Podcasts about laennec

Episode: 1095 The lesion within: Medicine learns look inside the human body.  Today, we try to locate the seat of disease.

Paul Harvey - Rene Laennec

Al giorno d'oggi è normale trovare medici con stetoscopi alle orecchie che si lavano le mani prima di visitarvi. E che sanno disinfettare le ferite del post operatorio. In questa puntata di Mc2 a cura di Matteo Curti e Francesco Lancia scoprirete che non è sempre stato così, e che c'è stato un periodo in cui si ignorava la connessione fra stracci usati e ferite infette, ad esempio. Periodo in cui si moriva per un nonnulla.See omnystudio.com/listener for privacy information.

Alla base di tutto c'è un gioco per bambini imparato da un medico francese: René Laennec, uno dei più celebri patologi di Parigi. L'ingegno e la sorte fanno il resto ed è così che nel 1816 nasce lo stetoscopio, uno degli strumenti che rivoluziona la capacità diagnostica dei medici e, in generale, la medicina.

Le président Emmanuel Macron a décidé de lancer une convention citoyenne au mois d'octobre, pour une durée de six mois, après la publication par le Comité consultatif national d'éthique d'un avis favorable à une aide active à mourir, strictement encadrée. Cette question hautement sensible est présentée comme un grand chantier sociétal de ce début de second quinquennat.  Pour rappel, la loi de 2016, dite loi Claeys-Leonetti, du nom de ses auteurs, interdit l'euthanasie et le suicide assisté. En revanche, elle permet ce que l'on appelle la «sédation profonde et continue» jusqu'à la mort pour les malades en phase terminale et en très grande souffrance quand leur pronostic vital est engagé à court terme. Le débat est officiellement lancé. L'émission Priorité Santé fait le point. Dr Denis Labayle, médecin, chef de service pendant vingt-cinq ans dans la région parisienne, Denis Labayle est à l'origine du manifeste des 2 000 soignants qui, en 2007, ont affirmé avoir aidé à mourir des malades en fin de vie. Coprésident de l'association Le Choix. Auteur de l'ouvrage Le Médecin, la liberté et la mort. Pour le droit de choisir sa fin de vie, aux éditions Plon   Pr François Damas, médecin au CHR de la Citadelle à Liège où, depuis 2014, il a ouvert une consultation de fin de vie Dr Isabelle Moulin, pneumologue, anime à l'Hôpital Delafontaine de Saint-Denis, une équipe mobile de soins palliatifs, après avoir créé celle de l'Hôpital Laennec, à Paris, en 1994. Auteure de l'ouvrage Allez donc mourir ailleurs ! - Un médecin, l'hôpital et la mort, aux éditions Buchet Chastel.   En fin d'émission, nous retrouvons la chronique nutrition du Dr Binetou Cheikh Seck, diététicienne-nutritionniste au Cabinet diététique nutridéal à Dakar au Sénégal.

Le président Emmanuel Macron a décidé de lancer une convention citoyenne au mois d'octobre, pour une durée de six mois, après la publication par le Comité consultatif national d'éthique d'un avis favorable à une aide active à mourir, strictement encadrée. Cette question hautement sensible est présentée comme un grand chantier sociétal de ce début de second quinquennat.  Pour rappel, la loi de 2016, dite loi Claeys-Leonetti, du nom de ses auteurs, interdit l'euthanasie et le suicide assisté. En revanche, elle permet ce que l'on appelle la «sédation profonde et continue» jusqu'à la mort pour les malades en phase terminale et en très grande souffrance quand leur pronostic vital est engagé à court terme. Le débat est officiellement lancé. L'émission Priorité Santé fait le point. Dr Denis Labayle, médecin, chef de service pendant vingt-cinq ans dans la région parisienne, Denis Labayle est à l'origine du manifeste des 2 000 soignants qui, en 2007, ont affirmé avoir aidé à mourir des malades en fin de vie. Coprésident de l'association Le Choix. Auteur de l'ouvrage Le Médecin, la liberté et la mort. Pour le droit de choisir sa fin de vie, aux éditions Plon   Pr François Damas, médecin au CHR de la Citadelle à Liège où, depuis 2014, il a ouvert une consultation de fin de vie Dr Isabelle Moulin, pneumologue, anime à l'Hôpital Delafontaine de Saint-Denis, une équipe mobile de soins palliatifs, après avoir créé celle de l'Hôpital Laennec, à Paris, en 1994. Auteure de l'ouvrage Allez donc mourir ailleurs ! - Un médecin, l'hôpital et la mort, aux éditions Buchet Chastel.   En fin d'émission, nous retrouvons la chronique nutrition du Dr Binetou Cheikh Seck, diététicienne-nutritionniste au Cabinet diététique nutridéal à Dakar au Sénégal.

Seguimos con nuestra tercera temporada, viviendo cómo se construye la medicina De la Carne a la Ciencia. En nuestro segundo episodio conocemos a René Laennec, el mojigato de bretaña. -------------- Hipócrates Rules es un podcast producido por Lo que es la ciencia (@loqueeslacienci) para Radio UNR Guión original y narración: Oscar Bottasso Producción: Natalia Fernández Baez , Martín Parodi y Juan Ignacio Isern Locución: Guillermo Peñalves Guión: Luciano Redigonda Actuación: Lucila Campos, Facundo Ibarra, Rodrigo Catalá, Federico Saenz, Virginia Tassone, Florencia Ferreira, Gabriel Bissang, Gabriel Levin, Federico Carra, Leonor Capara, Martín Parodi y Natalia Fernandez Baez Estrategia de comunicación y diseños:: Virginia Tassone La música de la tercera temporada de Hipócrates Rules fue producida a partir de un convenio con la Escuela de Música de la Facultad de Humanidades y Arte. En el Episodio 2 la música original es de Manuel Sánchez (Ig y Tw: @manusanchez_ros) Es un podcast pensado desde la Universidad Nacional de Rosario (@UNRoficial)

C'est un jour de février 1816, devant le palais du Louvre que René Laennec a eu la meilleure idée de sa vie ! Découvrez le moment où le premier dispositif de stéthoscope est apparu dans la tête de son inventeur. Tout sur Tout HISTOIRE est un podcast NRJ et iHeartPodcasts.

