- Mapping Progress in Reducing Cardiovascular Risk with Kidney Disease: Managing Volume Overload. [Journal Article]
- CJClin J Am Soc Nephrol 2018 Aug 15
- Laryngeal Inflammatory Pseudotumour Secondary to Mycobacterium kansasii. [Journal Article]
- CRCase Rep Pathol 2018; 2018:9356243
- CONCLUSIONS: This case demonstrates both the clinical and histological difficulties in making the diagnosis of IPT. A high index of suspicion is needed, and the importance of a multidisciplinary approach in the work-up, diagnosis, and management is highlighted.
- Laryngotracheal stenosis in burn patients requiring mechanical ventilation. [Journal Article]
- WJWorld J Otorhinolaryngol Head Neck Surg 2018; 4(2):117-121
- CONCLUSIONS: Patients become symptomatic within weeks of the initial injury. Treatment is challenging and multiple surgical procedures are often required. A larger study is necessary to determine if the incidence is higher among burn patients.
- Accidental discovery of a mass on the left main bronchus in a patient undergoing thyroid surgery. [Journal Article]
- SJSaudi J Anaesth 2018 Jul-Sep; 12(3):465-467
- A left lung mass after induction and tracheal intubation, which partially was obstructing the left main bronchus, was accidentally discovered in a 56-year-old female scheduled to undergo elective tot...
A left lung mass after induction and tracheal intubation, which partially was obstructing the left main bronchus, was accidentally discovered in a 56-year-old female scheduled to undergo elective total thyroidectomy. Her preoperative chest X-ray showed a right-sided shift of the trachea. She did not have stridor or shortness of breath or superior vena cava obstructive syndrome. Induction and tracheal intubation were performed uneventfully. Fiberoptic bronchoscopy performed and showed complete obstruction on the left main bronchus. Excision biopsy suggested mucoepidermoid carcinoma (MEC). MEC is one of the very rare neoplasms of the lungs. Most lesions are low grade and overall prognosis may be more favorable than other forms of lung cancer.
- Tracheal sounds accurately detect apnea in patients recovering from anesthesia. [Journal Article]
- JCJ Clin Monit Comput 2018 Aug 11
- Apnea should be monitored continuously in the post anesthesia care unit (PACU) to avoid serious complications. It has been confirmed that tracheal sounds can be used to detect apnea during sedation i...
Apnea should be monitored continuously in the post anesthesia care unit (PACU) to avoid serious complications. It has been confirmed that tracheal sounds can be used to detect apnea during sedation in healthy subjects, but the performance of this acoustic method has not been evaluated in patients with frequent apnea events in the PACU. Tracheal sounds were acquired from the patients in the PACU using a microphone encased in a plastic bell. Concurrently, a processed nasal pressure signal was used as a reference standard to identify real respiratory events. The logarithm of the tracheal sound variance (log-var) was used to detect apnea, and the results were compared to the reference method. Sensitivity, specificity, positive likelihood ratios (PLR), and negative likelihood ratios (NLR) were calculated. One hundred and twenty-one patients aged 55.5 ± 13.2 years (mean ± SD) with a body mass index of 24.6 ± 3.7 kg/m2 were included in data analysis. The total monitoring time was 52.6 h. Thirty-four patients experienced 236 events of apnea lasting for a total of 122.2 min. The log-var apnea detection algorithm detected apnea with 92% sensitivity, 98% specificity, 46 PLR and 0.08 NLR. The performance of apnea detection in the PACU using the log-var tracheal sounds method proved to be reliable and accurate. Tracheal sounds could be used to minimize the potential risks from apnea in PACU patients.
- Predicting spirometry readings using cough sound features and regression. [Journal Article]
- PMPhysiol Meas 2018 Aug 09
- Spirometry is a commonly used method of measuring lung function. It is useful in the definitive diagnosis of diseases such as asthma and chronic obstructive pulmonary disease (COPD). However, spirome...
