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PubMed2001

[A case of bronchiolitis obliterans: auscultation leading to accurate diagnosis].

This is a case of a 31-year-old man with a history of common cold. He had been suffering from productive cough and dyspnea on exertion. Squawks were heard through auscultation, and hyperinflation was also observed in his chest radiograph. Bronchiolitis was first suspected as a result of HRCT and TBLB. He was then treated with CAM for six months, but his symptoms showed little improvement. So we evaluated his squawks objectively by phonopneumograph, performed video assisted thoracoscopic surgery and diagnosed his illness as constrictive bronchiolitis. Based on the examinations, PSL therapy was applied to his case, which contributed improving his condition remarkably. The significance of this case is that proper auscultation led to the accurate diagnosis.

Adult↗
PubMed1975

[Carotid auscultation. Correlation in 200 patients with 332 angiograms].

1. Results of auscultation of carotid arteries have been reviewed in 200 adults patients with 332 carotid angiograms. Cases with abnormal cardiac bruits of supraclavicular buits were excluded. There was no case with stenosis of the external artery or significant anemia. 2. The present series of patients comprises : 100 with internal carotid artery (ICA) stenosis, 50 with ICA occlusion and normal contralateral ICA, 50 with cerebral space-occupying lesions. 3. A bruit was present in 80/132 ICA stenosis (60 per cent), 60/84 ICA stenoses reducing the lumen by more than 75 per cent (71 per cent), 20/48 ICA stenoses reducing the lumen by less than 75 per cent (41 per cent). It appeared likely that the presence of an ICA stenosis plays a role in the presence of a contralateral bruit where a contralateral stenosis or occlusion are present. 4. An ipsilateral bruit was present in 50/50 ICA occlusions. A contralateral bruit was present in 7 patients the ICA angiogram being normal. A bruit was present on both sides in 4 patients and it may be that some patients are somewhat apt to have bruits. 5. There was no bruit in 49 patients with normal carotid angiograms and a cerebral space-occupying lesion. Data from the present series suggest that where both ICA's are normal auscultation is falsely positive in less than 10 per cent of patients.

Adult↗
PubMed1992

CompuLung: a multimedia CBL on pulmonary auscultation.

Cardio-pulmonary auscultation, a time honored art, is suffering a declining interest caused by competing diagnostic technology and inadequate training of physicians. Overreliance on diagnostic technology is expensive, not cost-effective and bound to lead to loss of our clinical heritage. We need novel methods to teach and revive this art. Computer-Based Learning (CBL), particularly multimedia supporting graphics plus sound-and-motion pictures, appears to be ideally suited for teaching and sharpening this skill. We present in this paper a multimedia CBL ("CompuLung"), that provides the user with a comprehensive and interactive tutorial on pulmonary auscultation.

Auscultation↗
PubMed1992

[Acoustic frequency analysis of auscultation findings in neonates].

The authors analyzed 280 auscultation findings of 35 neonates with birth weights of 1800-4500 g and 65 pathological neonates with birth weights of 1150-3600 g. For recording of the auscultation findings an electronic phonendoscope EST 40 (Bosch) was used and the finding was recorded on a microtape recorder (Olympus). The frequency analysis was made on a Sonagraf analyzer (Kay Elemetric), using a 45 Hz filter a time range of 2.4 sec. From the results of the work ensues that in physiological neonates two basis types of sonagrams can be detected: 1. the record presenting itself as a continuous zone of noise with maximal cumulation of acoustic energy up to 500 Hz where the ratio of acoustic energy is equal in both stages of the respiratory cycle. The clinical correlate is "alveolar respiration". 2. a record with a discontinuous zone of noise with a more expressive ratio of acoustic energy up to 2500 Hz during inspiration. The clinical correlate is "sharper bronchoalveolar respiration". In the group of pathological neonates with different pneumopathies further sonagraphic phenomena were detected: a) "rales" as discontinuous acoustic phenomena persisting for 7-35 msec with a frequency range up to 3000 Hz, without a harmonious structure, present during inspiration as well as expiration, b) "transmitted phenomena"--discontinuous acoustic phenomena persisting for 75-150 msec with a frequency range up to 6000 Hz, without a harmonious structure, c) "wheezing"--continuous acoustic phenomena with a clearly marked harmonious acoustic structure lasting 540 +/- 240 msec with a frequency of the basic sound of 500 +/- 240 msec.(ABSTRACT TRUNCATED AT 250 WORDS)

Auscultation↗
PubMed1991

[Diagnostic value of auscultation of major arteries of the head].

Attention is drawn to the use of a simple method of examination such as auscultation of the main vessels of the head in practical activity of the neuropathologist. The diagnostic significance of the method in vascular pathology of the brain is documented. The method of transorbital auscultation to be used in the diagnosis of stenosis of the intracranial strip of the internal carotid artery is described.

Auscultation↗
PubMed1991

Auscultation with an esophageal stethoscope. A new test for pneumoperitoneum.

