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PubMed2003

[Effect of subcutaneous fatty tissue on normal respiratory sounds].

Auscultation is an important, non-invasive and simple measure in the diagnosis of lung diseases that can detect sometimes pathological processes prior to radiography. Attempts have already been made to automatically detect characteristic pathological sounds, but a knowledge of potential influencing factors is a must for correct interpretation. In this study we have investigated the effect of the subcutaneous fat layer on normal lung sounds. This is of importance to determine corrective factors for the automatic detection of bronchial breathing in pneumonia. The lung sounds of 125 healthy people (55f, 70m) were digitally recorded at four different positions of the thorax (3. ICR paravertebral, 7. ICR medioscapular, all left and right). Evaluation was done separately for gender. The subcutaneous fat layer was measured with a Holtain Skinfold Caliper at the identical four recording positions. For a quantitative evaluation of the sounds we calculated the relative power of frequency bands 330-600 Hz and 60-330 Hz and their ratio. The relation between these parameters and the subcutaneous fat layer was analyzed with the Pearson correlation. The results of this study show that the influence of subcutaneous fat layer is negligible and can be ignored in the automatic detection of lung sounds.

Adipose Tissue↗
PubMed1990

A new stereophonic stethoscope.

A new stereophonic stethoscope is presented. It is characterized by a single chest piece construction housing paired open-bell type sound accumulating chambers and paired diaphragm type sound accumulating chambers. A pair of separate ear tubes connected to each of the paired sound chambers establish two cross talk-free channels for collecting and delivering auscultatory sounds. Selective use of the open-bell and diaphragm sound chambers is assured with this new stethoscope. Advantages of stereophonic auscultation are discussed.

Equipment Design↗
PubMedDate not supplied

The effects of feeding and fasting on gastrointestinal sounds in adult horses.

The effect of changes in feed intake on auscultatable gastrointestinal sounds has not been systematically studied. Disagreement also is present in the literature about variation in sounds according to the quadrant of auscultation. Gastrointestinal sounds were recorded over the center of the left dorsal, left ventral, right ventral, and right dorsal quadrants and over the middle of the right abdominal flank. During 24 hours (n = 4) or 48 hours (n = 5) of fasting, there was a reduction in the intensity of gastrointestinal sounds as assessed by analysis of sound recordings. There was also a reduction in the number of mixing-like and propulsive-like sounds heard by 2 blinded observers. After refeeding, there was a marked increase in sound. Sound intensity varied among abdominal quadrants, but blinded observers did not notice significant differences in the number of mixing-like sounds. The left dorsal quadrant was quieter than others during fasting and refeeding. The right ventral quadrant appeared to be least affected by fasting, and sounds were louder over the right ventral and right middle quadrants than over the others. The blinded observers' perceptions of sound correlated poorly with one another and with objective measures of sound intensity. This experiment demonstrates the effectiveness of computerized analysis of abdominal sound in detecting a reduction in the intensity of gastrointestinal sounds during fasting and their return during refeeding. The left dorsal quadrant was quieter than other quadrants, likely because of its position over the small colon. There was considerable observer variation in the number of intestinal sounds heard.

Animals↗
PubMed2001

Congestive heart failure associated with myxomatous degeneration of the left atrioventricular valve in a parakeet.

Congestive heart failure was diagnosed in a 27-year-old Indian ringneck parakeet with exercise-induced dyspnea. A grade IV/VI holosystolic murmur that radiated to the right sternal area was auscultated over the left side of the sternum. Radiography revealed progressive cardiomegaly, hepatomegaly, pulmonary edema, and accumulation of fluid within the coelomic cavity. Echocardiography revealed biatrial enlargement and enlargement of the right ventricle. Doppler recording revealed high velocity left and right atrioventricular valve regurgitation. Treatment with digoxin and furosemide alleviated clinical signs for approximately 10 months. Gross postmortem examination revealed cardiac enlargement and eccentric hypertrophy of both ventricles on cross-section. Pulmonary congestion and edema, hepatomegaly, hepatic congestion, and ascites were also evident. Histologic examination of the heart revealed myxomatous degeneration of the left atrioventricular valve, muscular hypertrophy of the right atrioventricular valve, and biventricular chronic myofiber degeneration and necrosis.

Animals↗
PubMed1986

Comparisons between CK-B and other clinical indicators of cardiac contusion following multiple trauma.

