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PubMed2002

Effects of socioeconomic status on presentation with acute lower respiratory tract disease in children in Salvador, Northeast Brazil.

Two different socioeconomic groups of children with pneumonia were studied, and their clinical and demographic aspects were evaluated. The diagnosis of pneumonia was based on findings of cough and tachypnea, or on crackles on auscultation or on radiologically confirmed infiltrate. This was a prospective cross-sectional study conducted at the Professor Hosannah de Oliveira Pediatric Center, which cares for children of lower socioeconomic status (PHOPC), and at one private hospital which cares for children from middle to high socioeconomic status (Aliança Hospital, AH). Demographics and clinical differences were assessed by the Pearson chi-square test or Fisher's exact test as appropriate; means of continuous variables were compared by Mann-Whitney U-test. In a 26-month period, 3,431 cases were recruited. The 2,476 cases identified at the PHOPC were younger than the 955 identified at AH (2.2 +/- 2.3 vs. 4.5 +/- 3.1 years, P < 0.0001) and had higher scores for severity (3.5 +/- 1.5 vs. 2.7 +/- 1.7, P < 0.0001), duration of hospitalization (days) (10.9 +/- 12.1 vs. 6.2 +/- 7, P < 0.0001), frequency of tobacco smoker in the household (48% vs. 31%, P < 0.0001), cardiopathy (15.3% vs. 5.9%, P = 0.003), fever (44.4% vs. 36.3%, P = 0.0001), tachypnea (67.6% vs. 32.3%, P < 0.0001), crackles (69.5% vs. 64.9%, P = 0.02), somnolence (19.9% vs. 10.4%, P < 0.0001), malnutrition (13.7% vs. 5%, P < 0.0001), hospitalization rate (27.4% vs. 22.5%, P = 0.003), and death (0.9% vs. 0.1%, P = 0.009). However, other features were more frequent among AH cases: parent's university level of education (38.2% vs. 1.0%, P < 0.0001), underlying chronic illness (40.6% vs. 28.5%, P < 0.0001), asthma (62.7% vs. 50.8%, P = 0.01), rhinitis (9.2% vs. 0.4%, P < 0.0001), previous use of antibiotics (34.3% vs. 27.1%, P = 0.001), and wheezing (53.1% vs. 42.2%, P < 0.0001). Children of lower socioeconomic status have more serious lower respiratory tract disease, whereas children with pneumonia of middle to high socioeconomic status have more allergic diseases (rhinitis, asthma) and wheezing.

Adolescent↗
PubMed1990

Aerosolized budesonide in asthmatic infants: a double blind study.

The efficacy of nebulized budesonide (0.5 mg b.i.d.) against placebo was evaluated in the management of asthma in 23 infants, aged 3 to 17 months, using a double blind crossover design. After an initial treatment period of 2 weeks placebo and budesonide were randomly administered during two consecutive treatment periods of 1 month. The progress of the patients was monitored using diary score cards, the number of salbutamol doses needed during the treatment periods, clinical examinations using standardized scoring cards, and registration of parents' preference period. Although there was a tendency toward fewer wheezing periods during budesonide, the results of the diary score cards were not significantly different between the budesonide period and the placebo period. The number of salbutamol doses used was also the same during both periods. Clinical examination after budesonide revealed less rhinitis and a less pathological lung auscultation, but the difference between the two periods was also not significant. Furthermore, the parents' preference could not distinguish between budesonide and placebo. We conclude that the trends in favor of nebulized budesonide are not significant and do not suggest that the suspension is effective in severe infantile asthma.

Administration, Intranasal↗
PubMed1994

Protective effect of albuterol delivered via a spacer device (Babyhaler) against methacholine induced bronchoconstriction in young wheezy children.

Nine young asthmatic children aged 2-5 years underwent methacholine challenge after placebo or albuterol administered by metered dose inhaler through a spacer device (Babyhaler) with a face mask in a double-blind, cross-over, randomized study. The methacholine challenge was performed using chest auscultation to define the provocative concentration of methacholine that causes wheezing (PCW). The PCW increased from a geometric mean of 0.28 mg/mL after placebo to 3.59 mg/mL after albuterol (P < 0.0001). The protective effect of albuterol against methacholine-induced bronchospasm was 3.7 +/- 1.2 doubling doses. We conclude that administration of drugs from a metered dose inhaler through the Babyhaler with a face mask is effective. Albuterol causes a major reduction in the bronchial hyperreactivity in young wheezy children shortly after administration.

