Bruits, ophthalmodynamometry and rectilinear scanning on transient ischemic attacks.
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One hundred seventeen patients with clinical signs and symptoms of transient ischemic attacks (TIAs) were evaluated. All underwent clinical evaluation for bruit, ophthalmodynamometry, rapid sequence scintiphotography with rectilinear scanning and four-vessel cerebral angiography. The results of these tests were compared for reliability in predicting location of lesions causing transient ischemic attacks. Angiography remains the most accurate procedure in evaluating extracranial vascular lesions. When determination of bruits, ophthalmodynamometry and brain scanning are done together, accuracy is greater than when any one of the procedures is done alone. (+info)
Comparison of four methods for assessing airway sealing pressure with the laryngeal mask airway in adult patients.
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We have compared four tests for assessing airway sealing pressure with the laryngeal mask airway (LMA) to test the hypothesis that airway sealing pressure and inter-observer reliability differ between tests. We studied 80 paralysed, anaesthetized adult patients. Four different airway sealing pressure tests were performed in random order on each patient by two observers blinded to each other's measurements: test 1 involved detection of an audible noise; test 2 was detection of end-tidal carbon dioxide in the oral cavity; test 3 was observation of the aneroid manometer dial as the pressure increased to note the airway pressure at which the dial reached stability; and test 4 was detection of an audible noise by neck auscultation. Mean airway sealing pressure ranged from 19.5 to 21.3 cm H2O and intra-class correlation coefficient was 0.95-0.99. Inter-observer reliability of all tests was classed as excellent. The manometric stability test had a higher mean airway sealing pressure (P < 0.0001) and better inter-observer reliability (P < 0.0001) compared with the three other tests. We conclude that for clinical purposes all four tests are excellent, but that the manometric stability test may be more appropriate for researchers comparing airway sealing pressures. (+info)
Effect of positioning on recorded lung sound intensities in subjects without pulmonary dysfunction.
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BACKGROUND AND PURPOSE: Physical therapists often use positioning to assist in the reexpansion of collapsed lung segments. An increase in lung sound intensity on auscultation is considered indicative of lung expansion. This study was designed to examine whether clinical interpretation of auscultatory findings is warranted. SUBJECTS: The subjects (5 male, 6 female) were young physical therapist students without pulmonary dysfunction (mean age=20.4 years, mean height=166.3 cm, mean weight=57.5 kg). Subjects with lung disease were excluded because pulmonary pathology is difficult to standardize. METHODS: Lung sounds electronically recorded over the posterior chest wall of subjects in sitting and side-lying positions were compared. Measures included peak intensity, frequency at maximum power, and median frequency. RESULTS: In the sitting position, inspiratory sounds recorded over the left posterior chest wall were louder than those recorded on the right side. In the side-lying positions, the sound intensity recorded from the dependent chest wall was louder than that recorded from the nondependent chest wall. In side-lying positions, the upper hemithorax is "nondependent," and the side in contact with the bed is "dependent." Sound intensities recorded over both posterior chest walls in the sitting position were louder than those recorded over the same lung area in the nondependent side-lying position. There was no difference in the sound intensity recorded between the sitting and dependent side-lying postures. CONCLUSION AND DISCUSSION: When comparative auscultation of the chest wall is used by physical therapists to assess the adequacy of pulmonary ventilation, patient posture and regional differences in breath sound intensity can influence clinical interpretation. (+info)
Heart murmurs in pediatric patients: when do you refer?
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Many normal children have heart murmurs, but most children do not have heart disease. An appropriate history and a properly conducted physical examination can identify children at increased risk for significant heart disease. Pathologic causes of systolic murmurs include atrial and ventricular septal defects, pulmonary or aortic outflow tract abnormalities, and patent ductus arteriosus. An atrial septal defect is often confused with a functional murmur, but the conditions can usually be differentiated based on specific physical findings. Characteristics of pathologic murmurs include a sound level of grade 3 or louder, a diastolic murmur or an increase in intensity when the patient is standing. Most children with any of these findings should be referred to a pediatric cardiologist. (+info)
Methacholine challenge in preschool children: methacholine-induced wheeze versus transcutaneous oximetry.
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Tracheal/chest auscultation for wheeze and transcutaneous oximetry have both been suggested as measures of outcome in bronchial provocation tests in young children. This study aimed to compare the sensitivity and safety of these two techniques as end-points for methacholine challenge in children aged <4 yrs. Seventy-two methacholine challenges were performed in 39 children aged <4 yrs with recurrent wheeze. Arterial oxygen saturation (Sa,O2) and transcutaneous oxygen pressure tcPO2 continuously, and the test was terminated when wheeze was heard or at Sa,O2 <91%. tcPO2 was not used as an end-point. Wheeze or desaturation occurred at < or =8 mg x mL(-1) methacholine in every test. One child had transient clinical cyanosis, but no other ill-effects were seen. Fifty-six tests (78%) were terminated for wheeze, seven (10%) for fall in Sa,O2 and nine (12%) showed simultaneous responses in both parameters. Twenty-eight tests (39%) contained a fall in tcPO2 >3 kPa but six of these also showed a significant rise. Fifty-three tests (75%) contained a fall in tcPO2 >15%, but 20 of these also showed a significant rise. Tracheal/chest auscultation with Sa,O2 monitoring is a sensitive and relatively safe end-point for bronchial challenges in preschool children. The erratic pattern of transcutaneous oxygen pressure response in some children casts doubt on its reliability as a proxy measure of bronchial obstruction. (+info)
Acoustic monitoring of intraoperative neuromuscular block.
