Venothromboembolic signs and medical eponyms: Part II.

Eponyms were established to serve the purpose of honoring individuals who have made important observations and discoveries. The use of eponyms remains controversial, and important questions have been raised regarding their appropriateness. Although there have been instances where eponyms were abandoned, the remainder are largely embedded within the established literature making their disappearance unlikely. Physicians used a variety of techniques to describe signs of medical eponyms as a method for diagnosing deep venous thrombosis (DVT), pulmonary embolism (PE) or venothromboembolism (VTE). These methods (observation, palpation, pressure, or maneuvers), were detected during the physical examination and using bedside sphygmomanometer or radiographic imaging. Reviewed are both common and less frequently encountered VTE eponyms identified during the physical examination and radiologic imaging. Most of these signs have not been further studied and, therefore, there is a lack of information regarding their accuracy and reliability in clinical practice.

Korotkoff sounds -- the improbable also occurs.

Very few discoveries have had such a large impact on and relevance to clinical medicine as the noninvasive measurement of the diastolic blood pressure. A number of gifted physiologists and clinicians were ineffectively in search of a noninvasive method to determine the diastolic pressure. Nonetheless, the quantification of the diastolic BP was not achieved by any of these clinical or physiological researchers, but by an unlikely and unexpected figure: Nikolai Sergeevich Korotkoff (1874-1920), a young Russian army surgeon, working under precarious conditions in the hardship of diverse wars. It is easy to dismiss the achievement of Korotkoff as a serendipitous discovery, similar to that of Alexander Fleming in the discovery of penicillin. However, Nassim N. Taleb's recent black swan theory may serve to illustrate his discovery in a new and, perhaps, surprising way.

Pulse wave analysis as an experimental tool to clinical application: past and present (review).

Pulse examination by palpation of a peripheral artery against a bony prominence is the most commonly used and widely accepted method. However this is subjective and thus prone to errors. Although pulse waveform was recorded in the 19th century, it did not gain popularity because of inconvenience in using the recording instruments and the absence of a sound theory to explain the wave forms recorded. Sphygmomanometry for recording blood pressure gained popularity as it was easy to record and had a sound theoretical background. Sphygmomanometry provides two extreme values of blood pressure but does not give a true representation of the blood pressure changes occurring in the entire cardiac cycle. Recently there has been resurgence in the analysis of the graphical recording of the pulse wave. Photoplethysmography is becoming a widely accepted technique in assessing the volume pulse. The whole review is about historical background, non-invasive methods of pulse recording, relation of the digital volume pulse to the pressure pulse and the advantages of recording the pressure pulse.

Arterial blood pressure measurement and pulse wave analysis--their role in enhancing cardiovascular assessment.

The most common method of clinical measurement of arterial blood pressure is by means of the cuff sphygmomanometer. This instrument has provided fundamental quantitative information on arterial pressure in individual subjects and in populations and facilitated estimation of cardiovascular risk related to levels of blood pressure obtained from the brachial cuff. Although the measurement is taken in a peripheral limb, the values are generally assumed to reflect the pressure throughout the arterial tree in large conduit arteries. Since the arterial pressure pulse becomes modified as it travels away from the heart towards the periphery, this is generally true for mean and diastolic pressure, but not for systolic pressure, and so pulse pressure. The relationship between central and peripheral pulse pressure depends on propagation characteristics of arteries. Hence, while the sphygmomanometer gives values of two single points on the pressure wave (systolic and diastolic pressure), there is additional information that can be obtained from the time-varying pulse waveform that enables an improved quantification of the systolic load on the heart and other central organs. This topical review will assess techniques of pressure measurement that relate to the use of the cuff sphygmomanometer and to the non-invasive registration and analysis of the peripheral and central arterial pressure waveform. Improved assessment of cardiovascular function in relation to treatment and management of high blood pressure will result from future developments in the indirect measurement of arterial blood pressure that involve the conventional cuff sphygmomanometer with the addition of information derived from the peripheral arterial pulse.

The history and evolution of circulatory shock.

This article reviews the development of early ideas regarding the origins and pathogenesis of shock. The early history of shock is related primarily to traumatic shock. More recent history centers on differentiation of clinical syndromes and individual characteristics. Definitions, classification systems, pathogenic theories, and treatments have evolved. Progress has been aided by constant development of improved assessment technologies. Today, shock is not a single syndrome and the definition of shock no longer is descriptive in nature. The most accepted current definition involves an oxygen supply/demand imbalance that can have various causes-hypovolemia, cardiac dysfunction, vascular failure, or obstructive processes.

Arterial aging: pathophysiological principles.

In the nineteenth century, prior to the introduction of the cuff sphygmomanometer, arteriosclerosis (stiffening of arteries) was recognized by clinicians and by life insurance companies as an indicator of vascular aging and cardiovascular risk, even in asymptomatic individuals. Through the twentieth century, views on aging came to focus on values of systolic and diastolic pressure and on obstructive atherosclerotic disease. Such focus deflected attention from the primary aging change which occurs in all societies, and is represented by stiffening and dilation of the proximal aorta. This review emphasizes the cushioning function of elastic arteries - principally the aorta - and how in youth this results in optimal interaction with the heart, and optimal steady flow through peripheral resistance vessels. Aortic stiffening with age is principally due to fatigue and fracture of elastin lamellae, with transfer of stress to stiffer collagenous components. Stiffening increases left ventricular load and myocardial blood requirement, but limits the capacity for blood supply during diastole. Consequences are cardiac failure and predisposition to ischaemia. The second, under-appreciated effect of aortic stiffening is transmission of flow pulsations downstream into vasodilated organs, principally brain and kidney, where pulsatile energy is dissipated and fragile microvessels are damaged. This accounts for micro infarcts and microhaemorrhages, with specialized cell damage, cognitive decline and renal failure. The aging process can be best monitored by change in the arterial pressure wave rather than by reliance on the cuff sphygmomanometer. This reintroduces the approaches by clinicians and life insurance examiners of the nineteenth century, endorses modern treatments for established disease, and holds the promise of detecting premature arterial degeneration, and better applying lifestyle measures and vasoactive medications to modify the aging process.

