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PubMedDate not supplied

Cervical bruits in hemodialysis patients.

Twenty-five patients receiving chronic hemodialysis were studied with systematic cervical auscultation and periorbital Doppler tests to determine the incidence of cervical bruits and their significance. Eighteen (72%) of the patients had bruits. All of the bruits heard in this study were loudest in the supraclavicular fossa, and in no patient was a bruit heard along the carotid arteries without a louder bruit of similar characteristics more proximally. No patient with a bruit in the area of the carotid bifurcation had an abnormal ipsilateral periorbital Doppler examination, and none had symptoms of cerebral ischemia. There was no evidence in these patients that the bruits were related to occlusive arterial disease. It is concluded that most cervical bruits in patients receiving hemodialysis are the result of a hyperdynamic circulatory state associated with anemia and arteriovenous fistulae.

Arteriosclerosis↗
PubMedDate not supplied

Incidence of asymptomatic extracranial arterial disease.

Investigations of the incidence and the extent of the asymptomatic early stages of extracranial arterial disease (EAD) have been restricted for methodical reasons. Direct Continuous Wave-Doppler examination has given highly accurate results in the location and correct estimation of the degree of EAD both for the carotid (97%) and the vertebral arteries (90%), as shown from a detailed comparison with carotid (n = 604) and vertebral (n = 426) angiograms. Compared with this degree of reliability, the validity of normal auscultation for the diagnosis of EAD is shown to be poor: if bruits are taken as the only signs of associated EAD in patients with systemic atherosclerosis, only 27.6% in a group of 123 patients would have been correctly diagnosed. This parallels the number of false-positives (22.6%) in patients with normal results. The frequency and degree of EAD was studied by the use of direct Doppler examination in 2009 neurologically asymptomatic patients admitted either with severe vascular (n = 375) or coronary atherosclerosis (n = 262) or with high-risk factors (n = 1370). The frequency was significantly higher (32.8%) in patients with peripheral vascular disease than in those with coronary artery disease (6.8%) and in risk-factor patients (5.9%). The combination and degree of vessel involvement are presented in detail and their possible prognostic significance discussed.

Aged↗
PubMed1996

Effect of gas density on respiratory sounds.

The generation of normal lung sounds by turbulent air flow has been questioned because gas density appears to have only a minor effect. We studied whether gas density has a greater influence on lung sounds at higher frequencies than traditionally measured. Six healthy adult men breathed air followed by a mixture of 80% helium and 20% oxygen (He-O2) at a target flow of 1.5 L/s. Flow and sounds at the trachea and posterior right lower lobe were simultaneously acquired by computer. Fourier analysis was applied to sounds at target flow +/- 0.2 L/s. Average power spectra were computed for each recording site, respiratory phase, and respired gas. He-O2 reduced the power of inspiratory lung sounds below 300 Hz by only 1.7 +/- 1.5 dB whereas power between 300 and 600 Hz was reduced by 4.6 +/- 1.4 dB (p<0.05). Tracheal sound power was reduced less consistently but all subjects showed an upward frequency shift in power maxima on He-O2, similar to formant shifts observed in helium speech. Our findings suggest that flow turbulence is the major determinant of lung sounds at higher frequencies. Current instruments for auscultation and recording of respiratory sounds may have to be modified to optimize their response in this higher frequency range.

Adult↗
PubMed1999

Pulmonary auscultatory skills during training in internal medicine and family practice.

We conducted a multicenter, cross-sectional assessment of pulmonary auscultatory skills among medical students and housestaff. Our study included 194 medical students, 18 pulmonary fellows, and 656 generalists-in-training from 17 internal medicine and 23 family practice programs in the Mid- Atlantic area of the United States. All participants listened to 10 pulmonary events recorded directly from patients, and answered by completing a multiple choice questionnaire. Proficiency scores were expressed as the percentage of respondents per year and type of training who correctly identified each event. In addition, we calculated a series of cumulative scores for sound recognition, disease identification, and basic knowledge of lung auscultation. Trainees' cumulative scores ranged from 0 to 85 for both internal medicine and family practice residents (median = 40). On average, internal medicine and family practice trainees recognized less than half of all respiratory events, with little improvement per year of training, and were not significantly better than medical students in their scores. Pulmonary fellows had the highest diagnostic and knowledge scores of all groups. These data indicate that there is very little difference in auscultatory proficiency between internal medicine and family practice trainees, and suggest the need for revisiting these time-honored skills during residency training.

