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PubMed2001

On stethoscope design: a challenge for biomedical circuit designers.

Most clinicians learned the art and science of auscultation using an acoustic stethoscope. While many models of electronic stethoscopes have been marketed over the years, none of them seem to do a very good job of emulating the most common forms of acoustic stethoscopes available. This paper is an appeal to biomedical circuit designers to learn more about the acoustics of commonly used stethoscopes and to develop an appropriate group of circuits which would emulate them much like music synthesizers can emulate almost any musical instrument. The implications are for creative designers to move toward a rational and acceptable design for both personal physician use and for telemedicine.

Equipment Design↗
PubMed1996

[The anatomical-clinical observations of R.T.H. Laennec's Service at the Hôpital Necker (1816-1819)].

It is through Laennec's students observations, revised by himself, that we are able to follow his medical knowledge strides. Starting from the first mediate auscultation (1817) it shows the raising prevalence of physical marks against functional ones. It starts by the impairing of human voice sounds and tackles abnormal breathing murmurs; all these are combined with every other investigating process as percussion. Nevertheless, some failings appear about cardiology which is occasionally defective. Very complete autopsies give now famous descriptions of pulmonary emphysema and atrophic cirrhosis. Such a documentation shows how high a value Laennec and his followers were setting on anatomo-clinical method though they admitted its limit.

Auscultation↗
PubMed2002

[Acute abdomen in primary care].

The author--using his 30 years practical medical experience, from the point of view of a family doctor giving the first diagnose, analyses the problem of acute abdomen. Gives an overview of anamnesis (heteroanamnesis) and the data and their significance investigated during the physical examination of patient (inspection, palpation, percussion, auscultation), and that of the usefulness for the right diagnose. The author orients the reader's attention to the fact, that the beginning of the third millennium in the world of instrumental and laboratory diagnostics, in case of certain illnesses--so in the case of acute abdomen--physical examinations have not lost a bit from their significance.

Abdomen, Acute↗
PubMed2002

A novel paradigm for telemedicine using the personal bio-monitor.

The foray of solid-state technology in the medical field has yielded an arsenal of sophisticated healthcare tools. Personal, portable computing power coupled with the information superhighway open up the possibility of sophisticated healthcare management that will impact the medical field just as much. The full synergistic potential of three interwoven technologies: (1) compact electronics, (2) World Wide Web, and (3) Artificial Intelligence is yet to be realized. The system presented in this paper integrates these technologies synergistically, providing a new paradigm for healthcare. Our idea is to deploy internet-enabled, intelligent, handheld personal computers for medical diagnosis. The salient features of the 'Personal Bio-Monitor' we envisage are: (1) Utilization of the peripheral signals of the body which may be acquired non-invasively and with ease, for diagnosis of medical conditions; (2) An Artificial Neural Network (ANN) based approach for diagnosis; (3) Configuration of the diagnostic device as a handheld for personal use; (4) Internet connectivity, following the emerging bluetooth protocol, for prompt conveyance of information to a patient's health care provider via the World Wide Web. The proposal is substantiated with an intelligent handheld device developed by the investigators for pediatric cardiac auscultation. This device performed accurate diagnoses of cardiac abnormalities in pediatrics using an artificial neural network to process heart sounds acquired by a low-frequency microphone and transmitted its diagnosis to a desktop PC via infrared. The idea of the personal biomonitor presented here has the potential to streamline healthcare by optimizing two valuable resources: physicians' time and sophisticated equipment time. We show that the elements of such a system are in place, with our prototype. Our novel contribution is the synergistic integration of compact electronics' technology, artificial neural network methodology and the wireless web resulting in a revolutionary new paradigm for healthcare management.

Adolescent↗
PubMed1976

Electronic stethoscope with frequency shaping and infrasonic recording capabilities.

A small electronic stethoscope with variable frequency response characteristics has been developed for aerospace and research applications. The system includes a specially designed piezoelectric pickup and amplifier with an overall frequency response from 0.7 to 5,000 HZ (-3 dB points) and selective bass and treble boost or cut of up to 15 dB. A steep slope, high pass filter can be switched in for ordinary clinical auscultation without overload distortion from strong infrasonic signal inputs. A commercial stethoscope-type headset, selected for best overall response, is used which can adequately handle up to 100 mW of audio power delivered from the amplifier. The active components of the amplifier consist of only four opamp-type integrated circuits.

Auscultation↗
PubMed1976

The accuracy of the supraorbital Doppler examination in the diagnosis of hemodynamically significant carotid occlusive disease.

The supraorbital Doppler technique was used to study 102 carotid arteries prior to arteriography. A carotid stenosis was defined as being hemodynamically significant if the diameter of the lumen were reduced by more than 50 percent. The Doppler examination gave a false-positive result in only two of the 61 arteries which did not demonstrate significant stenoses. False-negative Doppler results occurred in 22 percent of the 41 significant carotid lesions. The presence or absence of significant carotid lesions were predicted in 96 percent of 67 arteries for which the results of the supraorbital examination and carotid auscultation were in agreement. False-negative results occurred in association with significant ipsilateral external and common carotid stenoses and in the presence of unusually efficient collateral circulation via the circle of Willis. The supraorbital Doppler examination is a valuable technique for the identification of patients with hemodynamically significant carotid stenoses.

