The first 200 years of cardiac auscultation and future perspectives

Maria Rosa Montinari,1 Sergio Minelli2 1Department of Biological and Environmental Science and Technology, University of Salento, Lecce, Italy; 2Department of Cardiology, Local Health Unit Lecce, Lecce, Italy Abstract: Cardiac auscultation – even with its limitations – is still a valid and economical technique for the diagnosis of cardiovascular diseases, and despite the growing demand for sophisticated imaging techniques, clinical use of the stethoscope in medical practice has not yet been abandoned. In 1816, René-Théophile-Hyacinthe Laënnec invented the stethoscope, while examining a young woman with suspected heart disease, giving rise to mediated auscultation. He described in detail several heart and lung sounds, correlating them with postmortem pathology. Even today, a correct interpretation of heart sounds, integrated with the clinical history and physical examination, allows to detect properly most of the structural heart abnormalities or to evaluate them in a differential diagnosis. However, the lack of organic teaching of auscultation and its inadequate practice have a negative impact on the clinical competence of physicians in training, also reflecting a diminished academic interest in physical semiotic. Medical simulation could be an effective instructional tool in teaching and deepening auscultation. Handheld ultrasound devices could be used for screening or for integrating and improving auscultatory abilities of physicians; the electronic stethoscope, with its new digital capabilities, will help to achieve a correct diagnosis. The availability of innovative representations of the sounds with phono- and spectrograms provides an important aid in diagnosis, in teaching practice and pedagogy. Technological innovations, despite their undoubted value, must complement and not supplant a complete physical examination; clinical auscultation remains an important and cost-effective screening method for the physicians in cardiorespiratory diagnosis. Cardiac auscultation has a future, and the stethoscope has not yet become a medical heirloom. Keywords: auscultation, stethoscope, medical history, medical sciences, cardiac physical examinatio

MORTALITY TREND IN APULIA PROVINCES, 1949-2008.

To estimate mortality trends by total and respiratory causes in 1949-2008, to evaluate the possible loss in health of Southern Italy resident

Analisi della mortalità nelle province pugliesi dal 1949 al 2008

Introduzione. Dalla fine degli anni ‘60, la Puglia è teatro di una vasta industrializzazione. Le città diManfredonia, Brindisi,Taranto e Bari hanno visto la nascita di insediamenti industriali, di enormi dimensioni, nei settori della chimica di base, della siderurgia, dell’energia e della farmaceutica, spesso costruiti in stretta prossimità degli abitati. Dalla fine degli anni ‘80 la Puglia annovera tre aree a elevato rischio di crisi ambientale:Manfredonia, Brindisi e l’area di Taranto, e cinque siti di interesse nazionale per le bonifiche localizzati nei comuni di Manfredonia, Bari, Taranto e Brindisi. Obiettivi. Stimare l’andamento della mortalità generale e dei tumori respiratori in quinquenni che coprono la finestra temporale 1949-2008. Metodi. Sono stati calcolati gli SMR% (Standardized Mortality Ratio) per le 5 province, adottando come riferimento la popolazione italiana di fonte censuaria fino al 1971; negli altri periodi la popolazione di fonte Istat stimata dalla rilevazione sulla popolazione residente comunale. I dati sanitari sono stati estratti dai volumi Istat sulle cause di morte. Le analisi non sono disaggregate per sesso. Risultati. I risultati sulla mortalità per tutte le cause indicano valori che oscillano intorno alla media nazionale con un range tra -20%e +20%. La mortalità risulta più elevata di quella nazionale in tutte le province a esclusione di Lecce, agli inizi degli anni ‘50 e degli anni ‘90. A Lecce gli SMR% sono sempre inferiori ai valori di riferimento, mentre nel periodo più recente (2006-08) l’unico valore superiore, ai limiti della significatività, si osserva nella provincia diTaranto (5.143 deceduti per anno, SMR% 101,5; LC95% 99,9-103,1). Per tutti i tumori dell’apparato respiratorio gli SMR% si discostano dai valori nazionali con un range tra -50%e +26%. Lamortalità risulta ovunque inferiore fino agli anni ‘80,mentre valori in eccesso statisticamente significativo si osservano agli inizi degli anni ‘90 nella provincia diTaranto (283 deceduti annuali, SMR% 126,5; LC95%119,9-133,2) e in quella di Lecce (425 deceduti annuali, SMR% 106,4; LC95% 102,0-111,1) e ancora a Lecce nei primi anni 2000 (475 deceduti annuali, SMR% 104,4; LC95% 100,2-108,7). Nelle province di Foggia, Bari e Brindisi la mortalità per questi tumori è sempre inferiore a quella nazionale; a Foggia e Lecce l’andamento è crescente negli anni. Conclusioni. Si conferma quanto già noto, che la mortalità totale nelle province pugliesi, dopo i valori elevati degli inizi anni ‘50, risultamediamente inferiore ai valori nazionali, con valori più elevati essenzialmente agli inizi degli anni ‘90.Nello stesso periodo si rilevano a Taranto e Lecce i primi valori in eccesso di mortalità per i tumori del respiratorio. Il lavoro continuerà ampliando le analisi a tutti i tumori e allemalattie respiratorie, e disaggregandole per sesso dal 1969

