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PubMed1992

Echocardiographic diagnosis of an anomaly of the tricuspid valve in a male pygmy goat.

A 3-year-old male pygmy goat was evaluated because of a grade III/V plateau pansystolic murmur that was auscultated over the tricuspid valve area and a grade II/V plateau pansystolic murmur that was auscultated over the left heart base. Echocardiography revealed a large right atrium and ventricle, an atrial septal defect, and a dysplastic tricuspid valve displaced apically into the right ventricle. Contrast echocardiography and color-flow Doppler echocardiography revealed flow from right to left through the atrial septal defect and severe tricuspid regurgitation. A diagnosis of tricuspid valve dysplasia and severe tricuspid regurgitation was made. This anomaly (Ebstein's anomaly) of the tricuspid valve should be considered in goats that have systolic, with or without diastolic, murmurs over the tricuspic valve. Two-dimensional echocardiography can confirm the diagnosis of the anomaly. The associated tricuspid regurgitation and interatrial right-to-left shunt flow can be detected and semiquantitated by use of contrast, continuous wave, and color-flow Doppler echocardiography.

Animals↗
PubMed1990

[Correlation of arterial pressure in the forearm with blood pressure in the ascending aorta].

Forearm blood pressures obtained by auscultation were compared with the data of pressure recording in the ascending aorta during diagnostic catheterization in 243 patients with coronary heart disease, arterial hypertension and some malformations of the heart. With indirect measurement, systolic blood pressure was shown to be sufficiently reliable and to characterize systolic pressure in the ascending aorta with assurance, the pressure in the aorta being slightly less (some 10%) in approximately half the cases. The regression equation for systolic pressure in the ascending aorta against forearm pressure is as follows: Y = 0.96X - 1. Measurement of diastolic pressure in the ascending aorta yields less accuracy, so it is advisable to use two regression equations: (1) Y = 0.98X - 1 for a diastolic pressure of 80 mm Hg or less and (2) Y = 0.85X + 2 for a pressure of greater than 80 mm Hg. Thus, ascending aorta pressure values required for invasive hemodynamic studies may be satisfactorily calculated from the data of blood pressure auscultative measurement.

Aorta↗
PubMed1989

[Measurement of blood pressure in children aged 0 to 2 years by four indirect methods].

In 75 children aged 0 to 2 years 104 blood pressure measurement have been performed by palpation, auscultation, ultrasound and sphigo-oscillographic method. It has been found that sphigo-oscillographic and ultrasound method are the most reliable and adequate for children below 2 years of age. The sphigo-oscillographic method shows higher and the method of palpation and auscultation lower values of systolic blood pressure than the ultrasound one. Hypertension has been detected in 7% of the investigated children.

Blood Pressure Determination↗
PubMed1986

Clinical significance of early or mid-systolic apical murmurs: analysis by phonocardiography, two-dimensional echocardiography and pulsed Doppler echocardiography.

The records of 2,000 consecutive patients who had been examined by auscultation, phonocardiography (PCG), two-dimensional echocardiography and pulsed Doppler echocardiography (PDE) were reviewed to assess the clinical significance of apical systolic murmurs which cease well before the aortic closure sound. Fifty-five patients were verified to have early or mid-systolic apical murmurs. Mitral regurgitation (MR) was detected in 32 patients by PDE (29/32) and/or PCG with methoxamine test (27/32). The degree of MR was judged to be mild by PDE in all cases. Apical systolic murmurs due to MR began mainly with the first heart sound (27/32), were confined to the apex (27/32), and high-pitched (25/32). Their intensity was grade III/VI or less in all cases. Mitral valve prolapse (12 patients) was the most common cause of MR. Other causes were rheumatic mitral involvement in seven patients, dilated or ischemic cardiomyopathy in five, mitral annular calcification in three, and hypertrophic cardiomyopathy in two. The causes of the MR in the remaining three patients could not be identified. Thus, early or mid-systolic apical murmurs are mainly attributable to mild MR which can be diagnosed by careful auscultation, PDE and/or PCG with the methoxamine test.