Albuterol↗
PubMed2006

Bronchial responsiveness to methacholine and adenosine 5'-monophosphate in preschool children with bronchopulmonary dysplasia.

Bronchial hyperresponsiveness (BHR) is a characteristic feature of asthma, but it is also frequently present in children and adults with chronic obstructive lung diseases. Bronchopulmonary dysplasia (BPD) is a chronic lung disease, most commonly developing after mechanical ventilation and oxygen therapy in premature infants. BHR is usually measured by bronchial challenges, using direct or indirect stimuli. The aim of this study was to evaluate BHR to direct and indirect stimuli in young children with BPD. Methacholine and adenosine 5'-monophosphate (AMP) bronchial challenges were performed on preschool children with BPD (n = 19), using a modified auscultation method. The endpoint was defined as the appearance of wheezing and/or oxygen desaturation. The results obtained were then compared with those of asthmatic (n = 25) and control (n = 23) preschool children. A positive response to methacholine (endpoint concentration, < or = 8 mg/ml) was observed in 89.5% (17/19) of patients with BPD, but a positive response to AMP (endpoint concentration, < or = 200 mg/ml) was observed only in 21.1% (4/19). All patients with asthma responded positively to methacholine, and most (23/25, 92.0%) of them also responded positively to AMP. The majority of controls were unresponsive to both challenges. BHR to methacholine is a frequent finding in preschool-age survivors of BPD, but is usually not accompanied by BHR to AMP. This suggests that most patients with BPD do not have the inflammatory airway response which is characteristic of asthmatic patients.

Adenosine Monophosphate↗
PubMed1997

Seroimmunological characteristics of Korean workers exposed to toluene diisocyanate.

Since type I allergy caused by specific IgE antibodies may play principal roles and IgG antibody-mediated reactions have been thought to be involved in some parts of the pathogenesis, this study was performed to investigate the role of IgE- or IgG-mediated hypersensitivity reactions in development of toluene diisocyanate (TDI) asthma in Korean workers. For 81 TDI spray painters, self-administrative questionnaires and direct interviews on respiratory symptoms, chest auscultation, and measurements of forced vital capacity (FVC) and forced expiratory volume in 1 sec (FEV1.0) were performed. The TDI concentration in their working environments was measured. Levels of serum IgE and IgG specific to TDI were estimated by radioallergosorbent test (RAST) and ELISA using p-tolyl isocyanate-human serum albumin (TMI-HSA) as the antigen. When sputum, cough, and dyspnea aggravated by work or wheezing existed, when FVC or FEV1.0 was less than 80% of the normal reference value, or when IgE RAST for TDI was positive, the peak expiratory flow rate (PEFR) was recorded four times per day for over 2 weeks. If decrease of PEFR was over 20% of baseline PEFR and changing pattern of PEFR was closely related to workshift in time, then a diagnosis of TDI asthma was made. Changing patterns of PEFR of 8 (9.9%) workers corresponded to the diagnostic criteria of TDI-related occupational asthma. Levels of the specific IgE were increased in 9 (11.1%) of the 81 subject workers and in 3 (37.5%) of the 8 PEFR-positive workers. Levels of the specific IgG were increased in 9 (11.1%) workers, and in only 1 (12.5%) of the asthmatics sensitive to TDI. Neither elevated TDI-specific IgE levels nor PEFR test positivities were associated with increased IgG levels. The mean titer of the PEFR-test-positive workers was slightly lower than that of the PEFR-negative workers and that of the IgE RAST-positive workers lower than that of the test-negative workers, but there was no statistical significance. These results suggest that IgG is not deeply involved in the pathogenesis of TDI-induced occupational asthma in Korean workers.

Adult↗
PubMed1988

Scintigraphic images of Swyer-James syndrome.