Adult↗
PubMed2003

The 'swoosh' test--an evaluation of a modified 'whoosh' test in children.

BACKGROUND: Caudal analgesia is widely used in paediatric anaesthetic practice. In adults, the 'whoosh' test has been recommended as a guide to successful needle insertion, but it has not been extensively studied in paediatric patients. We have investigated a modification of the 'whoosh' test, which we have christened the 'swoosh' test. It avoids the injection of air by performing auscultation during injection of the local anaesthetic solution. We have compared it with clinical judgement of correct placement. METHODS: We studied 113 children undergoing elective surgery. During insertion of the caudal block, a stethoscope was placed over the lower lumbar spine and the presence or absence of an audible 'swoosh' noted. The operator's clinical impression of successful insertion was also recorded. RESULTS: The overall success rate of caudal anaesthesia was 95.6%. Of the 108 patients with a successful block, 98 had a positive 'swoosh' test. There were no false positive results. Calculations show the 'swoosh' test to have a sensitivity of 91%, a specificity of 100% and a positive predictive value of 100%. CONCLUSIONS: The 'swoosh' test is a simple and accurate test to confirm successful caudal insertion in children, and is especially useful as a teaching aid for anaesthetists new to the technique.

Adolescent↗
PubMed2003

Temporal artery bruits in a patient with giant cell arteritis.

Giant cell arteritis (GCA) is a disease of unknown etiology characterized by granulomatous inflammation of medium and large arteries. A 69-year-old man presented with right jaw claudication, intermittent scalp tenderness without headache, and visibly swollen temporal arteries. Results of a right temporal artery biopsy were positive for GCA. Auscultation revealed audible bruits of the temporal arteries. We believe this is the first reported example of bruits of the temporal arteries as a manifestation of GCA. The condition resolved with corticosteroid therapy.

Aged↗
PubMed2003

[The effect of hypothyroidism on cardiac function in dogs].

The thyroid hormones have direct and indirect effects on the heart. So it is possible that depression of left ventricular function is associated with hypothyroidism. This publication describes cardiac findings (auscultation, electrocardiography, echocardiography) in ten hypothyroid dogs. Low heart rates, reduced R-amplitudes and bradycardic arrhythmias (first and second-degree AV block) were found on the electrocardiogram before treatment. On the echocardiograms most of the dogs showed reduced contractillity and reduced left ventricular wall thickness. Seven dogs were reexamined after levothyroxine supplementation. Effects of treatment were increased heart rates and R-amplitudes as well as disappearance of the bradycardic arrhythmias in electrocardiographic examination. The echocardiographic examination showed increased contractility and increased left ventricular wall thickness.

Animals↗
PubMed1963

Cardiovascular sound and the stethoscope, 1816 to 2016.

Cardiovascular sound escaped attention until Laennec invented and demonstrated the usefulness of the stethoscope. Accuracy of diagnosis using cardiovascular sounds as clues increased with improvement in knowledge of the physiology of circulation. Nearly all currently acceptable clinicopathological correlations were established by physicians who used the simplest of stethoscopes or listened with the bare ear. Certain refinements followed the use of modern methods which afford greater precision in timing cardiovascular sounds. These methods contribute to educating the human ear, so that those advantages may be applied which accrue from auscultation, plus the method of writing quantitative symbols to describe what is heard, by focusing the sense of hearing on each segment of the cardiac cycle in turn. By the year 2016, electronic systems of collecting and analyzing data about the cardiovascular system may render the stethoscope obsolete.

Auscultation↗
PubMed2003

The stethoscope: some preliminary investigations.

Textbooks, clinicians, and medical teachers differ as to whether the stethoscope bell or diaphragm should be used for auscultating respiratory sounds at the chest wall. Logic and our results suggest that stethoscope diaphragms are more appropriate.

Auscultation↗
PubMed2004

[Fasting and postprandial analysis of bowel sounds and plasma 5-hydroxytryptamine level].

BACKGROUND/AIMS: Auscultation of bowel sounds is a traditional technique for evaluating patients with abdominal symptoms. It is, however, subjective and qualitative method in general. Recently, analysis of bowel sounds becomes possible. We analyzed bowel sounds in healthy volunteers and measured platelet depleted plasma 5-hydroxytryptamine (5-HT) that may be associated with postprandial symptoms in irritable bowel syndrome. METHODS: We recorded both fasting and postprandial bowel sounds for 30 minutes in 16 healthy volunteers with a sensitive electronic stethoscope attached to a digital recorder. The files were saved in computer as wav files and analyzed with a specialized program. Blood samples were also taken before and 1 hour after meal for 5-HT analysis. RESULTS: Meal challenge made no statistically significant changes in the 5-HT concentrations and all the sound parameters including sound to sound interval, sounds/minute, average of sound amplitudes, sound length, percentage of bowel sounds representing sound clustering and dominant frequency of sounds. CONCLUSIONS: Postprandial changes in bowel sounds and plasma 5-HT were insignificant in healthy Korean volunteers.