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↗
PubMedDate not supplied

[Bronchiolitis. Our clinical experience in the 4 years from 1981 to 1984].

The clinical experience of 661 children with bronchiolitis is reported in four-years period to gain a better understanding of diagnosis and pathogenesis of bronchiolitis. Upper airways infections, expiratory dyspnea, clear sound by chest percussion, vesicular rales and whistling by chest auscultation, air trapping on the chest radiography were considered as essential data of diagnosis. It was found in 595 patients: expiratory dyspnea, air trapping, vesicular r. and whistling in 85% and whistling only in 15%; hypoxemia in 20% combined with hypercapnic acidosis in 10%; normoxemia in 80% combined with hypocapnia in 54%; hyperlactemia in 64% combined with an increment in the serum of CPK in 50% and of GPT in 30%; virus were cultured in 27%, adenovirus and RSV were identified in 90%. Instead it was found in 66 patients: air trapping but no difficult breath, with normal chest auscultation; crisis of cyanosis or paleness-cyanosis chilly sweat in 80% were motive of admission. The clinical and/or radiological features of "air trapping" were considered as essential symptoms and signs of bronchiolitis. The insufficient systemic perfusion was considered as a frequent occurrence and as cause for sudden respiratory and circulatory emergency.

Bronchiolitis, Viral↗
PubMed1986

Congestive heart failure associated with hyperthyroidism in cats.

Hyperthyroidism was diagnosed in 4 cats with congestive heart failure. Dyspnea and anorexia were observed in 3 of the 4 cats. In each cat, a holosystolic left and/or right apical heart murmur was auscultated. In 3 cats, a prominent extra heart sound (gallop rhythm) was auscultated. All cats had a palpably large thyroid lobe(s) and weight loss. The laboratory and ECG changes were similar to those reported for feline hyperthyroidism. Moderate-to-severe pleural effusion and cardiomegaly were detected via radiography in all cats. Some cats had radiographic signs of pulmonary venous engorgement and pulmonary edema. Echocardiography revealed cardiac dilatation and low left ventricular shortening fraction (wall motion) in all cats. Three cats responded initially to cardiac drugs and propylthiouracil or thyroidectomy. One of these died later, presumably from an adverse reaction to propylthiouracil, and the others died from recurrent congestive heart failure (1) or postoperative cardiac arrest (1). One cat did not respond to treatment, and died 2 days after diagnosis.

Animals↗
PubMed1985

[Comparison of the measurement accuracy of electronic blood pressure self measurement devices 1980-1983].

The accuracy of 21 new electronic devices designed for self-measurement of blood pressure has been tested on an average of 22-24 subjects each by simultaneous measurements on the same arm. Compared with electronic devices made in 1980 the accuracy has improved, especially with regard to the estimation of diastolic blood pressure. Nevertheless, most devices still give too low a value for diastolic blood pressure. In agreement with former results the systolic differences are greater in women and in normotensive subjects, whereas the diastolic differences are more pronounced in younger subjects, in males and in hypertensive patients. Despite the differences due to different sites of auscultation, the results of the best devices tested show that electronic devices may estimate the same blood pressure values over the brachial artery as measured by auscultation in the antecubital fossa. We therefore suggest stronger regulations for the licensing of new electronic devices.

Blood Pressure↗
PubMed1977

Coeliac artery compression syndrome: can we believe our ears?

Two patients with coeliac artery compression syndrome' are described.Symptoms were vague and nonspecific, and the diagnosis was made by finding an epigastric bruit on auscultation of the abdomen and confirming the presence of a vascular lesion by angiography. Both patients were cured by surgical decompression of the coeliac trunk. Auscultation of the abdomen can be a useful part of physical examination in general practice.

Adult↗
PubMed1984

Electronic fetal monitoring: physician liability and informed consent.