René Laennec morre aos 45 anos em 3 de agosto de 1826, em decorrência de tuberculose pulmonar, fato particularmente irônico para um homem que dedicou grande parte de sua vida a estudar as doenças pulmonares. Foi inventor da pectoriloquia – o famoso “diga 33” do médico – folhas de papel enroladas em forma de cilindro que, apoiadas no tórax do paciente, permitia ouvir bem a batida do coração. Aperfeiçoada, a invenção levou o nome de estetoscópio.Veja a matéria completa em: https://operamundi.uol.com.br/politica-e-economia/14039/hoje-na-historia-1826-morre-rene-laennec-inventor-do-estetoscopio----Quer contribuir com Opera Mundi via PIX? Nossa chave é apoie@operamundi.com.br (Razão Social: Última Instancia Editorial Ltda.). Desde já agradecemos!Assinatura solidária: www.operamundi.com.br/apoio★ Support this podcast ★

Alexis Drahos pour son beau livre "Art et Médecine" (Citadelles et Mazenod). Nouvel opus articulant l'art et la science, « Art et médecine » offre au lecteur un aperçu clair et précis des relations qui se sont nouées entre le monde artistique et la médecine. Des premières scènes de dissection de l'Antiquité aux découpes anatomiques dérangeantes de Damien Hirst en passant par les représentations de nains et de bouffons de Vélasquez, l'ouvrage revisite la grande épopée de l'histoire de la médecine tout en mettant à l'honneur des figures incontournables de la médecine comme Hérophile, Galien, Vésale, Laennec, Semmelweis ou Charcot. Grâce à une multitude de dessins, gravures, peintures et sculptures, il explore l'évolution, à travers les siècles, des disciplines médicales telles que la chirurgie, la dentisterie, l'ophtalmologie ou encore la cardiologie, la cancérologie et la psychiatrie. L'étude d'oeuvres d'art soigneusement choisies, aussi bien auprès de grands maîtres qu'auprès d'artistes moins connus, est l'occasion de faire revivre les grandes découvertes anatomiques et médicales telles que la circulation du sang, le vaccin, l'invention du stéthoscope, la théorie microbienne, l'anesthésie, la transplantation cardiaque... mais également de passer à la loupe les grands chefs-d'oeuvre de Van Eyck, Michel-Ange, Goya ou Munch sous le prisme souvent méconnu des pathologies.

Nouvelle diffusion des sorties BD avec Xavier Vanbuggenhout : - « Naphtaline » de Sole Otero (Ça et Là) - « La Part merveilleuse Tome 2 : Les yeux de Juliette » de Ruppert et Mulot (Dargaud) - « Les cabanes de Nylso » (Misma) Au tout début de sa carrière, Marc Danval a rencontré Salvador Dali à l'hôtel Meurice à Paris, alors qu'il travaillait à Paris pour Radio Luxembourg. On vous diffuse une partie de cette interview. Polar et littérature de genre avec Michel Dufranne : Deux romans qui (en apparence) ne donnent pas envie d'être lus mais qui sont passionnants à lire : - Jean-Baptiste Naudet, Seul pour tuer Hitler, Novice - Jeff Lindsay, Riley tente l'impossible, Gallimard/Série Noire Alexis Drahos pour son beau livre "Art et Médecine" (Citadelles et Mazenod). Nouvel opus articulant l'art et la science, « Art et médecine » offre au lecteur un aperçu clair et précis des relations qui se sont nouées entre le monde artistique et la médecine. Des premières scènes de dissection de l'Antiquité aux découpes anatomiques dérangeantes de Damien Hirst en passant par les représentations de nains et de bouffons de Vélasquez, l'ouvrage revisite la grande épopée de l'histoire de la médecine tout en mettant à l'honneur des figures incontournables de la médecine comme Hérophile, Galien, Vésale, Laennec, Semmelweis ou Charcot. Grâce à une multitude de dessins, gravures, peintures et sculptures, il explore l'évolution, à travers les siècles, des disciplines médicales telles que la chirurgie, la dentisterie, l'ophtalmologie ou encore la cardiologie, la cancérologie et la psychiatrie. L'étude d'oeuvres d'art soigneusement choisies, aussi bien auprès de grands maîtres qu'auprès d'artistes moins connus, est l'occasion de faire revivre les grandes découvertes anatomiques et médicales telles que la circulation du sang, le vaccin, l'invention du stéthoscope, la théorie microbienne, l'anesthésie, la transplantation cardiaque... mais également de passer à la loupe les grands chefs-d'oeuvre de Van Eyck, Michel-Ange, Goya ou Munch sous le prisme souvent méconnu des pathologies. Nouvelle diffusion de la chanson de Pompon : "Oxford Town" de Bob Dylan (1963).

Quelques infos Domitille est en 2ème année (P2) de médecine à Sorbonne Université. Classement : 500 au S1, 335 au S2 et 200 après les oraux. Médisup et le tutorat. Moyenne en terminale : 14,9 Son organisation Méthode des J Le carnet d'erreur Un peu de feeling Les sorties avec les copains : rarement Les breaks : une demie journée par semaine Les points + de la prépa : Les fiches et les concours blanc Les points - de la prépa : Le manque de pédagogie, peu de réponses aux questions, l'ambiance, les locaux, les fautes. Quelques extraits“Dans ma famille personne n'est dans le milieu médical” “J'ai adoré mon stage de prérentrée au tutorat” “J'ai jonglé entre prépa et tutorat” “J'ai jamais réussi à apprendre une fiche par coeur” “J'ai besoin d'apprendre au fur et à mesure avec les QCM” “J'ai une mémoire très auditive” “En biologie cellulaire, j'imaginais la cellule, je me faisais des petits films avec les macrophages.” “Le samedi, c'était la journée la plus difficile.” “Les gens avaient la hargne.” Domitille est aujourd'hui en 2ème année (P2) de médecine à Sorbonne Université. Elle a mis du temps avant de trouver sa propre méthode d'apprentissage. Elle a “trop” écouté à la lettre les conseils des autres : ne pas faire les annales tout de suite, ne pas aller en cours… ça l'a pénalisée. Elle s'est rendue compte qu'elle avait besoin de s'entraîner dès le début, d'écouter tous les cours, d'aller aux ED…. Je ne vous en dis pas plus.

It was back in the 19th century, exactly in the year 1816, Rene Laënnec, a French doctor was walking alone in the Louvre Palace in Paris. The 35-year-old physician and surgeon, observed two children playing by sending signals to each other using a long piece of solid wood and a pin. One child scratched a pin on a side of the wooden piece and the other child placed his ear on the opposite end of the wooden piece and received the amplified sound of the pin. Laennec loved the idea as he was a gifted musician who used to make and play on flutes.Shortly after, Laënnec who was known to be shy was called to see a lady with suspected heart disease. The lady was young and chubby, and so the bashful Laënnec was reluctant to stick his ears directly to her chest, which was the only way to listen to heart sounds at that time. In his moment of embarrassment, Laënnec recalled his observation of the children's wooden sound transmission. That observation inspired his invention of the device which is now the symbol of physicians “the stethoscope”The first generation was a rolled tube to funnel where one end was on the patient's chest and another side on the doctor's ear. He called it the “stethoscope” derived from the Greek words stethos, meaning chest, and skopein, meaning to explore. For 200 years, the stethoscope was essential to any physical examination with dedicated cardiology types and pediatric types. However, the importance of the stethoscope has declined dramatically in favor of more sophisticated technologies. Clinical skills in general are dwindling. There has been a constant decline in practitioners' ability to correctly identify heart sounds through auscultation, the accuracy of 22% in American trainees and slightly higher in fellows. No surprise as we are counting more on echo, angiography, CT, and MRI. We and patients trust these more than the good old stethoscope.But now, we are in the age of smart tools. We have smartphones, smart bags, smart lamps, and smart homes. How about a smart stethoscope? What would that look like and how useful would it be? Can it revive the dying stethoscope? Can it compete against the echo for example?https://doi.org/10.1016/S2589-7500(21)00256-9