The activity of creatine kinase (CK) and creatine kinase B(CK-B) was measured in 17 patients with injuries to multiple organ systems, including the chest. The patients were closely observed for clinical signs of disturbed cardiac function by means of serial ECG, continuous monitoring of cardiac rhythm, daily cardiac auscultation, serial chest roentgenography and monitoring of central hemodynamic parameters. No statistically significant difference in CK and CK-B activity was found between the group of patients with normal cardiac function and the group with disturbed cardiac function. The CK-B activity was markedly elevated, but CK-B activity relative to CK activity was normal in both groups during the first 7 days after the trauma. The authors conclude that the significance of these enzymes' serum activity, measured with the immunoinhibition method, is diagnostically doubtful not only as regards cardiac contusions, but also in other cardiopathy preceding or following major trauma.

Abdominal Injuries↗
PubMed2006

[The anatomical-clinical conceptualisation of pulmonary tuberculosis in the work of Laennec].

The present study discusses the description of the tubercules of the lung which appeared in the 1826 edition of the treatise De l'auscultation mediate (1819) by Laennec, the author with Bayle of the first anatomo-clinical conceptualisation of pulmonary tuberculosis. Employing the analytical framework developed by Othmar Keel, the study investigates the interrelationships between two contemporaneous modes of interpreting the pathological evidence--the localist vision and the anatomo-pathological conception--in order to understand the influences of the surgical model upon the progress of anatomical, physiopathological, and tissue investigations by researchers such as Hunter and Bichat.

Auscultation↗
PubMed1997

What makes a heart murmur innocent?

The physician determines that a murmur is innocent by evaluating it on its own merits. The information should be assessed in a logical and orderly fashion, and the possibilities are considered based on the information that is obtained. All of this information is processed through the physician's knowledge and experience base, and then a decision is made. One cannot increase one's skill as a cardiac auscultator by reading articles such as this-one can only learn what is abnormal by being completely comfortable with what is normal. There is no substitution for listening to many hearts, but the physician must listen to normal hearts thoughtfully and analytically. What makes a heart murmur innocent? The answer to this question includes the characteristics of the murmur in the context of the patient's total cardiovascular examination. How are these characteristics determined? They are determined the same way as any other technical skill is accomplished-with practice.

Clinical Competence↗
PubMed1989

Mitral valve prolapse: causes, clinical manifestations, and management.

PURPOSE: To assess the causes, methods of diagnosis, clinical spectrum, and management of mitral valve prolapse. DATA IDENTIFICATION: Results of prospective study of over 800 subjects at Cornell Medical Center from 1979 to the present were used along with studies published from 1963 to 1989 identified by computerized literature searches of Index Medicus and MEDLINE, and by hand searches. STUDY SELECTION: Studies involving controlled design, longitudinal follow-up, or critical assessment of diagnostic methodology, and clinical studies or previous reviews that have contributed most to the understanding of mitral valve prolapse were selected. DATA EXTRACTION: Data concerning the causes, clinical manifestations and complications, and prevalence of mitral valve prolapse, as well as the strength of association between mitral valve prolapse and diagnostic signs, were evaluated and used to develop a practical approach to evaluating and managing patients. RESULTS OF DATA SYNTHESIS: Most instances of mitral valve prolapse are primary and inherited, with possible genetic heterogeneity. Mitral prolapse may be diagnosed by auscultation of midsystolic clicks and late-systolic murmurs that respond typically to maneuvers, or by billowing of mitral leaflets across the mitral anular plane in long-axis, two-dimensional echocardiographic views or by a late-systolic, posterior leaflet displacement of at least 2 mm in meticulously targeted M-mode recordings. Mitral valve prolapse is associated with thoracic bony abnormalities, low body weight, low blood pressure, and a modest excess of orthostatic hypotension, syncope, palpitations, and atrial arrhythmias, but not with nonspecific symptoms (atypical chest pain, dyspnea, anxiety or panic attacks). Complications of mitral valve prolapse, including about 4000 mitral valve operations, 1100 cases of endocarditis, and possibly 4000 sudden deaths per year in the United States, are concentrated disproportionately in older men, with about 5% of affected men and 1.5% of affected women ultimately requiring valve surgery. CONCLUSIONS: Prophylaxis for endocarditis and closeness of follow-up should be related to the occurrence of the independent risk factors for complications of mitral prolapse (presence of mitral regurgitation, male gender, and age over 45 years), whereas active management and close observation are needed for severe mitral regurgitation and advanced ventricular arrhythmias.

Arrhythmias, Cardiac↗
PubMed1989

Prevalence of regurgitant murmurs in patients with valvular regurgitation detected by Doppler echocardiography.