Electronic fetal monitoring (EFM) has been criticized as ineffective, unsafe and costly. Despite existing controversy regarding the risks involved in using EFM, this monitoring procedure continues to be widely employed. In many jurisdictions, in fact, the use of EFM during labor may be considered the customary practice. This Article analyzes the medical and legal issues arising from a physician's use of or failure to use EFM. The Author argues that EFM subjects the mother and the fetus to risks which may be avoided if auscultation, a less intrusive monitoring technique, is employed. The "customary practice" standard of care, the ordinary negligence standard of care, and the "best judgment" and "duty to keep abreast" standards of care are compared and applied to the physician's decision to use EFM. The Author contends that physicians who employ auscultation may not be liable for failing to use EFM; however, physicians who use EFM despite the evidence of its risks may be liable for failing to "keep abreast" or to use their "best judgment" or for negligence. Finally, the Author contends that both physicians and their patients are best protected when the physician elicits the mother's informed consent to employ a particular monitoring technique during labor.

Defensive Medicine↗
PubMed1984

[Amiodarone: a new etiology of diffuse interstitial pneumopathy? Apropos of 2 personal cases and 10 cases from the literature].

Diffuse Interstitial Pneumonia (PID) is probably, although rarely, a complication of Amiodarone therapy. We describe two new cases and review 19 from the recent literature. The first patient was a man treated solely with Amiodarone for three years (total dose 185 g). He presented clinically with a picture of PID with slight dyspnoea, weight loss of 4 kilos and a dry cough. There were pulmonary crackles on auscultation, diffuse reticulo-nodular shadows radiographically and compatible pulmonary function tests. Broncho-alveolar lavage (LBA) was lymphocytic (30%). Stopping Amiodarone without resorting to steroids led to the disappearance of the clinical signs within 15 days and the return to normal of the LBA and pulmonary radiograph within six months though the pulmonary function was unchanged. The second case was a 78 year old man treatment with Amiodarone for six months (total dose 20 g). He presents acutely with grade IV dyspnoea and low grade fever. There were pulmonary crackles on auscultation and a bilateral pulmonary infiltrate on the chest radiograph. The pulmonary function tests were compatible with PID showing a restrictive ventilatory defect, a reduced Carbon Monoxide transfer (single breath) and hypoxia. The diagnosis was confirmed by a transbronchial biopsy showing a parieto-alveolar infiltration with increased cellularity and collagen formation. The LBA was predominantly polymorphonuclear. Stopping the Amiodarone associated with steroid treatment produced a normal chest radiograph within six weeks, whilst moderate dyspnoea and less severe restrictive ventilatory defects persisted. The clinical, radiological, functional and histological features of our patients were comparable to those 19 cases reported in the literature.(ABSTRACT TRUNCATED AT 250 WORDS)

Aged↗
PubMed1981

Ambulatory monitoring of arterial blood pressure. Comparison between blood pressure measurements obtained with the Remler M 2000 portable recorder and by radiotelemetry under laboratory conditions and during everyday activities.

Simultaneous indirect and direct arterial blood pressure measurements were performed with a Remler M 2000 (RM) portable recorder and by radiotelemetry (RT) in 21 subjects under various conditions such as rest in the supine position and in an 80 degree upright position on a tilting table, during bicycle ergometry, physical exercise on the terrain and under the emotional stress of driving a car. There is a good correlation between semiautomatic pressure measurements carried out with the RM portable recorder and radiotelemetric data. The differences observed are basically due to the auscultation method. But the RM has an advantage over the auscultation method in that it objectively registers the Korotkov sounds and records them on a tape, not only under laboratory conditions but also during everyday activities.

Activities of Daily Living↗
PubMed1995

Efficacy and safety of intrapartum electronic fetal monitoring: an update.