Spirometry is a commonly used method of measuring lung function. It is useful in the definitive diagnosis of diseases such as asthma and chronic obstructive pulmonary disease (COPD). However, spirometry requires cooperative patients, experienced staff, and repeated testing to ensure the consistency of measurements. There is discomfort associated with spirometry and some patients are not able to complete the test. In this paper, we investigate the possibility of using cough sound analysis for the prediction of spirometry measurements. Approach: Our approach is based on the premise that the mechanism of cough generation and the forced expiratory maneuver of spirometry share sufficient similarities enabling this prediction. Using an iPhone, we collected mostly voluntary cough sounds from 322 adults presenting to a respiratory function laboratory for pulmonary function testing. Subjects had the following diagnoses: obstructive, restrictive, or mixed pattern diseases, or were found to have no lung disease along with normal spirometry. The cough sounds were automatically segmented using the algorithm described in . We then represented cough sounds with various cough sound descriptors and built linear and nonlinear regression models connecting them to spirometry parameters. Augmentation of cough features with subject demographic data is also experimented with. The dataset was divided into 272 training subjects and 50 test subjects for experimentation. Main Results: The performance of the auto-segmentation algorithm was evaluated on 49 randomly selected subjects from the overall dataset with a sensitivity and PPV of 84.95% and 98.51%, respectively. Our regression models achieved a root mean square error (and correlation coefficient) for standard spirometry parameters FEV1, FVC, and FEV1/FVC of 0.593L (0.810), 0.725L (0.749), and 0.164 (0.547), respectively, on the test dataset. In addition, we could achieve sensitivity, specificity, and accuracy of 70% or higher by applying the GOLD standard for COPD diagnosis on the estimated spirometry test results. Significance: The experimental results show high positive correlation in predicting FEV1 and FVC and moderate positive correlation in predicting FEV1/FVC. The results show possibility of predicting spirometry results using cough sound analysis.
- Whistling Cough. [Journal Article]
- NEJMN Engl J Med 2018 Aug 09; 379(6):e10
- Adventitious and Normal Lung Sounds in the General Population: Comparison of Standardized and Spontaneous Breathing. [Journal Article]
- RCRespir Care 2018 Aug 07
- CONCLUSIONS: The mode of breathing had an impact on both adventitious and normal lung sounds. Although adventitious sounds were found with similar frequency between the modes of breathing, less than half of these subjects were identified with both methods. Spontaneous breathing was not inferior to standardized breathing in reflecting lung disease.
- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- In the era of technological advances, a thorough examination of the respiratory system retains its importance in diagnosing disorders of the respiratory system. Auscultation of the chest is among the...
In the era of technological advances, a thorough examination of the respiratory system retains its importance in diagnosing disorders of the respiratory system. Auscultation of the chest is among the oldest bedside diagnostic techniques used to assess airflow through airways. It is an easy, safe, non-invasive and cost-effective diagnostic technique.  The majority of the manifestations of respiratory disease present with abnormalities of chest examination. Egophony is increased resonance of voice sounds heard when auscultating the lungs. When spoken voices are auscultated over the chest, a nasal quality is imparted to the sound which resembles the bleating of a goat. Egophony (also known as “E” to “A” change) is an auscultatory finding due to a change in the quality (timbre) of the voice. A solid (consolidated), fluid-filled, or compressed lung decreases the amplitude and only allows select frequencies to pass through. This changes the sound of the vowel “E” to "A."  Pathophysiology Over the years there have been various theories explaining the mechanism of egophony. In 1894, Dr. Frederick Taylor described egophony as a musical discord.  Transmission of sound vibrations from the larynx and tracheobronchial tree to the chest wall depends on the state of the underlying lung tissue and surrounding pleural space. In the lung of a typical individual, air-filled spaces are surrounded by solid parenchymal tissue. Egophony is commonly seen in pneumonia (consolidation) and pleural effusion. Mechanism of egophony in consolidation The sound of the vowel "E" has a low frequency in the range of 100 to 200 Hz as compared to the low frequency of "A" which may reach up to 600 Hz. The sound "E" consists of a high frequency in the range of 2000 to 3500 Hz. Consolidation creates a dense medium that facilitates the transmission of lower frequencies. Hence in a patient with an underlying consolidation, an "E" is transformed into an "A."  Mechanism of egophony in pleural effusion In the case of pleural effusion, fluid accumulates in the pleural space. This fluid compresses the overlying lung parenchyma, making it more solid than usual. Due to this change, there is an alteration in the lung acoustics that preferentially transmits higher sound frequencies and gives rise to an egophony.  Egophony in pleural effusion is characteristically heard at the upper border of the effusion.
New Search Next
- Spontaneous Diaphragmatic Hernia. [Journal Article]
- CPClin Pract Cases Emerg Med 2018; 2(3):244-246
- A spontaneous diaphragmatic hernia (SDH) occurs when intra-abdominal contents extend into the thoracic cavity through a defect in the diaphragm after a sudden increase in intra-abdominal pressure. SD...
A spontaneous diaphragmatic hernia (SDH) occurs when intra-abdominal contents extend into the thoracic cavity through a defect in the diaphragm after a sudden increase in intra-abdominal pressure. SDH is one of the rarest surgical emergencies with less than 30 reported cases in the literature.1,2 In our case a 94-year-old female presented to the emergency department in respiratory distress with unilateral breath sounds and was diagnosed with a SDH. The only treatment option for a SDH is surgical.3,11 However, nasogastric tube decompression of the gastrointestinal tract and supplemental oxygen can be used to alleviate symptoms until definitive operative management is performed.