Pulmonary and hepatic lesions associated with suspected ganskweek (Lasiospermum bipinnatum) poisoning in cattle.

A field outbreak of poisoning of cattle by ganskweek (Lasiospermum bipinnatum [Thunb.] Druce) in the Molteno district is described. In addition to the typical histopathological lesion of zonal hepatic necrosis and haemorrhage, pulmonary lesions of interstitial pneumonia, emphysema and bronchial epithelial changes similar to those described in experimental ganskweek poisoning in sheep are reported.

K-wire fixation of supracondylar humeral fractures in children: results of open reduction via a ventral approach in comparison with closed treatment.

The morbidity and functional outcome of K-wire fixation of dislocated supracondylar humeral fractures in children after open reduction through a ventral approach were studied, using the results after closed reduction as a golden standard. A series of 49 children were evaluated retrospectively. Of these, 46 children could be included in the study, of whom 35 were treated with closed reduction (group A) and 11 were treated with open reduction via a ventral approach (group B). All fractures were splinted in plaster for 3 weeks postoperatively. Thereafter free active motion of the elbow was permitted. Our data show that open reduction via a ventral approach carries no morbidity. The time for full functional recovery was equal in both groups. Only one out of 11 patients showed mild varus deformity after open reduction, while this slight malalignment occurred in five of 35 patients after closed reduction. The final anatomical and functional results did not differ between the two groups. It can be concluded that K-wire fixation of dislocated supracondylar fractures in children gives excellent results and that open reduction via a ventral approach is a logical, safe and elegant alternative, if closed reduction fails.

Lung sound intensity in patients with emphysema and in normal subjects at standardised airflows.

BACKGROUND: A common auscultatory finding in pulmonary emphysema is a reduction of lung sounds. This might be due to a reduction in the generation of sounds due to the accompanying airflow limitation or to poor transmission of sounds due to destruction of parenchyma. Lung sound intensity was investigated in normal and emphysematous subjects in relation to airflow. METHODS: Eight normal men (45-63 years, FEV1 79-126% predicted) and nine men with severe emphysema (50-70 years, FEV1 14-63% predicted) participated in the study. Emphysema was diagnosed according to pulmonary history, results of lung function tests, and radiographic criteria. All subjects underwent phonopneumography during standardised breathing manoeuvres between 0.5 and 2 1 below total lung capacity with inspiratory and expiratory target airflows of 2 and 1 l/s respectively during 50 seconds. The synchronous measurements included airflow at the mouth and lung volume changes, and lung sounds at four locations on the right chest wall. For each microphone airflow dependent power spectra were computed by using fast Fourier transformation. Lung sound intensity was expressed as log power (in dB) at 200 Hz at inspiratory flow rates of 1 and 2 l/s and at an expiratory flow rate of 1 l/s. RESULTS: Lung sound intensity was well repeatable on two separate days, the intraclass correlation coefficient ranging from 0.77 to 0.94 between the four microphones. The intensity was strongly influenced by microphone location and airflow. There was, however, no significant difference in lung sound intensity at any flow rate between the normal and the emphysema group. CONCLUSION: Airflow standardised lung sound intensity does not differ between normal and emphysematous subjects. This suggests that the auscultatory finding of diminished breath sounds during the regular physical examination in patients with emphysema is due predominantly to airflow limitation.

Technical aspects and clinical results of an esophageal pick-up for better recording of posteriorly generated heart sounds.

A miniature esophageal microphone has been constructed. It has a cylindrical shape with 5-mm outer diameter and 25-mm length. It is a type of accelerometer that detects vibration from the esophageal wall. It has a resonance frequency of 2.1 kHz and an acceleration charge sensitivity of 2.8 pCm-1s2. The upper limit of the useful frequency range is about 1 kHz. It has directional sensitivity which reaches a maximum perpendicular to the plane of the crystal. With the esophageal microphone cardiovascular sound is recorded simultaneously with other tracings: external phonocardiogram, E.C.G., carotid pulse and M-mode echocardiogram. The great advantage of the application of the esophageal microphone is that it can be positioned in the esophagus close to the mitral valve and the left atrium by use of fluoroscopy, so that sounds and murmurs originating from that part of the heart are recorded in detail. In a case of a shunt between aorta and pulmonary artery the microphone was used at different levels in the esophagus, showing different amplitudes of a continuous murmur. In all other cases the probe was situated in the esophagus just above the level of the mitral valve behind the left atrium. In 2 cases the advantage of the esophageal microphone (revealing signs of slight mitral incompetence) over the body surface microphone is shown. In 3 patients with artificial valves in the aortic and mitral orifices (where left heart catheterisation and left ventricular angiography is a considerable risk), the esophageal microphone also improved the postoperative evaluation and diagnosis of mitral valve regurgitation considerably.

