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PubMedDate not supplied

Effectiveness of the auscultatory method in predicting feeding tube location.

A clinical study was conducted to determine the extent to which sounds generated by air insufflations through feeding tubes could be used to predict where the tubes' ports ended in the gastrointestinal tract (esophagus, stomach or proximal small intestine), and to differentiate between gastric and respiratory placement. Sounds generated by a series of air insufflations through the tubes of 85 acutely-ill adult subjects were recorded. One hundred fifteen usable tape-recordings of sound sequences were obtained. The principal investigator later played the tapes for the research team members (who were also skilled clinicians) so that they could independently record their impressions of the sounds. (No identification of subjects or tube positions were given on the tapes; however, each site of auscultation was announced.) The results were collated and compared against the hypotheses and actual tube location (as determined by X-ray). Overall, the average percentage of correct classifications of each tape was 34.4%. Descriptive data were reported for three subjects with feeding tubes inadvertently positioned in the respiratory tract; air insufflations were clearly audible in 2 of the 3 cases. Clinicians should not rely on the auscultatory method to differentiate gastric from intestinal placement, nor gastric from respiratory placement of feeding tubes.

Adult↗
PubMed1990

Detection of inadvertent respiratory placement of small-bore feeding tubes: a report of 10 cases.

Documented inadvertent respiratory placement of small-bore feeding tubes was identified in 10 patients over a 2-year period in five intensive care units and two general wards. Types and effectiveness of bedside methods used by clinicians to test tube position were described. The most frequently used methods were observation for respiratory distress and auscultation of the abdomen during air insufflations through the tubes. It was concluded that commonly used bedside methods to test feeding tube placement often gave false reassurance that the tubes were properly positioned.

Adult↗
PubMed1990

[A study of how to distinguish the side on which TMJ noise is occurring].

Many patients with TMJ dysfunction suffer from TMJ noise. The measurement of TMJ noise is an important factor in assessing the state of the TMJ dysfunction. Consequently we measured the TMJ noise using electrical techniques in order to make an accurate record. However, determining the side on which the noise occurs is not always easy in auscultation or when picking up the noise electrically, because the sound is carried across the bony structure and picked up on both sides. To solve this problem, we used a three-directional accelerometer, measuring the sound on both sides in the hope that a difference in measurements would allow us to identify the side of the noise. In this study, we vibrated one side of the TMJ with pulse waves, and we compared the vibrated side to the unvibrated side. The height of the pulses was held at 4 volts. In addition, we changed the rising time from 0 volt to 4 volts within a range of 0.6-2.0 msec. The following results were obtained. 1. The time difference between the peaks of the three directions was from 0.32 msec to 3.22 msec on the vibrated side, and from 2.92 msec to 18.2 msec on the unvibrated side. 2. Whenever the time was increased within the selected range, the time difference between the peaks of the three directions on the vibrated side was shorter than that on the unvibrated side. 3. These results suggest that the use of a three-directional accelerometer is a reliable method of distinguishing on which side the TMJ noise is occurring.

Acceleration↗
PubMed1990

Clinical and electrocardiographic characterization of cattle with atrial premature complexes.

Atrial premature complexes (APC) were identified in 16 cows over a 2-year period. Fourteen cows had concurrent gastrointestinal disease. Variation in the intensity of the first heart sound and an occasionally irregular heart rhythm were evident during thoracic auscultation. Neither cardiac murmurs nor pulse deficits were detected in any cows, and clinical signs of heart failure were lacking. Three cows had APC immediately prior to or after development of atrial fibrillation. The heart rate when APC were diagnosed ranged from 48 to 124 beats/min (mean, 77 +/- 20 beats/min), and the APC frequency ranged from less than 1 to 23/min (mean 9.4 +/- 8.0). The P-wave morphologic characteristics in 4 cows with APC was abnormal. The coupling index of the APC varied between 0.44 and 0.95, with a mean of 0.73. Aberrant ventricular activation was usually associated with a short coupling interval (coupling index less than 0.60) and was observed in 3 cows. Ten cows were determined to be hypocalcemic and 4 cows hypokalemic when APC were identified. Atrial ectopic activity could not be detected in 12 cows after resolution of the concurrent gastrointestinal disorder or electrolyte abnormality. Atrial premature complexes may be a functional cardiac disorder in cattle, unrelated to structural heart disease. The potential for APC to progress to sustained atrial arrhythmias such as atrial fibrillation should be considered.