Please visit us at http://www.patreon.com/TheCharacterNetwork (www.Patreon.com/TheCharacterNetwork) to help support TCN and help us keep providing these unique and extremely effective research based Bully and Violence Prevention and Character Education Programs to schools around the world, and help more kids who desperately need special intervention. Go to http://www.thecharacternetwork.org/ (www.TheCharacterNetwork.org) to learn more and get involved. Thank you! Public use in schools requires a site license, please visit The Character Network to find out how your school can get these life changing program as a part of the TCN METHOD for school violence and bully prevention. Go HERE for a Free Copy of Jim Lord's Life Changing Breakthrough Novel, Mr. Delaney's Mirror, A Reflection of Your Futurehttps://characternetwork.krtra.com/t/E6KcJXqk8olF (https://bit.ly/GetDelaneysMirrorHere)************** A HERO is someone who does something special to HELP OTHERS. Every hero STARTS as a CHILD, and every Child can CHOOSE to become a Hero... Just like THIS one!It was over 200 years ago, that a boy named Rene Laennec was born in France. He was a good student in school, and by the age of twelve, he could not only read and speak French, he also knew Greek, Latin, German, and English. There was a war going on in France while Rene was still very young, and when he was only 14-years-old, he began HELPING to care for wounded soldiers. By the time he was 18, he was actually serving in a military hospital as a surgeon. Rene Laennec became a famous doctor in France. He studied a lot about the human heart and lungs, as well as the diseases that can affect them. One morning, Dr. Laennec was out taking a walk when he saw two young children playing with a long piece of solid wood. One child was scratching the end of the piece of wood while the other child held his ear to the opposite end. He could hear the scratching very loudly. That's what inspired the doctor's invention of the stethoscope. After experimenting, Dr. Rene Laennec found that a hollow tube of wood HELPED him hear sounds of the heart and lungs very clearly and loudly. Although stethoscopes have changed through the years, it was Rene Laennec, the young boy from France, who grew up to absolutely revolutionize the medical field by inventing the stethoscope. That's what I know about the beginning of This Hero, and I know that YOU Can Be a Hero TOO! Dear Parents, After years of development, trial, and revision, we are so excited to now share with you the most effective version yet of our Proactive Bully Prevention Program that has proven to "change the culture" at hundreds of campuses across America in profound ways. Research has shown the TCN Method™ to be the single most effective school based Violence and Bully Prevention Intervention of its entire genre. We have hundreds of testimonials from educators describing the results they have gotten, and you can view many of these at http://www.thecharacternetwork.org/Testimonials (www.TheCharacterNetwork.org/Testimonials) This program, The Beginning of a Famous Hero™ is used in conjunction with a companion program called Bully Alert!™ in schools played over the intercom during morning announcements twice or more each school week, and backed up by a common culture which reinforces the principles taught, at every turn, and incorporates the phrases of the academic language during any teachable moment. These two sets of stories work together to convey a common academic language which says, “A bully is a person who hurts others on purpose (even if it's just hurting their feelings) but a HERO is a person who HELPS others. So CHOOSE to be a HERO by HELPING instead of a bully by hurting.” They also promote the concept of POSITIVE PERSONAL VISION, helping each student to realistically visualize his or her own "Future Self," and in doing so help relate consequences of actions and attitudes today (good or bad) to that future self. It Support this podcast

