 0.3 degrees C after 10 min of suctioning (p < 0.006) and returned to near baseline 10 min after cessation of suctioning. There was no significant change in Tnas over the 20 min observation period. CONCLUSION: We conclude that continuous gastric suctioning decreases esophageal temperature measurements. This phenomenon should be recognized as an artifactual change in esophageal temperature and not a reflection of core temperature.
Pneumothorax detection using pulmonary acoustic transmission measurements.
Pneumothorax is a common clinical condition that can be life threatening. The current standard of diagnosis includes radiographic procedures that can be costly and may not always be readily available or reliable. The objective of this study was to investigate the hypothesis that pneumothorax causes detectable pathognomonic changes in pulmonary acoustic transmission. An animal model was developed whereby 15 mongrel dogs were anaesthetised, intubated and mechanically ventilated. A thoracoscopic trocar was placed into the pleural space for the introduction of air and confirmation of a approximately 30% pneumothorax by direct visualisation. Broadband acoustic signals were introduced into the endotracheal tube, while transmitted waves were measured at the chest surface. Pneumothorax was found consistently to lower the pulmonary acoustic transmission in the 200-1200 Hz frequency band, whereas smaller transmission changes occurred at lower frequencies (p< 0.0001, sign test). The ratio of acoustic energy between low-(< 220 Hz) and high-(550-770 Hz) frequency bands was significantly different in the control and pneumothorax states (p < 0.0001, sign test). This implies that pneumothoraces can be reliably detected using pulmonary acoustic transmission measurements in the current animal model. Further studies are needed to investigate the feasibility of using this technique in humans.
Real-time adaptive cancelling of ambient noise in lung sound measurement.
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An unusual cause of difficulty confirming correct placement of an endotracheal tube.
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[The art of medicine].
Not too long ago, obtaining a patient's history and performing a physical examination was the beginning of every doctor-patient interaction. Today, impressing technical methods--extending the human "diagnostic horizon" to an unbelievable level of astonishing perception--are easily available in most places. So the question comes up whether clinical findings still have relevance in common medical practice. This article critically discusses the value of apparently "established" clinical signs, but also points out why taking a precise patient's history and performing a skilled physical examination is still essential-today and tomorrow.