Animals↗
PubMed1975

Edema of the pulmonary interstitium in infants and children.

Ten infants and children with respiratory failure, receiving standard maintenance water requirements, were treated on 13 occasions with intravenously given furosemide (1 to 2 mg/kg) because of continued impairment of oxygenation despite conventional therapy. Pulmonary auscultation and radiographs were normal or typical of the primary diagnosis. After a five-fold increase in urine output the mean Po2 rose from 61 mm Hg at a mean FiO2 of 0.7 to 140 mm Hg at an FiO2 of 0.65. The Pco2 decreased from 46 to 38 mm Hg. Interstitial pulmonary edema in these patients can be related to both their lung disease and impaired water tolerance during ventilatory therapy.

Adolescent↗
PubMed1989

[A study of how to distinguish the occurring side of TMJ noise--multiple click].

Patients with TMJ dysfunction often suffer from TMJ noise. However, determining the side at which the noise occurs is not always easy in auscultation or when picking up the noise electrically, because the sound is carried across the bony structure and picked up on both sides. To solve this problem, we utilized a three-directional accelerometer, measuring the sound on both sides in the hope that a difference in measurements would identify the side of the noise. We discovered that time difference between the acceleration peaks for the side originating the sound was shorter than that of the other side. Our report also contains a few observations on the result of this study on patients with plural TMJ noises occurring during one movement of the mandible.

Auscultation↗
PubMed1989

[ Self measurement of blood pressure. Equipment and comparison of equipment].

Precision is the primordial criterion for the evaluation of a blood pressure measuring device. While traditionally devices based on the auscultation technique have dominated semiautomatic devices have recently gained acceptance. The latter permit to reduce procedure-related errors. They are simpler to use and require less demanding instruction but are more expensive than stethoscopic devices.

Auscultation↗
PubMed1989

Mitral valve prolapse: an overview.

Since its original description by Barlow over a quarter of a century ago, mitral valve prolapse has become one of the commonest heart diseases around the world. It is commoner in women than men, in thinner than heavier subjects, and in younger than older persons. A unifying concept of a valvular-ventricular disproportion serves to explain the various conditions in which mitral valve prolapse occurs. The etiology of chest pain which is the most frequent symptom that brings the patient with mitral valve prolapse to a physician is multifactorial. Diagnosis of mitral valve prolapse is based on clinical grounds chiefly by careful auscultation. Echocardiography, angiocardiography, and radionuclide ventriculography are valuable adjuncts. Prognosis in the majority is excellent except when complications occur, such as progressive mitral regurgitation, infective endocarditis, cerebral ischemic episodes, and sudden death. For mitral valve surgery repair is preferred to replacement.

Adult↗
PubMed1989

Temporomandibular joint sounds: a critique of techniques for recording and analysis.

Sonography, or the graphic recording of sounds, has been proposed as an objective measure of various pathological conditions in the temporomandibular joint. Various electronic devices have been developed to enhance our ability to auscultate the joint, monitor the timing of the sounds with jaw movement, and analyze the characteristics of the sound; the intent of these devices is to diagnose the intracapsular condition "objectively." This review paper critically evaluates the advantages and limitations of this technique. Based on the existing literature, these instruments can record sounds; however, the origin of these sounds is uncertain, since room noise, skin and hair sounds, respiration, arterial blood flow, and cross-over noises from the opposite TMJ have not been excluded as possible artifacts of the recording. More important, the diagnostic specificity, as an indicator of each type of TMJ disease, has not been clearly and consistently demonstrated with the sonographic technique.

Auscultation↗
PubMed1989

[Venous hum and innominate vein flow velocity in chronic anemia: a pulsed Doppler echocardiographic study].