STUDY OBJECTIVE: To determine the relation between heart valve regurgitation detected by Doppler echocardiography and audible regurgitant murmurs. DESIGN: Consecutive sample. SETTING: Adult echocardiography laboratory in a tertiary care university hospital. PATIENTS: Sequential sample of 408 patients presenting for clinical echocardiographic studies who had technically satisfactory studies and were available for auscultation. MEASUREMENT AND MAIN RESULTS: Valvular regurgitation occurred in 43% of patients at the mitral valve, 39% of patients at the tricuspid valve, 33% of patients at the aortic valve, and 15% of patients at the pulmonic valve. Corresponding regurgitant murmurs were frequently absent. A murmur corresponding to Doppler-detected regurgitation was detected in 56% of patients with mitral regurgitation, 61% of patients with aortic regurgitation, 28% of patients with tricuspid regurgitation, and 15% of patients with pulmonic regurgitation. There was a highly significant positive correlation of audibility with severity of valve regurgitation for the aortic, tricuspid, and mitral valves. Audibility ranged from 10% to 40% for mild regurgitation to 86% to 100% for severe regurgitation. Murmur audibility was not related to the type of valvular disease present. CONCLUSIONS: Doppler echocardiography is a sensitive method for detecting valve regurgitation. Corresponding regurgitant murmurs are frequently not present. The audibility of regurgitant murmur is highly dependent on the severity of valve regurgitant and has little relation to the type of valve disease present.

Adolescent↗
PubMed1977

Acute severe aortic regurgitation. Pathophysiology, clinical recognition, and management.

Acute severe aortic regurgitation is a relatively unfamiliar, though life-threatening, disease. We review its diverse causes, anatomic faults, and hemodynamic sequelae and set the stage for an understanding of the clinical manifestations in light of their physiologic mechanisms. Clinical information includes the natural history, physical signs (physical appearance, systemic arterial pulse, jugular venous pulse, precordial palpation, auscultation), electrocardiogram, and chest roentgenogram. Echocardiographic features are especially emphasized and the need for prompt diagnosis and surgical intervention underscored, even in the setting of active infective endocarditis.

Acute Disease↗
PubMed2006

Observing the sick child: Part 2a. Respiratory assessment.

As the focus on evidence-based healthcare delivery gains momentum, nurses need to critically reflect on their traditional practice base. Assessment is the cornerstone of safe and effective practice and goes hand in hand with the process of prioritising a sick child's needs. This article begins with a practical and critical review of the validity and reliability of basic respiratory assessment focused on measurement of respiratory rate, rhythm and depth. Part 2b in February 2007 will be a practical step-by-step introduction to the theory and practice of advanced respiratory assessment using palpation. Part 2c in the following month will focus on respiratory auscultation methods.

Auscultation↗
PubMed1990

Comparing RCPs to physicians for the description of lung sounds: are we accurate and can we communicate?

UNLABELLED: Precise communication among clinicians of chest-auscultation findings depends on use of standardized nomenclature for lung sounds. To identify the current practice of clinicans in describing lung sounds, we surveyed physicians and respiratory care practitioners (RCPs). MATERIALS AND METHOD: Surveys were specifically designed to identify: (1) whether RCPs and physicians use similar terms to describe adventitious lung sounds (ALS), (2) whether changes are occurring in response to the recommendations of the ATS-ACCP Ad Hoc Subcommittee on Pulmonary Nomenclature, and (3) whether RCPs and physicians differ in their ability to accurately recognize ALS. We surveyed 156 RCPs at the 1987 Annual Meeting of the American Association for Respiratory Care and 223 pulmonary physicians (PPs) and 54 nonpulmonary physicians (NPPs) at the 1988 Annual Meeting of the American College of Chest Physicians. Each survey participant was required to listen to five examples of ALS using earphones and an audiocassette player and then to write 'free-form' descriptions of what they heard. (All participants listened to the same ALS.) RESULTS: Fine crackles and high-pitched monophonic and polyphonic wheezes were readily recognized by the majority of RCPs and physicians. Fine crackles were described as rales or crackles; high-pitched, monophonic wheezes were described as stridor or wheezes; however, high-pitched, polyphonic wheezes were usually described as wheezes. RCPs and physicians used a variety of terms to describe coarse crackles and rhonchi. The term rhonchi was frequently used inappropriately by all groups surveyed. There were no significant differences between PPs and RCPs in their ability to accurately recognize adventitious lung sounds; however, PPs were superior to NPPs (p less than 0.05) in this regard. PPs were superior to RCPs and NPPs (p less than 0.05) in appropriately using the term 'fine' for the description of crackles. CONCLUSION: All three groups of clinicians need to improve their ability to recognize and describe lung sounds.