THE INCURABLE WOUNDS OF THE SOUL: SUICIDE AS A TRAGIC SELF-AFFIRMATION IN ART AND LITERATURE

This article examines the theme of suicide from a cultural-historical point of view, using art and literature as its sources, particularly in the nineteenth and twentieth century. Art and literature can be used as therapies and medications, as an excellent way of expressing existential distress that, in most cases, requires a symbolic and evocative language. The pain cannot be contained in a definition but rather in a story. So the truth of medical science needs another truth, one that includes the whole person, her psyche and her physicality. The theme of death and suicide concerns the essential questions of human life, issues which statistics, clinical and experimental researches do not address. The art and literature lay bare what a person feels, allowing immediate access to his experience. They can be a response to the suffering and be salvation and medicine, place of disclosure of the human labour on the disease, be it physical, psychological or existential. The modern age is dominated by a medical approach that explains the suicide as a result of a pathological derangement. For Sigmund Freud (1856-1939), suicide was the product of a mental illness.The author's aim is to underline how the artistic-literary language is a privileged instrument to study mankind's mood and existential status

Mortality trend In Apulia Provinces, Italy, 1949-2008

Background Since the late 60s, in Apulia, in South-East of Italy, huge (in size and harmfulness) industrial sites have settled in close proximity to some cities. InLecce province, less heavily industrialized, male lung cancer mortality is a serious problem Aims To estimate mortality trends by total and specific causes covering the time frame 1949-2008, to evaluate the possible loss in health advantage of Southern Italy residents . Methods. Data come from historical publications of National Institute of Statistics: total number of deaths, by province, by specific causes but not by sex; national data instead disaggregated by sex, age and cause since 1927. Causes chosen after a careful evaluation of theICD codes ranging from ICD-5 up to ICD-10. SMR% (Standardized Mortality Ratio) have been computed. At the moment only mortality by all causes, respiratory cancers and pneumonia have been investigated since 1949. Results General mortality is on average lower than national levels, except in Taranto. In Lecce respiratory cancer mortalityshows higher values (+ 3 up to +6% ) since early seventies and Relative- SMR% (ratio to SMR by all causes) is growing with time (from +5% up to +10%) , while in Taranto it declines rapidly. Pneumonia mortality is clearly declining with time. The ratio with Apulia SMR% shows in Taranto high mortality (since 1981 for total and pneumonia mortality, since 1961 for respiratory cancer), in Lecce higher respiratory cancer mortality since 1971, while Bari shows higher mortality by pneumonia in all period. Conclusions As already known mortality in Apulia province is still lower than the national levels, but inside the region Taranto province shows higher mortality for the causes investigated. Bari emerges for high values of pneumonia deaths, while high respiratory cancers mortality is confirmed in Lecce since 40 years, and this corroborate the hypothesis of a local risk factor, as e.g. tobacco cultivation and manufactures

Cell shape and organelle modification in apoptotic U937 cells

U937 cells induced to apoptosis, progressively and dramatically modified their cell shape by intense blebbing formation, leading to the production of apoptotic bodies. The blebs evolved with time; milder forms of blebbing involving only a region or just the cortical part of the cytoplasm were observed within the first hour of incubation with puromycin; blebbing involving the whole cell body with very deep constrictions is the most frequent event observed during late times of incubation. The ultrastructural analysis of apoptotic cells revealed characteristic features of nuclear fragmentation (budding and cleavage mode) and cytoplasmatic modifications. The cytoplasm of blebs does not contain organelles, such as ribosomes or mitochondria. Scarce presence of endoplasmic reticulum can be observed at the site of bleb detachment. However, blebbing is a dispensable event as evaluated by using inhibitor of actin polymerization. In the present study, the progressive modifications of the nucleus, mitochondria, nuclear fragmentation, cytoplasmic blebs formation and production of apoptotic bodies in U937 monocytic cells induced to apoptosis by puromycin (an inhibitor of protein synthesis) were simultaneously analyzed