Dr. Carolyn Lam: Welcome to Circulation on the Run, your weekly podcast summary and backstage pass to The Journal and its editors. We're your co-hosts, I'm Dr. Carolyn Lam, associate editor from the National Heart Center and Duke National University of Singapore. Dr. Greg Hundley: And I'm Dr. Greg Hundley, associate editor, director of the Pauley Heart Center at VCU Health in Richmond, Virginia. Well Carolyn, it's another double feature Tuesday and today we get to discuss two articles. One, some insights from the CREDENCE trial. And second, another article about left atrial appendage closure devices, some results from the PINNACLE FLX trial. But before we get to those, how about we grab a cup of coffee and dive into some of the other really interesting articles in this issue? Would you like to go first? Dr. Carolyn Lam: I would, because this next paper, right up your alley and I'm sure you'll like it. But first, we talk about mitral valve prolapse. Now, we know that's a frequent disease that can be complicated by mitral regurgitation, heart failure, arterial embolism, rhythm disorders, and death. Left ventricular replacement myocardial fibrosis is a marker of maladaptive remodeling and has been described in patients with mitral valve prolapse. However, the implications of this finding remain scarcely explored. So these authors, led by Dr. [Le] Tourneau from Hôpital Laennec in France, aimed at assessing the prevalence, pathophysiological and prognostic significance of left ventricular replacement myocardial fibrosis through late gadolinium enhancement by cardiac magnetic resonance in 400 patients with mitral valve products. I bet you like that, right Greg? Dr. Greg Hundley: Oh my gosh Carolyn, not only a favorite topic of cardiovascular magnetic resonance, but this is a really large patient population with mitral valve prolapse that underwent CMR. So tell us, what did they find? Dr. Carolyn Lam: So replacement myocardial fibrosis was observed in 110 patients, so that's 28% of the patients. It was associated with mitral valve apparatus alterations, left ventricular remodeling, and ventricular arrhythmia. The ventricular arrhythmias were more frequent in patients with replacement fibrosis, but were not associated with the grade of mitral regurgitation. In patients with trace or mild mitral regurgitation, the presence of replacement myocardial fibrosis was nonetheless associated with specific mitral valve apparatus alteration at normal left ventricular dilatation, not explained by volume overload and ventricular arrhythmias, suggesting the presence of a mitral valve prolapse-associated cardiomyopathy. Dr. Greg Hundley: Wow Carolyn, really interesting. So the late gadolinium enhancement and the evidence therefore of replacement myocardial fibrosis that was identified by CMR, maybe this particular study is suggesting that we might want to integrate that into the clinical workup of patients with mitral valve prolapse. Very interesting work, and great job on that fantastic CMR presentation. I must say, got to recruit you into the club. Dr. Greg Hundley: Well, my next paper is another wonderful paper from the world of basic science and it comes from Dr. Douglas Lewandowski at the Ohio State University College of Medicine. So Carolyn, the failing heart is energy starved with impaired oxidation of long chain fatty acids at the level of reduced carnitine palmitoyltransferase-1, or CPT-1, activity at the outer mitochondrial membrane. Recent work shows that elevated ketone oxidation and failing hearts as an alternate carbon source for oxidative ATP generation. So Carolyn, these authors hypothesized that another short chain carbon source, short chain fatty acids that bypass CPT-1, could similarly support energy production in failing hearts. Dr. Carolyn Lam: Wow. Okay, so what did they find? Dr. Greg Hundley: So Carolyn, the failing heart oxidizes short-chain fatty acids more readily than ketones, with short-chain fatty acids also displacing long-chain fatty acid oxidation to somewhat of a greater extent. So in particular, the short-chain fatty acid butyrate has a higher affinity for entry into mitochondrial oxidation at the enzyme, short-chain Acyl-CoA dehydrogenase than does the ketone 3-hydroxybutyrate at the hydroxy butyrate dehydrogenase and then also through the respective downstream metabolic pathways for each substrate. So Carolyn, failing hearts of rats and humans have increased levels of Acyl coenzyme A synthetase medium chain three enzyme, which can also oxidize short-chain fatty acids to enhance butyrate oxidation. Dr. Carolyn Lam: Wow, that really is interesting. I can't say that I would have predicted that result. So could you give us a clinical implication? Dr. Greg Hundley: You bet, Carolyn. A lot of basic science here. So here's I think what we can take home, and what we learned. So while ketones have been sought as a potential supplemental fuel to remedy the impaired oxidative metabolism of the failing heart, this study shows that failing hearts preferentially oxidize short-chain fatty acids over ketones and short-chain fatty acids may prove to be a more efficient energy source during pathological stress. Dr. Greg Hundley: Next, novel alterations in metabolic pathways, favoring short-chain fatty acid oxidation in the failing heart occur in patients with non-ischemic cardiomyopathy. Then finally, circulating ketones are not a unique, super fuel beyond the ability to bypass the inhibition of long-chain fatty oxidation in the failing heart, as do the short chain fatty acids. Dr. Carolyn Lam: Thanks, I like the way you broke down the clinical implications. Well, Greg, I've got a question for you. Have you ever thought that statins may do more than lower cholesterol, but depending on what you eat? Dr. Greg Hundley: Oh wow, Carolyn. We always hear about the pleiotropic effects of statins, but I never really thought that could depend on what you eat. Tell me, so what did these authors investigate? Dr. Carolyn Lam: Yeah, so this next paper is so interesting. It's from Dr. Hu from Huazhong University of Science and Technology in Wuhan, China and colleagues, who present a novel perspective on the story of the pleiotropic effects of statins, exactly like you said, Greg. They started with the premise that statins exert pleiotropic or cholesterol-independent effects by reducing geranylgeranyl pyrophosphate production. I'm not going to keep saying that, so geranylgeranyl pyrophosphate or GGPP, is how I'm going to refer to it. Dr. Carolyn Lam: So they developed a sensitive technique to quantify dietary GGPP, and conducted proteomics, RT-PCR screening, and western blot, to determine signaling cascades, gene expression, protein-protein interaction, and protein-membrane trafficking in wild-type and transgenic rats, focusing on models of pulmonary hypertension, given their interest in the potential therapeutic efficacy of statins in pulmonary arterial hypertension. Dr. Greg Hundley: Interesting, Carolyn. Really complex and sophisticated. So what did they find? Dr. Carolyn Lam: Okay, listen up. Red meat and soybean have a high content of GGPP and their ingestion increases GGPP plasma levels, but reduces the effects of statins in rat models of pulmonary hypertension. Ingestion of garlic extracts, rich in methyl-L-phenyl sulfonate, which is a natural inhibitor of GGPP production, decreases GGPP bioavailability, and rescues statin effects in pulmonary arterial hypertension models. So consequently, first of all, diet may influence the cholesterol-independent effects of statins and the data really raise a provocative question of whether populations in which the typical diet contains high amounts of soybeans of beef may benefit less from statins. All this is discussed in an elegant editorial by Dr. Thomas Eschenhagen from Germany, who really ends with saying the present study should be considered hypothesis-generating and stimulate retrospective analysis of clinical registries and existing large interventional trials to either validate or refute this hypothesis. Whatever the outcome, the study is a nice example of thorough scientific underpinning of the widely held maxim that we are what we eat. Dr. Greg Hundley: Oh, absolutely Carolyn. I think next time with my spaghetti, I'll have the- Dr. Carolyn Lam: Garlic. Dr. Greg Hundley: ... sauce with the garlic, but I won't add the red meats. Especially if I'm taking a statin. Dr. Carolyn Lam: Oh, that's what I was afraid you might say. Oh well, let me tell you about other papers in this issue. There's an ECG challenge by Dr. Del-Carpio Munoz and entitled A Carousel ECG Confusion. There's an on my mind paper by Dr. Hammond, on the importance of shared decision making for return to play after COVID-19. Dr. Greg Hundley: Great, Carolyn. So, in the mailbag, there's a really nice research letter from Dr. Robert-Ebadi evaluating the impact of the age-adjusted D-dimer cutoff to exclude pulmonary embolism. It's from a multinational prospective real-life study or the RELAX-PE study. Well Carolyn, it's another double feature Tuesday. How about we get off to understand a little bit more about those insights from the CREDENCE trial, and then also left atrial appendage closure devices? Dr. Carolyn Lam: All right, come on with your garlic breath. Dr. Greg Hundley: Well listeners, we are onto our feature discussions and we are very fortunate, we're going to have two feature discussions. Our first feature really addresses high blood pressure. And we have with us today, Dr. Brendan Neuen from the George Institute of Global Health in Sydney, New South Wales, Australia. And our own associate editor, Dr. Wanpen Vongpatanasin from UT Southwestern in Dallas, Texas. Welcome to you both. Brendan, we're going to start with you. Could you describe the hypothesis that you wanted to test and what was your study population and your study design? Dr. Brendan Neuen: Well, thanks Greg. In this study, what we wanted to assess was the blood pressure lowering effects of the SGLT-2 inhibitor canagliflozin in people with type two diabetes and chronic kidney disease. The reason we thought that this is important is because what we know about the blood pressure lowering effects of these drugs is largely based on people with normal kidney function, with relatively less data in people with chronic kidney disease. So we aim to assess both the blood pressure lowering effects of SGLT-2 inhibition in chronic kidney disease, as well as treatment effects by baseline blood pressure and other blood pressure defined variables. This was conducted in the CREDENCE trial, which was a large primary renal outcome trial of the SGLT-2 inhibitor, canagliflozin, which enrolled about 4,400 people with type two diabetes and chronic kidney disease with a urine albumin to creatinine ratio greater than 300 milligrams per gram and a GFR greater than 30 at enrollment. This was a high risk hypertension population, about 30% of patients had apparent treatment resistant hypertension, about 60% of people had a GFR less than 60 and about 20% of people were on four or more blood pressure lowering agents. So really high burden of hypertension in the CREDENCE trial. Dr. Greg Hundley: Very good. Tell us a little bit about that design. So is this a randomized trial? Dr. Brendan Neuen: So CREDENCE was an event-driven randomized, double blind, placebo controlled, international trial. It was the first primary renal outcome trial of an SGLT-2 inhibitor, the primary results of which were reported in the New England journal in 2019. What this trial did, was it randomized participants, as I mentioned, with a GFR of greater than 30 and significant albuminuria and type two diabetes to either canagliflozin 100 milligrams or matching placebo in a one-to-one ratio with primary outcome overall of doubling of serum creatinine, kidney failure, cardiovascular or renal death. The trial was conducted in several, I think, 20 or 30 countries overall and enrolled at approximately 4,400 people, with participants followed for a median of about two and a half years. Dr. Greg Hundley: Excellent. So Brendan, tell us, what did you find? Dr. Brendan Neuen: So we found a couple of important findings with regards to blood pressure. Firstly, what we found was that canagliflozin reduced systolic blood pressure by about three and a half millimeters of mercury in the overall trial population. But most importantly, this blood pressure lowering effect was consistent across the number of blood pressure defined subgroups, including in people on multiple numbers of blood pressure lowering agents. So irrespective of the number of blood pressure lowering agents at baseline, and also irrespective of a history of apparent treatment-resistant hypertension at baseline, that was important. We also, secondly, found that the blood pressure lowering effective