The Swyer-James Syndrome, first described in 1953, is a rare entity which consists of severe oligemia of one or more pulmonary lobes accompanied with bronchial deformation. Recurrent bronchial infections in childhood are believed to be the cause, leading to obliteration of small airways, alveolar overdistension and, ultimately, the destructive changes characteristic of emphysema. Secondary vascular alterations occur resulting in oligemia of the afflicted lobe. The clinical presentation is variable ranging from the totally asymptomatic patient to dyspnea on exertion or recurrent lower respiratory tract infections. The physical examination may reveal hyperresonance over the affected area, restricted chest expansion on one side, or occasionally rales on auscultation. Radiological findings are characteristic and include a pronounced one sided hyperlucency of the lung (due to oligemia), a mediastinal shift toward the affected side on inspiration, a small ipsilateral hilus, and bronchial deformities as disclosed by bronchography. Another radiologic feature, described as a "sine quanon" condition for diagnosis by Fraser and Paré is the development of air trapping during expiration. Various diagnostic modalities including roentgenography, bronchoscopy, bronchography, angiography and radionuclide imaging are necessary to obtain the diagnosis.

Adult↗
PubMed1994

Symmetry and reproducibility of swallowing sounds.

Cervical auscultation is being used more frequently in the clinical assessment of dysphagic patients. The present study was designed to assess symmetry and the reproducibility of swallowing sounds detected simultaneously from bilateral cervical sites. Symmetry of the swallowing sounds acquired using our method was verified because no significant differences were found for any parameters in both time and frequency domain analyses between swallowing sounds detected bilaterally. This result supports the use of a "unilateral" site for the detection of swallowing sounds. The reproducibility of swallowing sounds was assessed by a coefficient of variation. Results of this analysis suggest that one should evaluate the acoustic characteristics of swallowing sounds from repeated swallows rather than from one swallow.

Acoustics↗
PubMed1996

Influence of age on the immediate cardiovascular response to orthostatic manoeuvre.

The dynamics of cardiovascular changes following standing up from the supine position were investigated in 41 healthy men aged 20-59 years, classified into three groups: (22-26 years, n = 14), (33-49 years, n = 13) and (51-59 years, n = 14). The protocols consisted of a sequence repeated twice lying down-standing up-lying down. The initial period supine was for 20 min and then the subjects remained in each position for 8 min. Stroke volume, cardiac output (CO), ejection time (ET), pre-ejection period and heart rate (HR) were continuously calculated using automated impedance cardiography and electrocardiography. Blood pressure was measured by the auscultation method. The patterns of HR and haemodynamic orthostatic response were shown to be highly reproducible. Most of the indices characterizing the amplitude and rate of cardiovascular changes following standing up showed a tendency towards attenuation with age. However, only the indices of HR, CO and ET responses correlated significantly with age. The strongest relationships with age were observed in the sudden increase in HR (r = -0.61, P < 0.01), the transient increase in CO (r = -0.45, P < 0.001), and the rapid decrease in ET (r = 0.42, P < 0.01) after standing up. A few indices of HR and haemodynamic response also showed weak correlations with the subjects' heights and body masses.

Adult↗
PubMed1989

Arc welders' respiratory health evolution over five years.

The respiratory health of 138 arc welders and 106 control subjects in the same company was studied in 1981 and in 1986. Most of the subjects welded mild steel using the Metal Inert Gas (MIG) process. The controls were workers in the same company, not exposed to any known pulmonary risk. The welders and controls in the analysis had not changed their professional activity nor their smoking habits during these five years. The examinations consisted of a questionnaire on respiratory symptoms, a thoracic auscultation, a chest X-ray and lung function tests: flow-volume curve and steady state CO transfer test. The examinations in 1986 confirmed the risk of non specific radiological impairment (pulmonary reticulo-micronodulation) and of obstruction in the small bronchi, which had already been observed in 1981 in the arc welders in this company. These impairments did not seem to have evolved more than in the controls, but do however justify regular surveillance of the respiratory health of arc welders.

Adult↗
PubMed1996

Quantitative assessment of swallowing in healthy adults.