OBJECTIVE: To compare the efficacy and safety of routine electronic fetal monitoring (EFM) of labor with intermittent auscultation, using the results of published randomized controlled trials (RCTs). DATA SOURCES: We identified RCTs by searching the MED-LINE data base for the period 1966-1994, contacting experts, and reviewing published references. METHODS OF STUDY SELECTION: Our search identified 12 published RCTs addressing the efficacy and safety of EFM; no unpublished studies were found. The studies included 58,855 pregnant women and their 59,324 infants in both high- and low-risk pregnancies from ten clinical centers in the United States, Europe, Australia, and Africa. DATA EXTRACTION AND SYNTHESIS: Data were abstracted, and their accuracy was confirmed independently. A single reviewer assessed study quality based on criteria developed by others for RCTs. Data reported from similar studies were used to calculate a combined risk estimate for each of nine outcomes. Overall, a statistically significant decrease was associated with routine EFM for a 1-minute Apgar score less than 4 (relative risk [RR] 0.82, 95% confidence interval [CI] 0.65-0.98) and neonatal seizures (RR 0.5, 95% CI 0.30-0.82). The protective effect of EFM for a 1-minute Apgar score less than 4 was apparent only in the non-United States studies, and the protective effect for neonatal seizures was evident only in studies with high-quality scores. No significant differences were observed in 1-minute Apgar scores less than 7, rate of admissions to neonatal intensive care units, and perinatal death. An increase associated with the use of EFM was observed in the rate of cesarean delivery (RR 1.33, 95% CI 1.08-1.59) and total operative delivery (RR 1.23, 95% CI 1.15-1.31). Risk of cesarean delivery was greatest in low-risk pregnancies. CONCLUSION: The only clinically significant benefit from the use of routine EFM was in the reduction of neonatal seizures. Because of the increase in cesarean and operative vaginal deliveries, the long-term benefit of this reduction must be evaluated in the decision reached jointly by the pregnant woman and her clinician to use EFM or intermittent auscultation during labor.

Female↗
PubMed1994

[Determination of forced expiratory volume (FEV 1) and maximal peak expiratory flow within the scope of routine diagnosis in general practice].

In 5 Viennese general practice offices we investigated patients by spirometry with the following indications: differential diagnosis of dyspnea; every 3rd smoker of more than 10 cigarettes a day (including asymptomatic ones); cough and nasal disorders of more than 4 weeks duration; indicative physical findings (cyanosis or auscultation). The sample control group was matched for age and gender and did not have any symptoms characteristic of the indication group. Nevertheless a spirometric test was also carried out in these patients. A total of 212 patients were examined in 4673 consultations on 202 workdays in the 5 offices. In the group of 109 patients 62 (56.9%) had dyspnea and/or positive signs on auscultation. Of these 62 patients 39 (62.9%) had 1 or more positive findings either from PEF or FEV 1 or both. There were significantly more referrals for X-rays in case of abnormal lung function. The control group of 103 obviously healthy persons in particular showed a significantly higher number of abnormal PEF values than expected (31 persons, 30.1%).

Adolescent↗
PubMed1995

[Prediction of the presence of pneumonia in adults with fever].

BACKGROUND: This study was performed to define what clinical and analytical variables were significantly associated with the presence of pneumonia in febrile patients. A predictive model which may rationalize radiologic explorations is presented. METHODS: A prospective study was carried out in two Emergency Departments in Madrid, Spain. One hundred forty-one patients presenting fever of more than 48 hours in evolution with symptomatology of the lower airway or without focal data were included. Following anamnesis, physical exploration and elemental hemogram the physician established a tentative diagnosis. Subsequently, on observation of thorax X-ray definitive diagnosis was made. RESULTS: Thirty-eight percent of the patients had pneumonia. The variables which were significantly associated with the presence of pneumonia were: history of smoking (odds ratio [OR] 2.06), alcohol abuse (OR 3.18), chronic obstructive bronchopneumopathy (OR 4.35), respiratory symptoms (OR 5.73), cough (OR 5.37), expectoration (OR 2.08), dyspnea (OR 7.03), pleural pain (OR 13.38), pathologic auscultation (OR 7.46), leukocytes (OR 6.34) and neutrophilia (OR 8.10). Clinical prior to radiologic diagnosis showed a sensitivity of 45.3% and specificity of 93.2%. Pneumonia was demonstrated in 10% of the cases with respiratory symptomatology with normal auscultation and without neutrophilia. A logistic regression model is proposed for the diagnosis of pneumonia. CONCLUSIONS: Clinical judgment prior to observation of radiography has a low sensitivity in the improvement in clinical judgment.

