FR2844177A1 - Combined stethoscopic and Doppler detection device for early screening and diagnosis of cardiovascular diseases has ear trumpet assembly incorporating an ultrasound probe from which is generated both stethoscopic and video signals - Google Patents

Abstract

Apparatus comprises a sound transmitting conduit (3) connected at one end to a housing (100) forming an ear trumpet (1') provided with a membrane (2'). The other end of the conduit has an earphone for listening to a stethoscopic signal from the trumpet. The housing also contains an ultrasound probe (8) that enables convergence of the reception of ultrasonic and stethoscopic signals. The probe is connected to a transducer processing circuit (37) that delivers an audio signal derived from a Doppler signal and a video signal. To generate an audio signal the processing circuit is coupled to a loudspeaker (34) in contact with the ear trumpet for stethoscopic type listening, while a video signal is generated by inputting the Doppler signal to the processing circuit, which is then coupled to display means (39) for output of a video signal.

Description

DOUBLE ST THOSCOPIC DETECTION AND DIAGNOSIS APPARATUS

AND DOPPLER

  The invention relates to an apparatus for medical screening and diagnosis by double sound detection, of the stethoscopic type, and ultrasound, of the Doppler type. Such a device allows in particular a crossed diagnosis by coupling these detections by auditory and visual analysis. The invention applies to the analysis of arterial pressure, in particular systolic pressure, and makes it possible, for example, to screen for early vascular stenosis. Doppler ultrasound devices are currently known comprising an ultrasound probe, equipped with means for emitting ultrasonic waves and for receiving these ultrasonic waves once reflected by a support, for example the blood flowing in a vessel of the patient. The slowing down or the acceleration of this flow results in a positive or negative variation of the ultrasonic Doppler frequency, by addition or subtraction of an interval of amplitude frequencies directly related to the Doppler effect, hereinafter "signal Doppler ". The measurement of the signal or of this variation can faithfully provide information on the caliber of the

slice of the vessels explored.

  A Doppler ultrasound machine includes,

  traditionally, in addition to the ultrasonic probe, successive stages of transducers allowing the detection of the Doppler signal (phase shifter, multiplier, amplifier and filter), a phase comparator assigning a positive or negative sign to the detected Doppler interval, an audio frequency amplifier and a speaker.

  However, the examination carried out using such Doppler devices requires specialization, or at least training, in order to acquire and maintain the practice of interpreting the results obtained. It follows that, concretely, this examination is left in the hands of specialists, the general practitioner not having the culture of this type of control.

  The invention aims to promote Doppler examination in order to allow early detection of cardiovascular diseases, in particular

  particular of vascular stenosis or early arterial disease.

  To learn, for example, about an early arterial disease of the lower limbs, a differential should be detected between the systolic blood pressure in the lower limbs and the upper limbs of the patient. Such a differential is generally determined by the measurement of the systolic pressure index (abbreviated IPS, equal to the ratio between the systolic arterial pressures in an arm and a lower limb

of the patient).

  The easier screening for arterial disease of the lower limbs will then encourage the practice of a general arterial assessment, in particular

coronary and carotid.

  Another object of the invention is to carry out a double detection (stethoscopic and Doppler) guaranteeing a high coherence between the 10 detections in order to obtain a diagnosis of high reliability.

  To achieve these goals, the invention uses means of integrating the Doppler examination into a device of structure such as a stethoscope, forming part of the portable set of the city doctor, these means aiming to allow, specifically, a convergence of the 15 stethoscopic and Doppler explorations of the same vascular segment (realizing a unit of place), with the possibility of providing simultaneously (unit

time) double detection.

  More specifically, the subject of the invention is a medical screening and diagnostic apparatus by double detection of the stethoscopic and Doppler signals, comprising a sound transmission link conduit connected, on one end, to a housing at least partially forming a horn. acoustic with a membrane and, on the other end, at least one earpiece for listening to a stethoscopic signal from the horn. In this device, the housing accommodates at least one ultrasonic probe arranged so as to allow convergence in reception of the ultrasonic and stethoscopic signals and connected to a transducer processing circuit capable of supplying, from a Doppler signal, an audio signal by coupling of the processing circuit to a loudspeaker in contact with the horn for stethoscopic listening, and a video signal by coupling of the processing circuit to display means to provide a

visual information.

  Thus, the invention makes it possible to obtain simultaneous and localized convergence of the stethoscopic and Doppler explorations without having to move or turn the housing during the examinations. In addition, the results are communicated using traditional or current means of use, a stethoscopic earpiece or a display screen, which allows a

  natural integration of this device into the practitioner's basic range.