Swallowing has hitherto been evaluated during physical examination, radiologic barium studies, manometry, and cervical auscultation. Radiography principally demonstrates qualitative aspects of oral and pharyngeal function, whereas quantitative aspects have primarily been documented by manometry. To evaluate swallowing quantitatively, without using invasive methods or radiation, we have applied a combined test of water drinking, i.e., the Repetitive Oral Suction Swallow test (ROSS). The test provides reliable measurements of suction pressure, bolus volume, timing of important events in oral and pharyngeal swallow, and respiration. The test is described and results from 292 healthy, non-dysphagic subjects are presented. We found a mean bolus volume of 25.6 +/- 8.5 ml during single swallow and 21.1 +/- 8.2 ml during stress (forced, repetitive swallow). During forced, repetitive swallow, the bolus volume was more strongly associated with suction time (r2 = 0.55) than with peak suction pressure (r2 = 0.04), indicating that suction time is more important than suction pressure in determining the bolus volume. The oral-pharyngeal transit time decreased: single swallow 0.56 +/- 0.36 sec, forced repetitive swallow 0.23 +/- 0.11 sec, as did the coefficient of variation (48% and 64%, respectively) indicating a more automatic neural process for pharyngeal function in forced, repetitive swallow. The postswallow respiration started with inspiration in 10% of studied individuals, but did not correlate with deviations in other variables in the test. Thus, postswallow inspiration must be considered as normal. The ROSS test offers a rapid and easy quantitative assessment of swallowing.

Adolescent↗
PubMed1979

Resting heart rate in apparently healthy middle-aged men.

Resting heart rate (fcrest) was measured by a standardized technique in 2,014 men aged 40-59 years during a cardiovascular survey. All men were thought to be healthy prior to the survey examination. According to the survey findings, the material was subdivided into 5 clinical subgroups, according to survey findings of coronary heart disease (CHD), or suspect symptoms, or signs. Coronary angiography was performed in 105 subjects with particularly strong suspicions of CHD. FCrest varied between 61-63 among the 5 groups (p greater than 0.10). In 1832/2014 defined as "normals" the following findings were made: 1. Mean fcrest 61 (SD 9.7), and almost identical values obtained by auscultation and from resting ECGs in the same persons. 2. Linear drop in fcrest by age (-0.126 beats/year, p less than 0.001). 3. Increase in fcrest with increasing systolic blood pressure. Since there is no generally accepted technique for measuring fcrest it is suggested that the wide variation in fcrest reported in the literature at least in part may be due to differences in techniques.

Adult↗
PubMed1986

Responses in muscle sympathetic nerve activity to sustained hand-grips of different tensions in humans.

To clarify whether sympathetic nerve activity increases in relation to the tension of a sustained muscle contraction, muscle sympathetic nerve activity (MSA) was recorded directly from the peroneal nerve fascicle at the popliteal fossa by means of tungsten microelectrodes in five healthy male subjects. A sustained muscle contraction was performed by handgrip for two minutes in a supine position at tensions of 10, 30 and 45% of maximal grip strength (MGS). MSA, electrocardiogram (ECG) using bipolar electrodes from the chest and surface electromyogram (EMG) from the extensor pollicis longus were recorded simultaneously before and during the sustained handgrip. Arterial blood pressure was measured at the resting upper arm by auscultation. During handgrip with tensions of 10, 30 and 45% MGS, average MSA burst rate (bursts X min-1) increased to 122, 152 and 230% of the resting value, respectively. During the same experimental procedures with tensions of 10, 30 and 45% MGS, average heart rate increased to 105, 110 and 111% of the resting value. These results confirm that sympathetic outflow to a resting muscle is increased with elevation of tension in an active muscle. This process would promote perfusion pressure in the active muscle.

Adult↗
PubMed1992

Gaucher's disease with mitral and aortic involvement: echocardiographic findings.

Cardiac involvement in Gaucher's disease has been reported in only a few patients, mostly adults with pericardial changes. We describe findings in two siblings with Gaucher's disease, aged 15 and 9 years respectively, in whom mitral and aortic valve lesions were evaluated by auscultation and echocardiography. In both cases the mitral and aortic valves were thick and restricted in motion. Continuous Doppler echocardiography revealed significant mitral regurgitation and mitral stenosis. At the aortic valve level there was a systolic pressure gradient. Echocardiographic investigation of patients with suspected cardiac involvement with Gaucher's disease is recommended.

Adolescent↗
PubMed1982

Remote Medical Diagnosis System (RMDS) concept.

The goal of the Remote Medical Diagnosis System (RMDS) is to provide assistance to medical personnel on navy ships and at remote locations by providing an adequate consulting link with a physician at some other site. The RMDS utilizes navy communication links and commercial telephone lines for the exchange of patient physiological information and diagnostic/treatment advice. Narrow band-width (3 kHz) hf and uhf radio and satellite communication channels are utilized. The RMDS terminals perform the function of processing analogue physiological information (images, electrocardiograms, (ECG), auscultation, and voice) into a digital format suitable for transmission over the communication links. These terminals also perform the inverse operation of processing the received digital bit streams into analogue information for visual display. The digital data are transmitted at a rate of 2,400 bps.