Allied Health Personnel↗
PubMed1999

[Rigid endoscopy and laryngo-tracheo-bronchial foreign bodies in children: observations apropos of 200 endoscopies conducted in a tropical setting].

Between 1986 and 1998, 200 rigid bronchoscopic procedures under general anesthesia were carried out at the Principal Hospital in Dakar, Senegal for foreign body extraction from the distal airways of 194 children. For the study period, the incidence of this accident was 3.7 p. 1000. Sixty-three percent of patients were male and 77 p. 100 were under 4 years of age. Most patients (69 p. 100) were examined within 48 hours after the accident. Examination of clinical records showed that aspiration was mentioned during anamnesis in only 56 p. 100 of cases. Persistent coughing (80 p. 100) and mild dyspnea (70 p. 100) were the most common symptoms. Auscultation of the lungs was negative in 25 p. 100 of cases and anterior x-ray of the neck and chest were normal or poorly informative in 59 p. 100. In 154 of the 200 procedures, extraction of the foreign body was successful from the trachea in 35 p. 100 of cases, the larynx in 13 p. 100, the right main stem bronchus in 31 p. 100 and the left main stem bronchus in 21 p. 100. In the remaining 46 cases, extraction was unsuccessful. The most frequent foreign body was a peanut. No deaths occurred in this series but cardiac arrest was observed in 6 patients during or immediately after endoscopy. This experience confirms the indication for immediate rigid bronchoscopy in cases involving aspiration or persistent respiratory symptoms. The high incidence of this accident suggests that information campaigns should be undertaken in health care facilities, households, and schools.

Accidents↗
PubMed1999

Case 2: a patient with an intermittent racing heartbeat.

Most clinicians currently rely on patient history and specific electrocardiographic criteria to establish the diagnosis of arrhythmias. However, as illustrated by this case, the physical examination-especially auscultation of the first heart sound-can also provide useful diagnostic clues.

Adolescent↗
PubMed1999

[Diagnosis of chronic abdominal ischemia due to compressive celiac trunk stenosis].

AIM: Elucidation of clinical symptoms of compressive celiac trunk stenosis (CCTS) and development of diagnostic programs and the disease classification. MATERIALS AND METHODS: Clinical signs of CCTS and results of device examinations have been analyzed in 511 patients operated for CCTS. The diagnostic program is proposed which simplifies CCTS identification. How to use methods of auscultation and phonoangiography of the abdomen, sonography and angiography of the visceral aortic branches, endoscopy and kinesography in this disease is shown. Three symptom complexes are most noticeable in CCTS clinical picture: abdominal pain after meals (100%), digestive tract dysfunctions (78.4%), neurovegetative disorders (84.38%). 67.44% of patients noted meteorological dependence of the disease exacerbation. Objective investigation revealed tenderness to palpation in the epigastrium (100%), systolic murmur in the epigastrium on an empty stomach after full expiration (98.67%). CONCLUSION: Sonographic and endoscopic investigations are recommended for screening of patients to reveal stenotic injury of the celiac trunk. Timely detection of the disease and surgical treatment produce a positive effect in most cases.

Abdomen↗
PubMed2000

[Mitral valve prolapse--diagnostic and therapeutic implications].

In the most patients the mitral valve prolapse (MVP) syndrome has a good prognosis. The gradual progression of MR may cause the progressive LV dysfunction and development of heart failure. Long-term prognostic studies showed, that complications like endocarditis, cerebrovascular accidents occur frequently in pts. with mitral systolic murmur, thickened mitral valve leaflets and presence of MR. The diagnosis of MVP is made by cardiac auscultation and confirmed by echocardiography. The procedures usefulness in sudden death stratification are discussed. The management of the symptomatic patients, particularly the indication for prophylaxis of endocarditis and cerebrovascular accidents has been demonstrated. The indications for cardiac catheterisation and surgical treatment are presented.

Auscultation↗
PubMed1975

Left displacement of the abomasum in a clinically normal cow.

A cow with left displacement of the abomasum (lda) was found to be clinically normal for 1 1/2 years. During this period, the cow calved twice and ate and produced milk normally. Auscultation and percussion at approximately weekly intervals revealed the continuing abomasal displacement, which was confirmed at necropsy.

Abomasum↗