SGLT-2 inhibition was present very early at the first trial visit at three weeks. This effect was sustained over the duration of the trial. Dr. Brendan Neuen: Thirdly, we also found that canagliflozin reduced the risk of kidney failure and cardiovascular events, regardless of the number of blood pressure lowering agents at baseline and regardless of blood pressure, history of resistant hypertension. Finally, there is this often important question of how do these drugs reduce the risk of kidney failure and heart failure. So we did a mediation analysis, looking at to what extent the blood pressure lowering effect of this drug explains the treatment effect on these important outcomes. We found that only about less than 10% of the treatment effect on kidney failure and cardiovascular events was explained by blood pressure lowering. Dr. Greg Hundley: Very interesting and strong, powerful results. Well, now we're going to turn listeners to our associate editor, Dr. Wanpen Vongpatanasin. Wanpen, I know you see a lot of papers come across your desk at circulation, really focused on blood pressure and its lowering. What struck you about this paper, and then how do you put into context the results that Brendan just describe for us with all the other results that you see in new blood pressure lowering strategies? Dr. Wanpen Vongpatanasin: Yes, so I think this is very important study and add to a body of literature showing that the canagliflozin, like many SGLT-2 inhibitors, inducing significant lowering of blood pressure. If anything, because CREDENCE is not designed to be hypertension study the effects of blood pressure lowering my even be underestimated because the backup ground therapy allowed to be changed throughout the trial, depending on physician judgment. Also, I think the effects of many studies start to look at effects of SGLT-2 inhibitor on out of office blood pressure, like home blood pressure, or 24 blood pressure. Some even that we have published over the years, show more pronounced blood pressure lowering effects when measure outside the office. So I think that it is very interesting study but it could be not just only the drug that we use cardiovascular and renal outcome, but maybe a new class of antihypertensive medication that we could use for that purpose, although it has to be tested. Dr. Greg Hundley: Very nice. Well, Brendan, I want to turn back to you and then we'll come to Wanpen. Brendan, what do you think as a followup study to yours, what do you think is the next study that needs to be performed in this space? Dr. Brendan Neuen: Thanks, Greg. I think there's so much we still need to know about the blood pressure lowering effects of these drugs in people with advanced CKD. It would be very interesting to look at the DAPA-CKD trial, to look at the blood pressure lowering effects in people with advanced CKD not due to diabetes, so nondiabetic kidney disease. These patients also have a high burden of hypertension and whether or not these effects are also present in this population would also be important to know, and study patients with even more advanced kidney disease. That is being done in the EMPA-KIDNEY study with empagliflozin. Those results should be known in the next 12 to 24 months. Dr. Brendan Neuen: So, I'm studying this further in people with kidney disease. And also as Wanpen mentioned, looking at effects on blood pressure phenotype, you know, 24 hour blood pressure dipping status would also be important though, blood pressure variability, all those things can add to our understanding of the effect of these agents on blood pressure. Dr. Greg Hundley: Excellent. And Wanpen, do you have anything to add? Dr. Wanpen Vongpatanasin: Yes. I think one also very important study that helps someone with carrying in the future is in the CREDENCE, the people who are already treated with a mineralocorticoid receptor antagonist were excluded. So whether among resistant hypertension group, adding canagliflozin will be beneficial in those groups already treated MRA and lower cardiovascular outcome in already treated with MRA will be very interesting to see. Dr. Brendan Neuen: Yeah, I think that's a really important point to point out about the design of the CREDENCE trial, that patients who were on MRAs were excluded from the trial initially. This was due to early concerns that canagliflozin might increase the risk of hyperkalemia. I think that risk has now been put to bed in the other SGLT-2 inhibitor trials. We've got more data looking at the effects on serine potassium coming out soon, hopefully, but the other trials in which enroll more patients on MRAs, it will be very important to look at the blood pressure lowering effects in these populations. Dr. Greg Hundley: Excellent. Well, listeners, we've heard a great discussion today and we want to thank Brendan Neuen for bringing this wonderful science to us through circulation at the American Heart Association. We also want to thank our associate editor, Wanpen Vongpatanasin for being present today and helping us discuss how, in patients with type two diabetes and chronic kidney disease, describing that the blood pressure lowering effect of canagliflozin occurs early and appears sustained over the long term and therefore perhaps canagliflozin and can be used or considered as an adjunct blood pressure lowering medicine in addition to perhaps its protective effects on the kidney and other cardiovascular-related issues. Well now listeners, we've got another feature to get onto. So we're going to get to that second feature discussion right now. Dr. Greg Hundley: Well listeners, we are now turning to our second feature discussion and we're so fortunate today to have with us Dr. Saibal Kar from the Los Robles Regional Medical Center in Los Angeles, California, and our own associate editor, Dr. Mark Link from UT Southwestern in Dallas, Texas. Welcome gentlemen. Saibal, let's start with you. Could you describe for us the hypothesis that you wanted to test and what was your study population and your study design? Dr. Saibal Kar: Dr. Hundley, or if I could allow to call you Greg, thank you very much for asking me this question. The hypothesis was that we do know that the WATCHMAN device does prevent ischemic strokes. We do know that the first generation device has a few limitations. So there were some modifications made to the new WATCHMAN device, which is now called the WATCHMAN FLX. We thought that these changes should translate into better safety and better efficacy. So, that was the hypothesis of the study. The study population was patients with nonvalvular atrial fibrillation with a CHADS-VASc score of three or more, who had high risk of bleeding or patients who cannot take long-term anticoagulants. The study design was a single arm, prospective multicenter study with endpoints, which were based on performance goals from previous clinical trials. Dr. Greg Hundley: Excellent. Before we get to your results, Saibal how many patients and how many centers participated in your trial? Dr. Saibal Kar: So as the national principal investigator, I've never seen a study which was enrolled so fast. So the intended population was 400 patients in 29 centers and before half those centers could be activated, the study was over in four months. Dr. Greg Hundley: Congratulations. I think all of us that have ... especially in this pandemic era for recruiting so well, and tell us, what did you find? Dr. Saibal Kar: So what we found is that there were two endpoints, a safety endpoint and the efficacy endpoint. So the first thing that we found is that of the 400 patients, we could actually implant in 395 patients, device actually, which made the primary success rate over 98%. regarding the safety endpoint, we had a safety margin around 4% based on a performance score and set about 2.5, but the actual safety event rate was 0.5%, which was only two minor ischemic events, peri-procedural. There were no pericardial effusions in the first seven days, and there was no device embolizations at any time period, so that was the primary safety endpoint. So we were actually clearly safer than the first-generation device. Dr. Saibal Kar: When it comes to efficacy, it was an anatomical efficacy and we set the primary goal for the previous generation to be 99%. We've made a delta to make it about 97% effective, but we actually achieved an effective closure in 100% of patients. When I say effective closure, I mean that anyone with a peri device leak of less than five millimeters. Going into a little bit of granular detail, we actually found out that 90% of the patients actually had no leak at all. So we did at least achieve both the anatomical as well as the safety endpoints. Dr. Greg Hundley: Excellent. Well, listeners, we're now going to turn to our associate editor, Dr. Mark Link and Mark, I know you have many papers that pass through your hands. What attracted you to this paper. Then, these results really sound significant. Can you describe what impressed you also with the results of this study and how do they relate to other studies pertinent to implantation of devices in patients with atrial fibrillation? Dr. Mark Link: Yeah, we were interested in this paper at CERT because it's the next generation of the WATCHMAN. The numbers of patients that are being implanted with this device to prevent strokes is dramatically going up, but it's not a perfect device. So we were, as the EP community, very interested in the next generation device. We're obviously also interested in other competitors' device, but it's clear that the WATCHMAN is probably the world's leader in this time. So we knew that many of our people reading this magazine, reading the circulation, would want to see how the next generation turned out, was it really safer. That was really the primary goal of this study, it's really a safety study more than an efficacy study because the efficacy was defined by echo criteria, not by clinical criteria of stroke, which is the ultimate criteria. It was a well done study and the results came out more positive than I think even the investigators thought it was going to come out. So we liked it and that's why we did our best to get it published in circulation. Dr. Greg Hundley: Very good. So it sounds like great new innovation and very, very safe, especially relative perhaps to the first-generation device. So Saibal, can you tell us in just a few words, what do you think is the next study to be performed in this space? After you answer, Mark, we'll turn to you and basically ask the same question. Dr. Saibal Kar: Thank you very much, Greg. Transcatheter left atrial appendage closure has been approved by the FDA, specifically the WATCHMAN device, for patients who are candidates for long anticoagulation, but have limitations to long-term anticoagulation and therefore not for all-comers and there's a reason for that. The time has now come to actually evaluate this device for all-comers. That means all patients with nonvalvular atrial fibrillations who are suitable for anticoagulants. Therefore, the next best study is the CHAMPION trial. This study is going to be a randomized trial of the WATCHMAN FLX versus NOACs, or more correctly DOACs, in all-comers, patients with nonvalvular atrial fibrillation who require long-term anticoagulants. It's a 3,000 patients clinical trial with a one-to-one randomization to WATCHMAN FLX or the continuation of DOACs and the primary endpoints will be estimated at three years with a follow-up up to five years. Our goal is to show that we are non-inferior in comparison to stroke and death, and superior respect to long-term bleeding. Dr. Greg Hundley: Very good, and Mark? Dr. Mark Link: Yeah, I agree. The CHAMPION trial is the obvious next trial that everyone wants to see the results of, comparing this device to DOACs. Another trial or data I'd like to see is the immediate post-procedural anticoagulation. It's still an area that we don't have enough data to know how to treat these patients. Traditionally, they've been treated with warfarin and anti-platelet agents, but many of the patients getting this WATCHMAN have a relative contraindication to anticoagulation. So I'd like to see some data on shorter term duration of anticoagulation post-implant. Dr. Greg Hundley: Very good. Well listeners, we've had a wonderful discussion here and we want to thank the lead author, Dr. Saibal Kar and also our own associate editor, Dr. Mark Link, for really providing us with new information that this left atrial appendage closure device met the primary safety outcome in 99.5% of all of those implanted within seven days, what a remarkable finding. So, on behalf of Carolyn and myself, we want to wish you a great week and we will catch you next week on the Run. This program is copyright of the American Heart Association, 2021.  