To assess the hemodynamic correlates of the cervical venous hum in patients with chronic anemia, 14 patients (mean age; 49 years, mean hemoglobin (Hb); 7.3 g/dl) and 14 control subjects (mean age; 50 years, mean Hb; 14 g/dl) without cardiac disease were studied by auscultation, phonocardiography and Doppler echocardiography in two positions (supine and sitting). Venous hum was detected in the sitting position in 11 of the 14 anemic patients whose Hb was less than 9 g/dl, and in six anemic patients in the supine position, while venous hum was absent in the control subjects in both positions. Pulsed Doppler echocardiography with the transducer in the supraclavicular fossa revealed significantly (p less than 0.01) higher peak velocity in the innominate vein in the 11 anemic patients with venous hum (supine; 71 +/- 12, sitting; 111 +/- 24 cm/sec, mean +/- SD) than in the control subjects (supine; 46 +/- 15 sitting; 76 +/- 27 cm/sec) in both positions. Intensity of venous hum increased concomitantly with increased innominate vein flow velocity when the body position was changed from supine to sitting. Peak velocity in the innominate vein correlated significantly with Hb in all study subjects (r = 0.65, p less than 0.01). In conclusion, the cervical venous hum in patients with chronic anemia is related to the hemoglobin concentration and flow velocity in the innominate vein.

Adolescent↗
PubMed1989

[Evaluation of the reliability of the diagnostic methods in farmer's lung].

Following a study of the diagnosis of farmer's lung (PDF) carried out in 1763 active farm workers in Doubs, 294 (16.7%) were suspected of PDF and they were invited to a secondary consultation in hospital for a further work up which consisted of a clinical examination for crepitations (RC) on pulmonary auscultation (AP) and for evidence of an interstitial lung disorder (SI) on pulmonary radiograph (RP) and for evidence of a restrictive syndrome (SR) on pulmonary function tests (EFR). 238 patients (80%) accepted the additional assessment and were divided into two groups on the basis of the history and serology (precipitin tests), group 1: probable PDF (n = 65): symptoms suggestive of PDF in the presence of serum precipitins; group 2: possible PDF (n = 173): non specific symptoms with or without serum precipitins. RC were present in 21.9% of patients in group 1 and 6.4% of patients in group 2 (p less than 0.001). There was an SI in 9.2% of patients in group 1 and 4% of patients in group 2 (non significant). For the elevated radiology scores for SI there was a significant difference: 7.7% for SI in group 1 and 1.73% in group 2 (p less than 0.05). There was 38.1% of abnormal EFR in group 1 and 14.7% in group 2 (p less than 0.001) but the difference of the frequency of SR in the 2 groups was not statistically significant (9.5% in group 1 and 4.7% in group 2). In this study, an additional assessment (AP, RP, EFR) carried out at a difficult moment during winter does not appear to confirm great benefit.(ABSTRACT TRUNCATED AT 250 WORDS)

Auscultation↗
PubMed1987

High frequency of mitral valve prolapse and aortic regurgitation among asymptomatic adults with Down's syndrome.

Although cardiac anomalies are well documented among children with Down's syndrome, data on the cardiac status of adults with Down's syndrome are sparse. Therefore, we performed cardiac auscultation and Doppler echocardiographic examinations in 35 asymptomatic adults with Down's syndrome. There were 25 men and ten women; their mean age (+/- SD) was 26 +/- 8 years. Only ten subjects (29%) had normal findings on examination. The most frequent abnormal findings were holosystolic mitral valve prolapse (MVP) in 20 subjects (57%) and mild aortic regurgitation in four subjects (11%). Of the 20 subjects with MVP, five had associated tricuspid valve prolapse, but none had notable mitral regurgitation. Thus, we found that the majority of asymptomatic adults with Down's syndrome had valvular heart abnormalities. The high frequency of MVP and aortic regurgitation suggests that these lesions may be specifically associated with Down's syndrome in adults.

Adult↗
PubMedDate not supplied

Measures to test placement of nasogastric and nasointestinal feeding tubes: a review.

A literature review regarding commonly recommended bedside measures to test nasogastric and nasointestinal feeding tube placement is presented in this article. Among the methods discussed are: aspiration of recognizable gastrointestinal contents, auscultation of insufflated air, measurement of pH of gastrointestinal secretions, and observing for coughing and choking, inability to speak, and the appearance of bubbles from the end of the tube when it is held under water. Fallibilities in these methods as well as discrepancies in recommendations for their implementation and interpretation are discussed along with implications for current practice and needed areas for research.