Evaluation of the Penàz servo-plethysmo-manometer for the continuous, non-invasive measurement of finger blood pressure.

Blood pressure in the finger was measured by a servo-plethysmomanometer constructed after the design of Penàz, which uses the principle of the unloaded arterial wall. The device contains a photoelectric plethysmograph mounted in an inflatable cuff and an electro-pneumatic transducer to control air pressure in the cuff via a servosystem. Comparison of simultaneous measurements of intra-arterial pressure in the brachial artery was performed on 33 patients suspected of having hypertension. In 12 patients evaluation of the technique could not be carried out due to technical failures or distorted blood pressure wave forms. Results of the remaining 21 patients show a mean underestimation of intra-arterial blood pressure by finger cuff blood pressure of 0.8 kPa (6 mm Hg), both for systolic and diastolic levels. The scatter range of the difference is from 1.9 to -3.5 kPa for systolic and 0.1 to -2.5 kPa for diastolic values. It appears that, although not all technical problems are solved, the Penàz servo-plethysmo-manometer is potentially an elegant method by which to arrive at the fully calibrated wave form of blood pressure in a finger in a non-invasive and continuous fashion.

A non-invasive study of the third heart sound in children by phono and echo-cardiography.

There has been in the past and still is controversy over the genesis of the third heart sound (S3). Recent studies, however, strongly suggest that S3 is a manifestation of a sudden intrinsic limitation in the expansion of the L.V. The present study has aimed to explore that hypothesis further, using a spectral analysis technique. A FFT technique was used to determine the spectral distribution of S3 in 14 child subjects between the ages of 2 and 19 years. Spectral energies in 15 Hz frequency bandwidths were correlated with various 2D-echocardiographically derived parameters. This study has shown that the spectral energy of S3 is distributed in the lower frequency bands. Fifty percent (47 +/- 16%) is distributed in the 0-15 Hz band. Also it was found that: (i) as mitral orifice size increases, energy in the 0-15 Hz band of S3 decreases. (r = -0.53, p less than 0.05), (ii) S3 occurs earlier in the cardiac cycle with increase in age of the subject. (r = -0.76, p less than 0.005), (iii) the energy distribution of S3 tends towards the higher frequencies with increase in age. (r = 0.52, p less than 0.05). Further, the above results support the hypothesis that S3 is the result of an intrinsic limitation to the expansion of the L.V. due to an early diastolic pressure rise caused by an increased viscoelasticity of the myocardium. This, and the relation of the results in certain pathologies are also discussed.

Evaluation of specific pick-ups and preamplifiers for the recording of heart vibrations.

Experiments have shown that pick-ups used for the recording of heart vibrations (apexcardiography, phonocardiography) can influence the vibrations of the soft tissue chest wall to which they are applied. This influence is most pronounced in the medium and high frequency range (10 . . . . . 1000 Hz). Owing to the mechanical loading effect of the pick-up on the chest wall, the vibrations are attenuated and distorted. This is also shown with respect to pure mass loading of the chest wall. The loading effect on the chest wall (coupling function) has been studied by us in the frequency-domain as well as in the time-domain on 6 normal subjects who were in the recumbent position. Typical parameters of the coupling function have been established in relation to mass loading. An empirical formula has been found for the degree of attenuation of the vibrations caused by the load. In order to perform these investigations, a special seismic pick-up FYSPac2 has been constructed which will load the tissue to a slight degree only. Its mass is 1 g and it has a flat frequency response up to 1 kHz and a high sensitivity (12 pC m-1s2). The problem of the vibration measurement on soft tissue is discussed here in its whole context: the loading effect of the pick-up, the sensitivity (and bandwidth) of the pick-up as well as the quality of the preamplifier as regards its transfer characteristics and its electronic noise level.(ABSTRACT TRUNCATED AT 250 WORDS)