Lalu Ia berkata kepada mereka: "Pergilah ke seluruh dunia, beritakanlah Injil kepada segala makhluk." (Markus 16:15) Renungan: Laennec adalah tokoh yang sangat penting di dunia kedokteran karena dirinyalah yang pertama kali menemukan alat stetoskop. Di dalam salah satu tulisannya, Laennec menceritakan bagaimana ia menemukan stetoskop. Pada tahun 1816, seorang wanita datang untuk konsultasi kesehatan padanya. Dari gejalanya, wanita tersebut memiliki penyakit jantung. Laennec agak kesulitan memeriksa wanita ini dengan metode mengetuk tubuh pasien menggunakan tangan, karena tubuh wanita itu cukup gemuk. Cara lain yang dapat digunakan adalah menempelkan langsung telinganya ke tubuh pasien. Namun oleh karena perbedaan umur Laennec dan pasien yang berbeda jauh ditambah jenis kelamin yang berbeda, menempelkan telinga ke tubuh pasien dianggap tidak sopan. Kemudian Laennec menemukan ide lain dengan cara menggulung beberapa lembar kertas membentuk silinder dan menempelkan salah satu ujung kertas ke bagian dada pasien wanita, dan ujung kertas yang lain digunakan Laennec untuk mendengarkan detak jantung si pasien. Hasilnya sangat mengejutkan, karena dengan menggunakan silinder kertas tersebut, Laennec dapat mendengarkan detak jantung jauh lebih jelas daripada ketika ia menempelkan telinganya langsung ke dada pasien. Kemudian Laennec membuat stetoskop pertamanya dari bahan dasar kayu dan kuningan. Penemuan ini baru diakui dunia kedokteran dua tahun setelah kejadian tersebut. Sebelum meninggal Laennec memberikan stetoskop ciptaannya yang pertama kepada keponakannya dan mengatakan bahwa benda itu adalah penemuan terbesar di dalam kehidupannya. Stetoskop adalah alat yang membantu dokter untuk mendengarkan detak jantung pasien sehingga dapat menemukan jawaban yang diperlukan untuk mengobati penyakit si pasien. Sebagai pengikut Kristus, kita juga harus menjadi seperti stetoskop yang dipakai sebagai alat untuk membuat orang-orang mendengar Kabar Baik sehingga mereka dapat menemukan jawaban atas keselamatan hidup mereka. Tuhan menugaskan kita menjadi saluran Kabar Baik kepada semua orang yang kita kenal sehingga mereka juga dapat mengecap indahnya hidup di dalam Tuhan dan memperoleh keselamatan kekal di dalam nama-Nya. Tuhan Yesus memberkati Doa: Tuhan Yesus, jadikanlah aku alat-Mu untuk menjadi saluran berkat rohani bagi orang lain. Amin. (Dod).