Auscultation↗
PubMed1987

Evaluation of the neck veins.

In spite of numerous technical advances in cardiovascular diagnosis, the bases for determination of the need for diagnostic tests and therapy and for evaluation of the response to therapy often remain the history and bedside physical findings. The complete cardiovascular examination includes evaluation of the arterial pulsations, the precordial pulsations, and cardiac auscultation. The correct interpretation of the jugular venous pulse is an integral part of the examination. The jugular venous pulsations reflect the systolic and diastolic hemodynamics of the right atrium and, in the absence of obstruction of the tricuspid valve, of the right ventricle as well. When correctly interpreted, the jugular venous pulsations provide information about right ventricular hemodynamics and important clues to the diagnosis. Instead of trying to find the classically described A and V waves in normal people, one should look for the systolic collapse of the normal jugular venous pulse. When one is thoroughly familiar with the normal variations, the few common abnormalities are easy to appreciate.

Cardiomyopathies↗
PubMed1988

[Computer-assisted analysis of intestinal sounds for assessing the motility of the gastrointestinal tract].

Intestinal noise analysis by means of a computerized analyser is a method by which various functional states of the gastro-intestinal tract can be diagnosed. Interference noise from respiration and cardiac action can be suppressed by filtering. Frequency patterns determined were in good correlation with the clinical picture and auscultation findings. It is, basically, possible to identify the original causative organ.

Auscultation↗
PubMed1987

Phonocardiographic diagnosis of diaphragmatic flutter.

A 45-year-old man was reported who experienced rapid rhythmic nodding of his head and equally rapid contractions in his epigastrium, which participated by certain psychic situations. Auscultation and phonocardiography revealed a sound with "machine" rhythmicity at a rate of 333 per minute over the lower lateral thoracic region during all cardiac phases, and a diagnosis of "diaphragmatic flutter" was established. The symptoms and signs were controlled by diazepam.

Adult↗
PubMed1987

[Examination and treatment of respiratory tract diseases in the horse in clinical practice].

In spite of regular vaccinations against equine influenza we are still observing a high rate of patients with respiratory problems in the equine practice. In our practice in Munich Riem, into which a horse clinic has been integrated, 4000 horses have been treated in 1985 alone. 874 of these showed some form of respiratory disease (= 22%). All of the 4000 horses have only been treated curatively, i.e. preventive forms of treatment such as vaccinations, deworming and examinations for insurance companies and prior to selling have not been taken into account. From 1983 until today in our clinic 256 horses with COPD had undergone clinical treatment. While out-patient horses had been treated for acute, subacute and chronic diseases of the respiratory system, in-patients were examined and treated for chronic respiratory disorders. Hospitalised horses had previously undergone treatment for varying periods of time. Apart from endemic or epidemic horse affections with signs of acute infections, the majority of patients treated belonged to a basically sound population. In the latter cases it is often just not possible to ascertain the individual causes of respiratory disease. Following documentation of the history of the present illness and after careful clinical examination including determination of breath frequency and type, lung auscultation and endoscopy (laryngoscopy, bronchoscopy), a symptomatic treatment of the horse is usually initiated. In cases of laryngitis or laryngotracheitis inhalations may be successful.(ABSTRACT TRUNCATED AT 250 WORDS)

Animals↗
PubMed1987

The lung exam.

Accurate diagnosis is essential for effective treatment. After history-taking, the physical examination is second in importance in assessing a pulmonary patient. The time-honored sequence of inspection, palpation, percussion, and auscultation is appropriate. Diagnostic tests are becoming more complex, more expensive, and more inclined to separate the patient and physician. The stethoscope is still the more commonly used diagnostic medical instrument, but it is not always used to best advantage. It is familiar, harmless, portable, and inexpensive. Its appropriate use improves medical practice and reduces costs. Improvements in sound recording and analysis techniques have spurred a renewed interest in lung sounds and their meaning. This is likely to lead to better understanding of what we hear, and perhaps to the development of new noninvasive diagnostic and monitoring techniques.

Auscultation↗