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J R Guarino

Publications and source records attributed to J R Guarino.

8 recordsLinked to original sources
PubMed1994

Auscultatory percussion: a simple method to detect pleural effusion.

OBJECTIVE: To assess a new technique for the detection of free pleural fluid. DESIGN: 118 consecutive inpatients with radiologic evidence of free pleural fluid and a control group of 175 randomly selected inpatients were examined over a three-year period in a prospective blind study by auscultatory percussion (AP) for evidence of pleural effusion. The cutoff in the percussion note by AP is strikingly loud and sharp at the fluid level and allows precise delineation of even minimal amounts of pleural fluid. The fluid level was measured in reference to the last rib. The criterion for detection of pleural effusion by AP was a demonstrable horizontal fluid level at the sound cutoff across the posterior hemithorax above the last rib that shifted with lateral tilt. SETTING: A general medical and surgical university-affiliated teaching Veterans Affairs hospital. PATIENTS/PARTICIPANTS: All inpatients were eligible. Ready availability of examiners was essential. Rotating third- and fourth-year medical students, residents, and senior staff members participated. INTERVENTIONS: None. MAJOR RESULTS: 113 of the 118 patients with radiologic evidence of pleural effusion had a distinct horizontal fluid level above the last rib that shifted with lateral tilt (sensitivity = 95.8%). None of the 175 control patients examined at random showed evidence of pleural effusion by AP examination, which was confirmed by chest radiography (specificity = 100%). Nine of the 175 patients without radiologic evidence of pleural effusion had elevated diaphragms that simulated a fluid level in the examination by AP. Each of the nine patients, however, had no shift in the level with lateral tilt. Subpulmonic effusions were readily displaced and identified by this method of AP. CONCLUSIONS: Examination by AP is highly sensitive and specific for the detection of free pleural fluid, even in the presence of obesity, thickened pleura, lung masses, pneumonia, and associated lung disease. The examination correlates closely with standard and lateral decubitus chest radiography. Pleural effusion unsuspected by conventional means of physical examination and undetectable by standard chest radiography can readily be detected by the method of AP. The examination is easy to do and is particularly suited to enhance detection of pleural effusion. As little as 50 mL of free pleural fluid can be detected.

Adult↗
PubMed1985

Auscultatory percussion of the urinary bladder.

A volumetric study of the bladder was done in 170 adult male patients examined by auscultatory percussion. The upper border of the urinary bladder was defined and measured in reference to the symphysis pubis to gauge urinary volume. The findings were correlated with the urinary volumes obtained after the bladder had been emptied by voiding in 90 patients without urinary tract disease and in 42 patients who required catheterization. With a bladder level less than 2 cm, none of the patients had a full bladder or a urinary volume of 250 mL. Of the 55 patients with bladder levels of 3 cm or more, 53 patients had full bladders. Catheterizations were timely and avoided frequent and unnecessary catheterization. Residual urinary volumes estimated by auscultatory percussion in 12 patients with obstructive uropathy and 26 patients studied with indwelling catheters correlated closely with the catheterized urinary volumes. Full bladders, obstructive uropathy, and malfunctioning indwelling catheters were readily detected.

Adult↗
PubMed1982

Auscultatory percussion of the head.

Eighty-nine consecutive patients with suspected intracranial masses were examined by auscultatory percussion in a blind study to assess the sensitivity of the procedure. Each patient underwent computed tomography (CT) of the brain as part of his medical care, and the results were compared with those of auscultatory percussion. Fifty-one of the patients had abnormal CT scans, of whom 44 (86%) had abnormal (positive) findings on auscultatory percussion; seven (13%) yielded false-negative results. Each of the patients with subdural haematomas had distinctly positive findings by auscultatory percussion. Of the 38 patients with normal CT scans, 11 had strokes with hemiparesis, and each had positive findings in the contralateral hemisphere by auscultatory percussion. The remaining 27 patients with normal CT scans were healthy; 25 had normal findings on auscultatory percussion, two (7%) gave false-positive results. Twenty subjects were studied with phonoscopy. Auscultatory percussion is easy to perform and is clinically useful.

Adult↗
PubMed1980

Auscultatory percussion of the chest.

In a controlled blind study 28 patients with prominent chest disease by chest X-ray each had normal or equivocal findings by conventional methods of percussion. In each case the lung abnormality was readily detected by auscultatory percussion. Lesions less than 2 cm in diameter were detected.

Adult↗