Adult↗
PubMedDate not supplied

[Experience in developing devices for medical use exemplified by the electronic stethophonoendoscope].

The paper describes the use of the expert's error technique to provide evidence and pool medical specifications for an electron amplifying stethophonoendoscope, a medical diagnostic device. It illustrates the impact of variations in amplitude-frequency responses (AFR) on the auscultation properties of the devise. An AFR variation of only 10-12 dB can distort sound perception at auscultation. The results of development of the electron stethophonoendoscope indicate that the correct choice of criteria for expert's estimates allows the device's specifications to be worked out with simultaneous simplification of testing procedures.

Artifacts↗
PubMed1997

Modification of cardiopulmonary and intestinal motility effects of xylazine with glycopyrrolate in horses.

Xylazine (XYL) administration in horses is accompanied by significant cardiovascular depression characterized by a 25-35% decrease in cardiac output (CO) which is likely to compromise tissue oxygen delivery (DO2), and usually vagally mediated bradycardia is an important cause of this reduced cardiovascular performance. To examine the possible benefit of preventing the bradycardiac response, 6 healthy horses were treated with intravenous (IV) saline (SAL) or 2.5 micrograms/kg glycopyrrolate (GLY) in a blinded, randomized, crossover trial. Fifteen minutes later, 1 mg/kg XYL was administered IV and systolic, diastolic and mean blood pressures (SBP, DBP, and MBP, respectively), central venous pressure (CVP), mean pulmonary artery pressure, heart rate (HR), CO, and arterial and mixed venous blood gases were measured at the following times: baseline, 2, 5, and 10 min post-SAL or GLY; and 2, 5, 10, 15, 30, 45 and 60 min post-XYL. Determination of cardiac index (CI), stroke index (SI), left ventricular work, systemic vascular resistance (SVR), DO2, oxygen uptake, and oxygen extraction ratio were made at the same time. Gastrointestinal (GI) motility was evaluated by four-quadrant auscultation for 24 h post-XYL. Statistical analysis of continuous variables was carried out using ANOVA for repeated measures and Wilcoxon's rank-sum test for non-parametric data. In GLY treated horses, HR, SBP, MBP, DBP, CI, DO2 and mixed venous oxygen tension were significantly higher up to 30 min after XYL (P < or = 0.02) while CVP and SI were significantly lower 2 and 5 min post-XYL, respectively. In both groups, GI motility as assessed by auscultation was virtually abolished for an hour, with a non-significant tendency for the decrease in motility to last longer in the GLY/XYL group. None of the treated horses developed abdominal discomfort. No significant difference was observed in the other variables. The study shows that 2.5 micrograms/kg GLY premedication reduces the cardiovascular depression caused by 1 mg/kg XYL, without adversely affecting GI motility.

Adjuvants, Anesthesia↗
PubMed1977

Supraclavicular and carotid bruits in hemodialysis patients.

Auscultation of the neck vessels in patients receiving chronic hemodialysis reveals a high incidence of subclavian and carotid bruits as well as the expected precordial hemic murmurs. These bruits are associated with the high-output hyperdynamic circulatory state. In older patients the finding could be misinterpreted as evidence of extracranial cerebrovascular disease, but clinical considerations should obviate unnecessary neuroradiological diagnostic procedures.

Adult↗