Adolescent↗
PubMed1992

[Anamnesis and physical examination in pneumonology].

The time the physician spends to take the patient-history is a privileged moment during which the most important informations for diagnosis are gathered which in turn will govern further investigations and measures for treatment. Among the physical examinations auscultation of the lung is often regarded as obsolete. If however acoustic phenomena are evaluated with respect to intensity, duration, pitch and position within the respiratory cycle valuable objective information can be obtained.

Auscultation↗
PubMed2005

[Diagnostic criteria and diagnostic considerations for hypertension in the elderly].

Hypertension in the elderly consists mostly of essential hypertension, and its pathophysiology differs in many ways from that of essential hypertension in the young or middle-aged. No special diagnostic criteria for hypertension in the elderly were stated in ESH/ESC JNC 7 guidelines, that is, the criteria is systolic pressure of 140 mmHg and greater or diastolic pressure of 90mmHg and greater as in general adults. As the diagnostic considerations for hypertension in the elderly, we should pay much attention to medical history taking, measurement of blood pressure, discrepancy on auscultation, pseudohypertension, fluctuation of blood pressure, and diagnosis of secondary hypertension.

Aged↗
PubMed1991

[New viewpoints on old cases: pneumonia. 1841].

In this third presentation of reviewed old case histories a lecture by the famous clinician Schoenlein held in 1841 at the Charité on a patient with pneumonia is commented on. This case is in many ways instructive and interesting. The lecture at first reveals the numerous diagnostic difficulties in medicine 150 years ago and then demonstrates the great innovation brought to physical examination by ausculatation introduced to the clinic by Schoenlein against great opposition. For the first time the clinical diagnosis of pulmonary lesions had become possible whereby the diagnostic criteria for pneumonia obtained by auscultation and percussion were already precisely established. Furthermore the utilized therapeutic measures are in part still applicable. This impressive didactic demonstration reveals why Schoenlein was regarded as the most important clinical teacher of his time introducing modern scientific medicine.

Auscultation↗
PubMedDate not supplied

Real time sound spectral analysis for early detection of thrombosed Björk-Shiley standard disc valves.

Clinical usefulness of sound spectral analysis (SSA) in early detection of thrombosed Bjork-Shiley standard tilting disc prostheses (B-SP) was evaluated. Among a total of 365 B-SP, nine valves developed thrombosis. These included seven MVR and two AVR, and replacement of the affected valves was performed in all cases. Thrombus formation was localized at the minor strut in two cases in which the SSA demonstrated preoperative abnormalities of only opening clicks. In four cases, thrombus formation was noted at both minor and major struts, and the SSA showed abnormalities both on opening and closing clicks. In two cases with pannus formation, no abnormalities were found by SSA. As the thrombi were seen on the minor strut during surgery in all cases with thrombosed valves, the minor strut is considered as the preferred, and probably initial area of thrombus formation, and the diagnosis therefore could be made by abnormal findings on opening clicks. In conclusion, the SSA was found to be a useful diagnostic tool for early detection of thrombosis of B-SP, because the opening clicks of the tilting disc valves were often too low in amplitude for abnormalities to be detected by auscultation.

Adult↗
PubMedDate not supplied

[Screening for a frequent cardiac disorder: mitral valve prolapse].

Mitral valve prolapse (MVP) screening using bidimensional echocardiography was performed on 171 healthy subjects from Lorraine of both sexes, aged 20 to 60 years. Six men and seven women presented this valvular disease. In the Lorraine population, the estimated prevalence of MVP was 7.6% (95% confidence interval: 3.6-11.6%). In this study, only seven cases of MVP had a cardiac auscultation suggestive of MVP. As compared with echocardiography, clinical screening of MVP had a low validity (sensibility 54%, specificity 69%) and a poor positive predictive value (12.5%). Because MVP has severe complications, and because clinical screening has a low performance, a strategy of screening with bidimensional echocardiography could be interesting.

Adult↗
PubMed1991

Left atrial myxomas--a case report.

A 49-year-old woman presented with symptoms of congestive cardiac failure. Cardiac auscultation revealed a crunching sound difficult to characterise in addition to a pansystolic murmur maximally audible in the 4th left intercostal space. The ausculatory findings varied from day to day but were unaffected by posture or exercise. A clinical impression of left atrial myxoma was confirmed by two dimensional echocardiography which revealed a well circumscribed mass almost completely filling the left atrium with a pedicle attached to the interatrial septum. The patient's cardiac failure improved with conservative management using frusemide and digoxin. The patient, however, refused cardiac surgery which is the definitive management of this disease.

Digoxin↗