Karl Samuel Ritter Von Basch: the sphygmomanometer and the Empire.

The measurement of blood pressure is essential in clinical practice, and sphygmomanometers are a necessary appliance in every medical office. One of the most important men in the development of the sphygmomanometer was the Austrian physician Karl Samuel Ritter Von Basch. Even though Von Basch's name is not widely known, he developed the first non-invasive and clinically acceptable sphygmomanometer and introduced the aneroid manometer for the measurement of blood pressure. He also had an important role in history by witnessing, and documenting, the short lived Second Mexican Empire of Maximilian of Hapsburg. His contributions to Mexico's history and to the study of hypertension make him a notable figure, and one that should be remembered.

Sons de Korotkoff: desenvolvimento da pesquisa em esfigmomanometria na Escola de Enfermagem da USP / Korotkoff Sounds: development of the sphygmomanometry research at the Nursing School of the USP

Este artigo tem como objetivos reverenciar Sergei Nicolai Korotkoff por ocasião do centenário da descoberta do método auscultatório de medida da pressão arterial na Rússia, em 1905; relatar os fatos que culminaram no desenvolvimento da esfigmomanometria no Brasil; historiar a valiosa contribuição da Escola de Enfermagem da Universidade de São Paulo (EEUSP) no desenvolvimento da pesquisa, na área da medida da pressão e analisar o produto da linha de pesquisa “Influência da Largura do Manguito na Medida da Pressão Arterial”, gerada na EEUSP a partir de 1974. O artigo relata a consolidação dos achados iniciais pelos estudos que permitiram a formação dos primeiros doutores na área, que sugere a confirmação de hipóteses em estudos longitudinais.

Scipione Riva-Rocci and the men behind the mercury sphygmomanometer.

The history of the blood pressure (BP) concept and measurements is described. Many scientists were involved. Among them, major triumphs were achieved by William Harvey during the early 1600s who announced that there is a finite amount of blood that circulated the body in one direction only. In the mid-1700s, Reverend Stephen Hales reported the first invasive measurement in horses and smaller animals. Poiseuille introduced in the early 1800s the mercury hydrodynometer and the mmHg units. Karl von-Vierordt described in 1855 that with enough pressure, the arterial pulse could be obliterated. He also created the sphygmograph, a pulse recorder usable for routine non-invasive monitoring on humans. In 1881, von Basch created the sphygmomanometer and the first non-invasive BP measurements. However, in 1896, Scipione Riva-Rocci developed further the mercury sphygmomanometer, almost as we know it today. The sphygmomanometer could only be used to determine the systolic BP. Observing the pulse disappearance via palpitation would only allow the measuring physician to observe the point when the artery was fully constricted. Nikolai Korotkoff was the first to observe the sounds made by the constriction of the artery in 1905.

Desde Riva Rocci, Recklinghausen e Korotkoff até a atualidade: o desafio da mensuração precisa da pressão arterial / From Riva Rocci, Recklinghausen and Korotkoff to nowadays: the challenge of blood pressure measurement accuracy

A possibilidade de medir a pressão arterial, procedimento mais realizado por médicos e enfermeiros no mundo, representou um dos maiores desafios enfrentados pelos cientistas do século XVI ao XIX. A introdução do esfigmomanômetro de Riva-Rocci em 1896 e do método auscultatório por Korotkoff em 1905, grandes conquistas na área cardiovascular, constituíram fatos promissores ao melhor conhecimento das moléstias cardíacas e nefrológicas. Entretanto, após um século de pesquisas em esfigmomanometria, o desafio imposto pela obtenção de uma medida livre de erros, que garanta o diagnóstico preciso da hipertensão, continua sem ser vencido. A comemoração do centenário da descoberta dos “Sons de Korotkoff”, neste ano de 2005, suscita reflexões sobre o desafiante trabalho realizado pelos cientistas pioneiros da esfigmomanometria e suas conquistas na caracterização conhecimento na área, até a descoberta do método auscultatório. O autor espera oferecer subsídios para que o leitor compreenda os fatos vêm retardando o conhecimento na área desde o início do século XX, tornando difícil o controle das variáveis implícitas na garantia da medida acurada e prejudicando o diagnóstico e tratamento da hipertensão.

This review points out the centenary of the Korotkoff Sounds and the importance of his study to blood pressure control and the development of the cardiovascular area. The author aims to homage the Russian investigator and other scientists who developed the sphygmomanometer studies in the previous centuries. It presents an overview of the literature related to cuff size, from Recklinghausen's study up to the last American Heart Association recommendation for cuff size published in 2005. Cuff width influence on blood pressure measurement and its consequences in the misdiagnosis and mistreatment of hypertension is discussed. It emphasizes particularly the imprecision of blood pressure measurements in lean and normal weighted persons, as well as the lack of attention of the AHA to the results reached by scientific groups dedicated to the specific area.