Diagnosis↗
PubMed1992

PADS (Patient Archiving and Documentation System): a computerized patient record with educational aspects.

Rapid acquisition and analysis of information in an Intensive Care Unit (ICU) setting is essential, even more so the documentation of the decision making process which has vital consequences for the lives of ICU patients. We describe an Ethernet based local area network (LAN) with clinical workstations (Macintosh fx, ci). Our Patient Archiving and Documentation System (PADS) represents a computerized patient record presently used in a university hospitals' ICU. Taking full advantage of the Macintosh based graphical user interface (GUI) our system enables nurses and doctors to perform the following tasks: admission, medical history taking, physical examination, generation of problem lists and follow up notes, access to laboratory data and reports, semiautomatic generation of a discharge summary including full word processor capabilities. Furthermore, the system offers rapid, consistent and complete automatic encoding of diagnoses following the International Classification of Disease (ICD; WHO, [1]). For educational purposes the user can also view disease entities or complications related to the diagnoses she/he encoded. The system has links to other educational programs such as cardiac auscultation. A MEDLINE literature search through a CD-ROM based system can be performed without exiting the system; also, CD-ROM based medical textbooks can be accessed as well. Commercially available Macintosh programs can be integrated in the system without existing the main program thus enabling users to customize their working environment. Additional options include automatic background monitoring of users learning behavior, analyses and graphical display of numerous epidemiological and health care related problems. Furthermore, we are in the process of integrating sound and digital video in our system. This system represents one in a line of modular departmental models which will eventually be integrated to form a decentralized Hospital Information System (HIS).

Computer User Training↗
PubMed1992

Capnography does not reliably detect double-lumen endotracheal tube malplacement.

Two patients are described in whom double-lumen endotracheal tube malplacement and its ventilatory consequences were not detected by infrared capnography. Problems were suspected on auscultation, and the malplacement was diagnosed by means of bronchospirometry. We conclude that bronchospirometry helps detect problems with endotracheal intubation.

Carbon Dioxide↗
PubMed1991

Improved detection of hypotension by automated noninvasive blood pressure monitoring.

This study was undertaken to determine whether the use of automated noninvasive blood pressure monitoring altered the frequency of detection of intraoperative hypotension. We retrospectively reviewed 1,861 anesthetic records from a period in 1987, when blood pressure was obtained manually by auscultation. We compared the records from 1987 with 1,716 anesthetic records from 1989, when automated blood pressure monitors were used universally. The incidences of hypotension requiring vasopressor therapy were determined during the two periods and compared using Student's two-tailed t test. The data revealed that the incidence of detected hypotension increased from 2.4 to 5.2% with the use of automated blood pressure monitors (P less than 0.00002). We conclude that at our hospital the use of automated noninvasive blood pressure monitors increases the incidence of detection of intraoperative hypotension as compared with the use of manual blood pressure measurement.

Anesthesia↗
PubMed1989

Sampling intervals for clinical monitoring of variables during anesthesia.

Although five minutes is the sampling interval mentioned by the American Society of Anesthesiologists for monitoring blood pressure and heart rate during anesthesia, most patients are monitored more closely by continuous auscultation and with the help of automated instruments. Yet this difference between the interval recommended and that actually used indicates that sampling intervals are not defined clearly enough. Therefore, we present three methods with which to determine sampling intervals during monitoring. To explore the feasibility of these methods we examined data gathered every 7.5 seconds during three typical, noncatastrophic physiologic perturbations induced in an anesthetized dog. We chose hypercapnia secondary to rebreathing, hypotension secondary to deep anesthesia, and hypoxemia secondary to a low concentration of inspired oxygen as realistic examples of what can occur during operation and anesthesia. We studied three variables: respired carbon dioxide, femoral arterial blood pressure, and oxygen saturation of hemoglobin (pulse oximeter). The data obtained during monitoring were subjected to three methods of analysis: (1) recording of sets of data, with various starting times, at five-minute intervals only (moving grid); (2) Fourier analysis; and (3) analysis of slopes. For the data of the experiment, the Fourier analysis yielded, on average, longer sampling intervals than did the analysis of slopes.

Anesthesia, General↗