Attitude of Health Personnel↗
PubMed2000

The relationship between normal lung sounds, age, and gender.

Auscultation is one of the most important noninvasive and feasible methods for the detection of lung diseases. Systematic changes in breathing sounds with increasing age are of diagnostic importance. To investigate these changes, we recorded lung sounds taken from four locations in the posterior thorax of 162 subjects, together with airflow. The data were analyzed according to age, sex, and smoking habit. In order to describe the power spectrum of the lung sounds, we calculated mean and median frequency, frequency with the highest power, and a ratio (Q) of relative power of the two frequency bands of 330 to 600 Hz and 60 to 330 Hz. Linear regression analysis was used as a measurement of age-dependence of these variables. Significant differences in Q were found in men versus women (p < 0.05), but not in smokers versus nonsmokers. Within the groups, a small but significant correlation existed between Q and age (r(2) </= 0.1, p < 0.05). For both men and women, a slight increase of the relative power in the frequency band of 330 to 600 Hz was recorded with increasing age. However, on the basis of large individual variations, these small changes (DeltaQ approximately 5%, SD(Q) >/= +/- 5%) have no clinical significance and need not to be considered in the automatic detection of lung diseases by analyzing lung sounds.

Adult↗
PubMed1984

Lung sounds.

A resurgence of interest in clinical auscultation is in progress. Recent technical advances permit more objective observations than were previously possible. Quantified lung sounds are being correlated with clinical, physiologic, and roentgenologic information. The purpose of this article is to summarize current knowledge on the production, transmission, and clinical significance of lung sounds. The complex sonic signals arising in the lung during respiration reflect its mechanical state. More precise understanding of pulmonary sounds and their clinical correlations could lead to powerful diagnostic tools, which have particular appeal because of their noninvasive nature.

Asthma↗
PubMed1987

Mitral valve prolapse and thyroid abnormalities in patients with panic attacks.

Panic disorder has been associated with mitral valve prolapse and thyroid abnormalities. Mitral valve prolapse has also been associated with thyroid abnormalities. The authors studied a consecutive series of 65 patients self-referred for evaluation of panic attacks, who were examined for cardiac and thyroid abnormalities. Fifty percent of the patients had mitral valve prolapse according to both cardiac auscultation and echocardiography. Twenty-six percent of the women had some thyroid abnormality; 17% had thyroid microsomal antibodies. There was no apparent relationship between mitral valve prolapse and thyroid abnormalities. These observations suggest that panic attacks, mitral valve prolapse, and autoimmune thyroid disorders are associated.

Adult↗
PubMed1976

Phonocephalography extra-cephalic.

Phonocephalography is the amplification and recording of sounds from the surface and cavities of the head aiming for the introduction of a non-invasive pre-angiographic technique. Nasopharyngeal Phonocephalography was found successful for recording of normal tracing. The effect of the extra-cephalic sounds and factors on the tracing were discussed. Phonomyelography is the application of the idea on the vertebral column. The tracing recorded was demonstrated. Modern technology has undergone considerable progress for the introduction of non-invasive techniques in medical diagnosis. Since Laennec introduced his stethoscope auscultation, amplification and recording of sounds in cardiology had reached a respectable diagnostic procedure. This article represents a trial for the introduction of a simple non-invasive pre-angiographic diagnostic technique by amplification and recording of sounds from the surface and cavities of the body.

Auscultation↗
PubMed1986

Graphic representation of carotid artery bruits.

Auscultation of the neck for detection of bruits over the carotid arteries has become a necessary part of any complete physical examination. Early detection of atherosclerotic occlusive disease in these vessels can play a major role in prevention of stroke. Such findings have previously been recorded as word descriptions in varying degrees of detail. A method is presented for quickly and easily recording the presence and character of cervical bruits, plus additional important information, including blood pressure, pulse, heart rhythm, prior vascular surgery, and known occlusion in these vessels. The figure used allows others to rapidly perceive this information and enables ready comparison on successive examinations.

Arteriosclerosis↗
PubMed1991

Cervical bruits: clinical correlates of stenosis.