René Laennec's sStethoscope: giving doctors a new way to listen to patients महिलाओं के दिल की धड़कन सुनने में दिक्कत होती थी तो रेने ने बनाया स्टेथस्कोप, आज उनका जन्मदिन

Diagnosis is arguably the most important job of a physician. But what does it actually mean to make a diagnosis? In this episode, we’ll explore this question by tracking the development of the “classical” model of diagnosis and pathological anatomy and discussing three cases over three hundred years. Along the way, we’ll ponder the concept of the lesion, iatromechanistic theories of the human machine, the birth of the International Classification of Diseases, and the rise and decline of the autopsy. You can sign up for the iMED Digital Education conference at cmeregistration.hms.harvard.edu/digitaleducation.   Sources: Hooper R, The Physician’s Vade-Mecum: Containing the Symptoms, Causes, Diagnosis, Prognosis and Treatment of Diseases. 1812.  Holdman L et al, The Value of the Autopsy in Three Medical Eras. N Engl J Med 1983; 308:1000-1005. Cabot RC et al. CASE RECORDS OF THE MASSACHUSETTS GENERAL HOSPITALANTE-MORTEM AND POST-MORTEM RECORDS AS USED IN WEEKLY CLINICO-PATHOLOGICAL EXERCISES. Case 9431. Boston Med Surg J 1923; 189:595-599. Shojania KG and Burton EC, The Vanishing Nonforensic Autopsy. N Engl J Med 2008; 358:873-875 Morgagni GB. The seats and causes of diseases investigated by anatomy in five books, containing a great variety of dissections, with remarks. To which are added ... copious indexes. 1769. Retrieved online: https://openlibrary.org/works/OL15821973W/The_seats_and_causes_of_diseases_investigated_by_anatomy Castiglioni A, GB Morgagni and the Anatomico-pathological Conception of the Clinical. Proceedings of the Royal Society of Medicine, November 7, 1934. Thiene G, Padua University: The role it has played in the History of Medicine and Cardiology and its position today. European Heart Journal, Volume 30, Issue 6, March 2009, Pages 629–635. Zampieri F et al, Origin and development of modern medicine at the University of Padua and the role of the “Serenissima” Republic of Venice. Glob Cardiol Sci Pract. 2013; 2013(2): 149–162. Conner, Annastasia (2017) "Galen’s Analogy: Animal Experimentation and Anatomy in the Second Century C.E.," Anthós: Vol. 8: Iss. 1, Article 9.  Zampieri F et al. The clinico-pathological conference, based upon Giovanni Battista Morgagni's legacy, remains of fundamental importance even in the era of the vanishing autopsy. Virchows Arch. 2015 Sep;467(3):249-54. Ghosh SK, Giovanni Battista Morgagni (1682-1771): father of pathologic anatomy and pioneer of modern medicine. Anat Sci Int. 2017 Jun;92(3):305-312.  O’Neal JC, Auenbrugger, Corvisart, and the Perception of Disease. Eighteenth-Century Studies Vol. 31, No. 4, The Mind/Body Problem (Summer, 1998), pp. 473-489 Brown TM, THE COLLEGE OF PHYSICIANS AND THE ACCEPTANCE OF IATROMECHANISM IN ENGLAND, 1665-1695. Bulletin of the History of Medicine Vol. 44, No. 1 (JANUARY-FEBRUARY 1970), pp. 12-30  Roos AM, Luminaries in Medicine: Richard Mead, James Gibbs, and Solar and Lunar Effects on the Human Body in Early Modern England. Bulletin of the History of Medicine Vol. 74, No. 3 (Fall 2000), pp. 433-457 (25 pages) Frith J, History of Tuberculosis. Part 1 – Phthisis, consumption and the White Plague. JMVH. 2014; 22(2). World Health Organization, History of the development of the ICD. https://www.who.int/classifications/icd/en/HistoryOfICD.pdf Laennec RTH, A treatise on diseases of the chest and on mediate auscultation. 1834. Retrieved from: https://archive.org/details/b21987002. Marinker M, Why make people patients? J Med Ethics. 1975 Jul; 1(2): 81–84. King LS, Medical Thinking: A Historical Preface. Princeton University Press, 2016.

Thinklabs was founded in 1991 by Clive Smith, an Electrical Engineering graduate of Caltech. The name implies the company's goal - think deeply about problems that matter and develop imaginative solutions. Smith has always had a passion for medical electronics, sound, music, and signal processing. In the mid-'90s, Smith read a Circulation paper, indicating that stethoscope acoustics had not improved since Laennec built the first stethoscope in 1816. Physicians confirmed that even top-of-the-line conventional stethoscopes did a poor job of amplifying heart and lung sounds. Thus began Smith's obsession to re-invent the stethoscope. The concept of an electronic stethoscope was not new. For a century, the road to perfect auscultation was littered with the carcasses of failed efforts. Smith started experimenting. Technologies were tested, rejected, modified and retested. The key breakthrough came with a question: How can one create an electrical analog to the acoustic pressure changes in a conventional stethoscope? All the benefits of advanced electronic technology would then accrue and the authentic sound of the stethoscope would be preserved. Physicians would not require any ear retraining. A completely new transducer was needed. Clive Smith went on to design the One Digital Stethoscope. But I want to find out more about that journey and the Thinklabs One motto of never stop inventing. We discuss how doctors and patients are leveraging new technology for remote medicine.

Première femme chirurgienne cardiaque en France, elle aime redonner une seconde vie à ses patients. Elle se spécialise dans la chirurgie des enfants. En 1996, elle créée une association pour permettre aux enfants du monde entier, victimes de malformations du cœur, de se faire opérer. Son nom: Francine Leca. A travers son énergie et son incroyable détermination, découvrez sa True Story. Une femme d'actionFrancine Leca née le 20 mai 1938 à Neuilly sur Seine d’une famille originaire de Corse, une terre à laquelle elle tient particulièrement. Ses parents l’ont toujours invité à faire ce qu’elle avait envie et l’ont toujours soutenu, peu importe ses choix. Leur relation est très forte et ils sont restés une famille soudée toute leur vie.Chahuteuse, Francine a été renvoyée de deux collèges différents. C’est une femme directe au verbe tranchant. Elle a la parole franche, la poignée de main ferme et une immense sensibilité planquée derrière une rugosité de façade. Elle n’aime pas vraiment parler d’elle et a toujours été plus à l’aise derrière une table de chirurgie que devant une machine à café à raconter sa vie. C’est une femme d’action plus que de parole, même si elle doit faire entendre sa voix pour son association. Ce qui est sûr, c’est que sa sincérité et son énergie se font ressentir dans ses discours.Francine n’aime ni le foot, ni la violence. Elle tient ça de son père qui l’emmenait pêcher en France et en Autriche dans des rivières magnifiques. “Vous imaginez qu’un poisson se trouve à un endroit précis, soit parce qu’il vient gober les mouches à la surface et que cela forme des petits ronds sur l’eau, soit parce que vous reconnaissez la structure de la rivière, les recoins propices. A ce moment-là, vous prenez votre canne à mouche, qui est comme le fouet de Zorro en beaucoup plus long, et vous allez délicatement poser, à vingt mètres s’il le faut, une petite mouche artificielle merveilleuse, choisie avec raffinement.”Rencontre avec la chirurgie cardiaque Francine a toujours aimé l’idée de soigner les gens. Elle entreprend des études de médecine. C’est lors de son premier service d’internat à l'hôpital Laennec à Paris, en rentrant pour la première fois dans une salle d’opération, qu’elle tombe amoureuse de la chirurgie cardiaque.“J’ai vu ce cœur s’arrêter, les chirurgiens ont réparé, et ensuite le cœur s’est remis à battre. De cet instant j’ai dit, c’est ça que je veux faire.” See acast.com/privacy for privacy and opt-out information.

durée : 00:03:07 - Ils sont fous ces Bretons France Bleu Breizh Izel - Pourquoi la place Laennec à Quimper se transformera subitement en Jardin à la Française le 5 Juin ? Marine nous dévoile les coulisses de cet événement.