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Standard methods for accurate intraoperative measurement of neuromuscular block are either expensive or inconvenient and are not used widely. We have evaluated a new method of monitoring neuromuscular block using a low-frequency microphone. The method is based on the phenomenon of low-frequency sound emission by contracting skeletal muscle. Acoustic monitoring (MIC) with an air-coupled microphone was used to evaluate intraoperative neuromuscular block in 25 anaesthetized patients. The MIC recorded the response of the adductor pollicis muscle to supramaximal electrical stimulation of the ulnar nerve with train-of-four stimuli. The ratios of the first response (TI) to control (TC) were used for evaluation. Data obtained from the MIC were compared with simultaneous recordings, from the same hand, of mechanomyography (FDT), electromyography (EMG) and accelerography (ACC). Throughout the operative procedure, TI/TC ratios of the acoustic method correlated with the three reference devices: FDT, 12 patients, 262 data sets, r = 0.86, bias (%MIC-%FDT) = mean -5.3 (SD 19.6)%; EMG, 18 patients, 490 data sets, r = 0.85, bias (%MIC-%EMG) = -0.39 (20.29)%; and ACC, 13 patients, 328 data sets, r = 0.91, bias (%MIC-%ACC) = -3.0 (15.6)%. We conclude that monitoring intraoperative neuromuscular block by a microphone which transduces low-frequency muscle sounds is clinically feasible. (+info)
A new double cuff sphygmotonometer for accurate blood pressure measurement.
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Accurate measurement of blood pressure (BP) is essential in the diagnosis and treatment of hypertension, but neither auscultatory nor oscillometric methods measure intra-arterial BP accurately in all circumstances. Algorithms for automatic BP-measuring devices differ from manufacturer to manufacturer, and no clear authorized algorithm criteria have yet been established. We have devised a double-cuff sphygmotonometer to measure BP on the basis of clear algorithms, and investigated the accuracy of this new method by comparing it with the photo-oscillometric method, which is the most accurate method for non-invasive measurement of intra-arterial BP. In the new method, a small cuff (3x6 cm) replaces the photo-sensor in the brachial cuff (13x24 cm) of the photo-oscillometric device, and BP is determined by means of the oscillation within the small cuff. The comparison based on procedures of AAMI-protocol was performed in 136 hypertensive patients and 54 normotensive subjects. The difference in systolic BP between the photooscillometric and double-cuff methods was -2.26+/-2.31 mmHg (89% under 5 mmHg), and the corresponding difference in diastolic BP was 1.9+/-2.50 mmHg (94% under 5 mmHg). In conclusion, we have devised a new double-cuff method which improves on the photo-oscillometric method, and although it seems to be less accurate than the photo-oscillometric method, the clarity of its algorithm makes it superior to the conventional oscillometric and auscultatory methods employing only one cuff. (+info)
The clinical evaluation of the Respi-check mask: a new oxygen mask incorporating a breathing indicator.
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Study objective-To investigate the correlation between the Respi-check sensor and simultaneous chest auscultation in determining the respiratory rates in adults. METHODS: Random visits to a local accident and emergency (A&E) department were made and all patients wearing oxygen masks were recruited into the study. The new sensor was attached to the outside of the mask. One researcher auscultated the chest to count breaths, the other counted the sensor activity. Each was blinded to the activities of the other. Breaths were counted by each researcher simultaneously and independently over one minute. A total of 40 patients were recruited into the study. A difference of more than two breaths/min compared with chest auscultation was deemed as a sensor failure. RESULTS: The respiratory rates of 40 patients were measured. There were 28 men, 12 women. Twenty six patients were wearing an Intersurgical high concentration (flow 12l/min) mask, 14 were wearing an aerosol mask with variable venturi (flow 3-12l/min) by Medicaid. Over one minute rates determined by the two methods were the same in 28 cases (70%). It was accurate to within one breath in 37 cases (93%) and to within two breaths in 39 (98%) cases and in one case (2.5%) the sensor failed. The mean difference (mean of the differences between rates obtained from auscultation and the new sensor) was -0.1282 breaths/min, with limits of agreement (d (2SD) between -1.414 to 1.157 breaths/min. CONCLUSION: The Respi-check sensor provides an accurate method of estimating the respiratory rate in adult patients attending the A&E department. (+info)