To analyze the relationship among characteristics of buits, degree of underlying stenosis, and neurologic symptom complexes, the authors studied 157 patients with bruits undergoing digital subtraction angiography. Symptom status assignment (definite lateralizing, possible lateralizing, vertebrobasilar, diffuse, and asymptomatic) and cervical auscultation for location, duration, and other bruit characteristics were performed independently. Bruit occurrence was associated with stenosis of greater than or equal to 50% of the underlying vessel with the association being no stronger at higher levels of stenosis (greater than or equal to 80%). No relationship existed between the side of bruit and side of symptoms in those with lateralized symptoms. The authors found more severe degrees of carotid stenosis in two symptomatic groups (vertebrobasilar insufficiency [VBI] and definite lateralized) compared with asymptomatic patients. Those with VBI had more high-grade stenosis, whereas those with lateralized symptoms had more occlusions, which tended to be ipsilateral to the symptoms.

Aged↗
PubMed1987

Bicentenary of Sir John Forbes (1787-1861).

This year is the bicentenary of the birth of the distinguished Scottish physician, Sir John Forbes, famous for his translation of the great French medical classic, De L'Auscultation Médiate by R.T.H. Laennec, the inventor of the stethoscope.

Auscultation↗
PubMed1993

The Australian Incident Monitoring Study. The stethoscope: applications and limitations--an analysis of 2000 incident reports.

The first 2000 incidents reported to the Australian Incident Monitoring Study (AIMS) were analysed with respect to the role of the oesophageal or precordial stethoscope as a continuous monitor. There were 1099 of the 1256 incidents during general anaesthesia in which one might have been used in this way, but use was reported in only 65 cases (5%), predominantly during paediatric cases. In only one report, a cardiac arrest, was the stethoscope the first to detect the incident. In a theoretical analysis it was considered that the stethoscope, used on its own for continuous monitoring, could have detected 54% of the 1256 incidents (almost 25% before any potential for organ damage), had they been allowed to evolve. However, AIMS data suggest that the actual yield using a stethoscope as a continuous monitor may be much lower than this, and that even the use of a "mobile" stethoscope can not be relied upon to detect oesophageal or endobronchial intubation. These reports confirm that there is limited use of the stethoscope for continuous monitoring in current anaesthetic practice in Australia; it has been superseded by the sophisticated electronic monitors now available. However, in areas with limited resources continuous auscultation with a stethoscope remains a basic requirement.

Accidents↗
PubMed1981

Physical assessment series: the thorax and the lungs.

The anatomy of the thorax and lungs and the physiology or respiration are complex. The physical assessment techniques which, on the surface, appear relatively easy to master, require hours of practice of observation, palpation, percussion, and auscultation before the examiner becomes familiar with the more subtle changes of disease process and the wide variations of normal that may be confused with illness. These are skills that may be quickly lost if not regularly applied. But perhaps with the use of such techniques, the pharmacist can play an even greater role in the monitoring of drug therapy.

Adult↗
PubMed2004

Case report: aortic dissection and cystic medial degeneration in a 24-year-old without Marfan syndrome.

The effective management of aortic dissection relies heavily on a high index of suspicion followed by timely definitive diagnosis. Young adults without a history of blunt trauma who are not at risk for atherosclerotic disease may lower this suspicion. We present a 24-year-old patient with complaints of chest pain who presented in multiple urgent care clinics and emergency departments. With a normal chest radiograph, he was repeatedly discharged home on analgesics until a loud murmur was heard. An echocardiogram revealed a dilated aortic root with an intimal flap consistent with a type II dissection. After surgical aortic repair with a Bentall procedure, he was discharged with complete relief of symptoms. Histologic reports revealed cystic medial degeneration. Physical examinations did not demonstrate the phenotypic manifestations of Marfan syndrome. This case illustrates the importance of cardiac auscultation when assessing an individual with chest pain, even with a low likelihood for alteration in arterial structure, and the maintenance of a high index of clinical suspicion despite a normal chest radiograph. We consider this case to be of interest because of its rarity in a 24-year-old.

Adult↗
PubMed2006

Inaudible temporomandibular joint vibrations.