Auscultation for the tympanic sound characteristic of developing pneumoperitoneum during insufflation of the abdomen at laparoscopy was performed with an esophageal stethoscope. Such auscultation detected pneumoperitoneum as soon as or sooner than did the other, standard methods to which it was compared. This test requires no additional maneuvers beyond those routine in standard laparoscopic and anesthetic procedures, providing a useful adjunctive test for pneumoperitoneum acquisition.

Adult↗
PubMed1979

The arts of percussion and auscultation of the chest re-examined.

Clinical teaching of percussion and auscultation is examined critically, and it is suggested that there is confusion on the subject both in textbooks and in the minds of clinicians and students. Percussion should be viewed more in terms of 'feel' than 'sound', and thus a classification of 'hard', 'intermediate' and 'soft' dullness is introduced. As regards auscultation, a plea is made for differentiation between obstructed and non-obstructed consolidation of lobes, a point recognized by some clinicians, but not enunciated with clarity by teachers. The differences between the clinical findings in obstructive consolidation of the upper and lower lobes are discussed. The importance of distinguishing between tracheal and bronchial breathing is emphasized.

Auscultation↗
PubMed1982

A critical appraisal of auscultation of human joints.

Auscultation of human joints is a rarely practiced art. Many attempts have been made to develop a technique with objective parameters but none are sufficiently sensitive for clinical use. This article reviews the history of auscultation as applied to human joints. An acoustic system was critically evaluated and attempts were made to exclude skin friction and ambient noise. Human joint sounds were found to be at the low end of the acoustic range. The microphone was a poor transducer in terms of frequency and dynamic sensitivities for use with human joint emission because of the large acoustic impedance. Many of the problems encountered by workers in this field might be due to failure to appreciate the limitation of detection apparatus.

Auscultation↗
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↗
PubMedDate not supplied

[Measurement of the frequency response of several stethoscopes in common use. Consequences for cardiac and pulmonary auscultation].

We measured the frequency response of eight stethoscope membranes and of thirteen types of stethoscopes. Measurements were made in an anechoic chamber calculating the ratio between the intensity of a sinusoidal sound coming from a loud speaker and the intensity of the transmitted sound through the membrane of the stethoscope. Small membranes have a bandwidth (without attenuation or amplification) between 10 and 600 Hz while large membranes have a bandwidth twice the size (10-1200 Hz). This good result does not appear in the case of stethoscopes showing increasing attenuation versus frequency, with a mean value from -2.5 to -10.5 dB and variations of 10 dB in the range 50-1200 Hz which is the useful bandwidth for cardiac and pulmonary auscultation. By contrast, fidelity of the measured stethoscopes was good. Discussion of the results suggests modification of stethoscope design to eliminate faults of sound transmission and to elaborate a microphone sensor allowing an electric transmission.

Auscultation↗
PubMed1994

Stethoscope acoustics and cervical auscultation of swallowing.

Frequency response characteristics of six popular stethoscopes are reported for the higher frequency range (to 3000 Hz) to supplement equivalent measurements for the lower frequencies (35-1000 Hz) published previously. Spectra of the sounds of swallowing from the throat, transduced with an accelerometer, demonstrate important frequency composition in this higher range. Two stethoscope models were found to have superior transmission characteristics for use in cervical auscultation of swallowing sounds.

Acceleration↗
PubMed1991

Blood pressure changes associated with tilting in normotensive subjects: differences in response pattern as measured by oscillometry and auscultation.

Three non-invasive instruments were used to measure blood pressure in the supine position and on tilting--a conventional and a random-zero sphygmomanometer, and an oscillometric device (Accutorr 1A). Twenty normotensives volunteered for the study. There was no statistically significant difference in systolic blood pressure and diastolic blood pressure measured by the conventional and random-zero sphygmomanometers in the supine position. There was a difference between these recordings and those of the Accutorr, with the Accutorr giving higher readings of systolic blood pressure (p less than 0.001), analysis of variance, 95% confidence interval of the difference between the Accutorr and the random-zero was 5.1-15.7 mmHg) and lower readings of diastolic blood pressure (p less than 0.0001, analysis of variance, 95% confidence interval of the difference between the Accutorr and the random-zero was -12.2- -2.2 mmHg). On tilting, the Accutorr showed an increase in systolic blood pressure while the other two machines did not (p less than 0.01, analysis of variance). By contrast, the Accutorr detected a smaller rise in diastolic blood pressure than with the other two instruments (p less than 0.05, analysis of variance). The difference between blood pressure measurements made in the supine position by the two different techniques, auscultation and oscillometry, might be expected. However, the two different techniques do not detect the same blood pressure responses to a change in posture.

Adult↗
PubMed1997

Auscultation revisited: the waveform and spectral characteristics of breath sounds during general anesthesia.