Did Hippocrates call consults for chest pain? Were there specialists in black bile? Where does our poetic terminology for heart and lung sounds come from? Is there a historical parallel for #MedTwitter? I’ve fallen off the bus with #AdamAnswers, so in this month’s episode I’m playing catch up on many of the amazing questions you guys send me with the first Winter Short (#spoileralert -- not actually short) -- the Backlog!

The first population study in history was born out of a dramatic debate involving leeches, “medical vampires,” professional rivalries, murder accusations, and, of course, bloodletting, all in the backdrop of the French Revolution. The second of a multipart series on the development of population medicine, this episode contextualizes Pierre Louis’ “numerical method,” his famous trial on bloodletting, and the birth of a new way for doctors to “know”. Plus a brand new #AdamAnswers about Occam’s razor and Hickam’s Dictum. All this and more on Episode 38 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine! To claim CME and MOC credit, please go to www.acponline.org/BedsideRounds.   Best M and Neuhauser D, “Pierre Charles Alexandre Louis: Master of the spirit of mathematical clinical science,” Qual Saf Health Care 2005;14:462–464. Duffin J, “Laennec and Broussias: The ‘Sympathetic’ Duel,” from La Berge A and Hannaway C, Paris Medicine: Perspective Past and Present. (1977) The French Revolution: A Revolution in Medicine, Too, Hospital Practice, 12:11, 127-138 Hillard A, et al. “Occam’s Razor versus Saint’s Triad, N Engl J Med 2004;350:599-603. Lo Re V 3rd, Bellini LM, William of Occam and Occam's razor. Ann Intern Med. 2002 Apr 16;136(8):634-5. Kirk GW and Pemberton N. Leech, 2013 Kirk GW and Pemberton N, Re-imagining Bleeders: The Medical Leech in the Nineteenth Century Bloodletting Encounter. Med Hist. 2011 Jul; 55(3): 355–360. La Berge A and Hannaway C, Paris Medicine: Perspective Past and Present. Louis PCA. Researches On The Effects Of Bloodletting In Some Inflammatory Diseases. Boston: Hilliard, Gray, 1836. Morabia A. PCA Louis and the birth of clinical epidemiology. J Clin Epidemiol 1996;49: 1327-33 Morabia A, Pierre-Charles-Alexandre Louis and the evaluation of bloodletting. J R Soc Med. 2006 Mar; 99(3): 158–160. Niehyl PH. The English bloodletting revolution, or modem medicine before 1950. Bull Hist Med 1977; 51, pp. 464-483. Papavramidou N and Christopolou-Aletra H, Medicinal use of leeches in the texts of ancient Greek, Roman and early Byzantine writers. Intern Med J. 2009 Sep;39(9):624-7. “Suckers for Success,” Nature volume 484, page 416 (26 April 2012). “Walter Chatton,” Stanford Encyclopedia of Philosophy, retrieved from: https://plato.stanford.edu/entries/walter-chatton/ Wardrop D, “Ockham’s Razor: sharpen or re-sheathe?” J R Soc Med. 2008 Feb; 101(2): 50–51.

The physical exam has become a ritual of the modern doctor’s appointment, with pokes, prods, and strange tools. How did this become a normal thing to do? In this episode, I’ll discuss how the physical exam went from the medieval examination of a flask of urine to basically what we have today in just a few decades in early 19th century France, and how the exam is still developing in the 21st century. Plus, a brand new #AdamAnswers about why Americans insist on using the Hermes’ Staff as a symbol for medicine. All this and more in episode 34 of Bedside Rounds, a tiny podcast about fascinating stories in clinical medicine!   Sources: Antic T, DeMay RM. “The fascinating history of urine examination,” Journal of the American Society of Cytopathology (2014) 3, 103e107 Ghasemzadeh N and Zafari AM, “A Journey into the History of the Arterial Pulse,” Cardiology Research and Practice Volume 2011 (2011). McGee S, Evidence Based Physical Diagnosis 4th edition. Amazon link: https://www.amazon.com/Evidence-Based-Physical-Diagnosis-Steven-McGee/dp/0323392768 Nicolson M, Commentary: Nicholas Jewson and the disappearance of the sick man from medical cosmology, 1770–1870. Int J Epidemiol 2009;38:622–33) Jewson ND. The disappearance of the sick-man from medical cosmology, 1770–1870, Sociology , 1976, vol. 10 (pg. 225-44) Robertson WE. Physical diagnosis from the time of Rontgen. Ann Med Hist. 1934;6:255–63 Rodgers MM, “Piorry on Pleximetry and Auscultation,” Boston Med Surg J 1852; 46:151-152 Tan SY and Hu M, “Josef Leopold Auenbrugger (1722 - 1809): father of percussion. Singapore Med J 2004 Vol 45(3):103 Walker HK, “The Origins of the History and Physical Examination,” Clinical Methods: The History, Physical, and Laboratory Examinations.Boston: Butterworths; 1990. Wallis F, Signs and Senses: Diagnosis and Prognosis in Early Medieval Pulse and Urine Texts. Social History of Medicine Vol. 13 No. 2 pp. 265-278. Wilcox RA et al, “The Symbol of Modern Medicine: Why One Snake Is More Than Two,” Ann Intern Med. 2003;138:673-677. Verghese et al, A History of Physical Examination Texts and the Conception of Bedside Diagnosis. Voswinkel P, From uroscopy to urinalysis. Clinica Chimica Acta 297 (2000) 5–16

See acast.com/privacy for privacy and opt-out information.

See acast.com/privacy for privacy and opt-out information.

In the beginning of a string of podcasts about sound in medicine, Bedside Rounds goes back to the beginning, with the invention of the stethoscope by Rene Laennec. How was the stethoscope invented? What are doctors listening for when they listen to their lungs? Who was Rene Laennec? Well, learn all the answers to these questions in Episode 9 of Bedside Rounds, Laennec's Cylinder!

La médecine est certainement un art (dans le sens étymologique de artisanat, « école des arts et métiers ») depuis qu’Hippocrate l’a arrachée des mains des prêtres et des charlatans au Ve siècle avant notre ère. Mais est-elle une science ? C’est l’avis de d’Alembert et de Diderot qui dans leur introduction de l’Encyclopédie en font, avec l’agriculture, la plus ancienne des sciences. Mais il n’y a pas de prix Nobel d’agriculture ! Et Molière s’est moqué non seulement des médecins dans ses farces mais aussi de la Médecine dans son « Malade imaginaire », corroboré par le récit fantastique de la mort de Louis XV. En suivant son évolution historique, la médecine apparaît bien comme une science. Mais une science double, clinique (Laennec) et expérimentale (Claude Bernard), qu’il est logique, comme le fait le prix Nobel, de ne pas la séparer de la physiologie, car c’est la physiologie de l’homme malade. Et c’est une science récente qui n’a pu faire sa révolution « copernicienne » qu’après le développement de l’anatomie (Vesale à la Renaissance), de la physiologie (Harvey au XVIIe s.), de la chimie (l’école anglaise et Lavoisier au XVIIIe s.), etc. Le professeur Jean-Pierre Delmont tentera de démystifier nombre d’idées reçues dans ce domaine.