The aim was to test the hypothesis that inaudible vibrations with significant amounts of energy increasing during jaw movements can be recorded in the temporomandibular joint (TMJ) area. Twenty one subjects, who could perform wide opening movements without feeling discomfort, 12 with and 9 without TMJ sounds audible at conventional auscultation with a stethoscope, were included. Recordings were made during opening-closing, 2/s without tooth contact, and during mandibular rest, using accelerometers with a flat frequency response between the filter cutoff frequencies 0.1 Hz and 1000 Hz. The signals were digitized using a 24 bits card and sampled with the rate 96000 Hz. Power spectral analyses, and independent and paired samples t-tests were used in the analysis of the vibration power observed in frequency bands corresponding to audible and inaudible frequencies. An alpha-level of 5% was chosen for accepting a difference as being significant. In the group with audible sounds, about 47% of the total vibration energy was in the inaudible area below 20 Hz during opening-closing and about 76% during mandibular rest. In the group without audible sounds, the corresponding proportions were significantly different, 85% vs. 69%. The energy content of the vibrations, both those below and those above 20 Hz, increased significantly during jaw movement in both groups. Furthermore, percentage of signal energy above 20 Hz showed a noticeable increase in the group of subjects with audible sounds. This can physically be explained by decreased damping properties of damaged tissues surrounding the TMJ. Vibrations in the TMJ area can be observed with significant portions in the inaudible area below 20 Hz both during mandibular rest and during jaw movements whether or not the subjects have audible joint sounds. Further studies are needed to identify sources and evaluate possible diagnostic value.

Adult↗
PubMed1995

Acoustic properties of the normal chest.

Laënnec invented the stethoscope in 1816 and published a treatise on auscultation in 1819. We then had to wait until the 1950s to observe development of modern devices and methods of recording and signal-processing, which allowed objective studies of lung sounds in time and frequency fields. Tracheobronchial sounds generated by ventilation originate in the upper airways, the frequency content of these sounds has led to extensive research. Consolidated lungs act as more efficient sound conductors to the chest wall (bronchial breathing murmur). Tracheobronchial sounds contain higher frequency components compared to vesicular lung sounds. The origin of vesicular lung sounds has been becoming progressively clear for about 10 yrs. It is at least partly produced locally, deep, and probably intralobular. Clearly, further studies need to be performed in order to elucidate the true mechanisms involved in generating vesicular lung sounds, the redistribution of intrapulmonary gas or vibrations caused by the stretching of lung tissue. The devices developed are already useful for monitoring the state of patients in intensive care. Sooner or later, real time analysis and automated diagnosis will become available.

Auscultation↗
PubMed1995

Crackles: recording, analysis and clinical significance.

Crackles are short interrupted breath sounds usually associated with pulmonary disorders. According to present opinion, a crackle is generated when an abnormally closed airway opens during inspiration or closes at the end of expiration. The timing of crackles in breathing cycles can be assessed with phonopneumography, their duration with time-expanded waveform analysis, and their pitch with analysis of frequency spectra. The timing, pitch and waveform of crackles are different in pulmonary disorders reflecting different pulmonary pathophysiology. This review deals with the genesis, auscultation, recording and analysis of crackles, with an emphasis on modern signal-processing methods.

Asbestosis↗
PubMed2005

Methacholine bronchial provocation measured by spirometry versus wheeze detection in preschool children.

BACKGROUND: Determination of PC20-FEV1 during Methacholine bronchial provocation test (MCT) is considered to be impossible in preschool children, as it requires repetitive spirometry sets. The aim of this study was to assess the feasibility of determining PC20-FEV1 in preschool age children and compares the results to the wheeze detection (PCW) method. METHODS: 55 preschool children (ages 2.8-6.4 years) with recurrent respiratory symptoms were recruited. Baseline spirometry and MCT were performed according to ATS/ERS guidelines and the following parameters were determined at baseline and after each inhalation: spirometry-indices, lung auscultation at tidal breathing, oxygen saturation, respiratory and heart rate. Comparison between PCW and PC20-FEV1 and clinical parameters at these end-points was done by paired Student's t-tests. RESULTS AND DISCUSSION: Thirty-six of 55 children (65.4%) successfully performed spirometry-sets up to the point of PCW. PC20-FEV1 occurred at a mean concentration of 1.70+/-2.01 mg/ml while PCW occurred at a mean concentration of 4.37+/-3.40 mg/ml (p < 0.05). At PCW, all spirometry-parameters were markedly reduced: FVC by 41.3+/-16.4% (mean +/-SD); FEV1 by 44.7+/-14.5%; PEFR by 40.5+/-14.5 and FEF25-75 by 54.7+/-14.4% (P < 0.01 for all parameters). This reduction was accompanied by de-saturation, hyperpnoea, tachycardia and a response to bronchodilators. CONCLUSION: Determination of PC20-FEV1 by spirometry is feasible in many preschool children. PC20-FEV1 often appears at lower provocation dose than PCW. The lower dose may shorten the test and encourage participation. Significant decrease in spirometry indices at PCW suggests that PC20-FEV1 determination may be safer.

Asthma↗