Although auscultation is commonly used as a continuous monitoring tool during anesthesia, the breath sounds of anesthetized patients have never been systematically studied. In this investigation we used digital audio technology to record and analyze the breath sounds of 14 healthy adult patients receiving general anesthesia with positive pressure ventilation. Sounds recorded from inside the esophagus were compared to those recorded from the surface of the chest, and corresponding airflow was measured with a pneumotachograph. The sound samples associated with inspiratory and expiratory phases were analyzed in the time domain (RMS amplitude) and frequency domain (peak frequency, spectral edge, and power ratios). There was a positive linear correlation (R2 > 0.9) between inspiratory flow and sound amplitude in the precordial and esophageal samples of all patients. The RMS amplitude of the inspiratory and expiratory sounds was approximately 13 times greater when recorded from inside the esophagus than from the surface of the chest in all patients at all flows (p < 0.001). The peak frequency (Hz) was significantly higher in the esophageal recordings than the precordial samples (298 +/- 9 vs 181 +/- 10, P < 0.0001), as was the 97% spectral edge (Hz) (740 +/- 7 vs 348 +/- 16, P < 0.0001). In the adult population esophageal stethoscopes yield higher frequencies and greater amplitude than precordial stethoscopes. Quantification of lung sounds may provide for improved monitoring and diagnostic capability during anesthesia and surgery.

Adolescent↗
PubMedDate not supplied

Automated cardiac auscultation for detection of pathologic heart murmurs.

Experienced cardiologists can usually recognize pathologic heart murmurs with high sensitivity and specificity, although nonspecialists with less clinical experience may have more difficulty. Harsh, pansystolic murmurs of intensity grade > or = 3 at the left upper sternal border (LUSB) are likely to be associated with pathology. In this study, we designed a system for automatically detecting systolic murmurs due to a variety of conditions and examined the correlation between relative murmur intensity and likelihood of pathology. Cardiac auscultatory examinations of 194 children and young adults were recorded, digitized, and stored along with corresponding echocardiographic diagnoses, and automated spectral analysis using continuous wavelet transforms was performed. Patients without heart disease and either no murmur or an innocent murmur (n = 95) were compared to patients with a variety of cardiac diagnoses and a pathologic systolic murmur present at the LUSB (n = 99). The sensitivity and specificity of the automated system for detecting pathologic murmurs with intensity grade > or = 2 were both 96%, and for grade > or = 3 murmurs they were 100%. Automated cardiac auscultation and interpretation may be useful as a diagnostic aid to support clinical decision making.

Adolescent↗
PubMed2004

Bronchial auscultation: an effective adjunct to speech and language therapy bedside assessment when detecting dysphagia and aspiration?

Detection of aspiration by bedside examination has frequently been found to be clinically inadequate when compared with videofluoroscopy (VF) as the gold standard. In Doncaster, UK, a new multidisciplinary approach to bedside assessment was devised using physiotherapists (PT) performing bronchial auscultation (BA) in combination with the speech and language therapists' (SLT) clinical examination of dysphagia. In this study 105 patients referred for VF examination of dysphagia were first tested by the BA team. Comparison was made between the results of the VF team and the results of the BA team in classifying the patients as "aspirating" or at "risk of aspirating." A high degree of agreement was found for risk of aspiration (sensitivity 87%), although specificity was low (37%). BA was highly specific (88%) when confirming the absence of aspiration, but sensitivity to the presence of aspiration was 45%. From the 105 patients tested, the BA team would have failed to modify the diet in only one subject who was aspirating and would have unnecessarily modified the diet of 17 subjects. In conclusion, in the sample population of individuals with complex dysphagia, the BA team approach reliably detected patients identified by VF as at risk of aspiration. In the group of patients identified by VF as aspirating, the BA team proved unreliable in detecting the presence of aspiration, although it did reliably identify patients who were not aspirating. BA is a potentially useful clinical tool which requires further research.

Adolescent↗
PubMed1978

Group teaching of auscultation. Use of a new wireless stethoscope-type headphone.

A new technique using infrared light for the transmission of heart sounds and murmurs is described. This method enables the simultaneous transmission of heart sounds and murmurs to large groups of persons without the need for hard-wire connections to the amplifying device. The method facilitates teaching of cardiac auscultation at the bedside as well as in the setting of conferences, seminars or postgraduate education programs.

Audiovisual Aids↗
PubMed1981

Laennec and the discovery of mediate auscultation.

The invention of the stethoscope by René Théophile Hyacinthe Laennec occurred within an emerging French tradition of bedside empiricism that combined physical diagnosis with autopsy correlation. On the occasion of the bicentennial of the birth of the discoverer of mediate auscultation, we celebrate the life and work of one of the founders of modern medicine.

Auscultation↗
PubMed1991

Electronic fetal heart monitoring, auscultation, and neonatal outcome.

In a large randomized, controlled study of fetal heart rate monitoring with either continuous electronic fetal heart monitoring or auscultation at specified intervals, only one pattern of deviation in the fetal heart rate correlated significantly with neonatal neurologic examinations at 0 to 48 hours and 72 hours to 1 week: late decelerations in stage 1 and in stage 2. Other variables from labor and delivery, specifically, duration of labor after hospital admission, failure of labor to progress, number of fetal scalp pH values, and presence of meconium were important predictors of neonatal outcome in the regression analyses. The fetal heart rate deviations did contribute significantly to the percent variance accounted for in the regression analyses with neonatal outcomes of Apgar scores at 1 and 5 minutes and serial neonatal neurologic examinations.

Apgar Score↗