  According to preferred characteristics: - means are provided for delivering and forming a film of semi-solid product on the patient's skin, in particular a gel, to make intimate skin / case contact and to channel the propagation of waves; a reservoir of this product, connected to the delivery means, can advantageously be housed in the housing; the loudspeaker is placed substantially against the acoustic horn so that the audio signal is amplified by the horn and makes the stethoscopic listening perceptible at the level of the atrium via the connection conduit, in the same way as in a stethoscope ; a microphone is coupled to the horn in order to collect the sound stethoscopic signal and transmit it, in the form of an electrical signal, to the processing circuit and produce a video signal; - The display means are in the form of a liquid crystal screen, allowing the graphic display of a stethoscopic and Doppler signal, or in the form of light-emitting diodes; - a microprocessor is controlled by an interpretation algorithm and coupled to the processing circuit to allow an analysis and a combination of the stethoscopic and / or Doppler measurements delivered by the processing circuit, or else captured from stethoscopic monitoring, and for ability to provide stethoscopic, Doppler, and / or cross-over diagnosis; - a display module with three light-emitting diodes mounted on the box visualizes the interpretation, and provides a diagnosis based directly on the measurement of the Doppler signal or a cross-diagnosis based on the interpretation algorithm by favoring the Doppler diagnosis when the differing interpretations, each diode emitting in a specific color corresponding, respectively, to a positive diagnosis (existence of a pathology), a negative diagnosis (no pathology) or an uninterpretable diagnosis (too many doubts in the measurements); a module for recording and viewing the Doppler or stethoscopic video signal is provided by wireless link, for example radio or infrared, between the electronic processing circuit and a viewing or printing module; - peripheral outputs are provided to allow a connection to a microcomputer, to a hearing headset (auxiliary); - To simply carry out the commissioning of the probe, in particular using a finger, an electrical circuit is provided for energizing the ultrasonic probe, controlled by an actuator which can be mounted on the connection duct or on the housing; the actuator is a multifunctional switch which also serves for selective control of the means for delivering stethoscopic, Doppler or crossed diagnostics by the display means, to the means for triggering the diagnosis from measurements delivered by the treatment circuit or else input from tapping, as well as from the remote recording and viewing system; - The multifunction is achieved by different stages, a decision table or a logic for programming the connections of the 1 5 circuits according to the number of stresses on the switch;

  - a battery or rechargeable battery supply is also provided.

  According to a first embodiment, the housing forms an acoustic horn housing the ultrasonic probe, in particular in a centered manner, and contact means can be temporarily interposed between the ultrasonic probe and the membrane of the acoustic horn, to transmit a signal Doppler to the processing circuit coupled to the speaker which emits the

  amplified audio signal in the acoustic horn.

  When the ultrasonic probe is brought out of contact with the membrane, a usual stethoscope is available. However, when the probe is brought into indirect contact with the membrane, a device of the Doppler type is available. The interposition means preferably comprise an inflatable balloon covering the distal end of the probe and a balloon inflation device. This inflation device may comprise a tube putting the balloon in communication with a source of liquid, and means, preferably comprising a button, intended to discharge

  liquid from the source in the tubing, so as to inflate the balloon.

  The control actuator and the button for delivering liquid are preferably one and the same button which can be actuated by a finger, and means are provided for maintaining the delivery of liquid when the actuating button is released. , these means possibly being in particular an electromagnetic coil applying a magnetic holding force to a piston, made of a magnetic material, for discharging the liquid. In addition, means for delivering semisolid product

  can form a film between the skin and the membrane.

  Depending on whether or not the balloon is inflated, a Doppler device or a traditional stethoscope is available. It is thus possible to determine approximately approximately, using the apparatus operating in stethoscope, the anatomical location, for example carotid, where it is advisable to practice an ultrasonography, then to carry out the fine operation of ultrasound at this

  location determined initially in an approximate but rapid manner.

  We know that it is desirable, in a Doppler device, to be able to tilt the probe. In this first embodiment, there are advantageously provided means controlled from the outside of the horn and intended to tilt the probe. These means may comprise a cable, preferably a set of four cables at the four cardinal points of the probe, one end of which is fixed to the end of the probe, and means intended to pull the other end of the cable. The cable, or part of all the cables, is pulled so as to tilt the end of the

  probe to direct it towards the most perceptible sound response to the headset.

  According to a second embodiment, the probe is housed in the housing and outside the horn, the housing forming a substantially cylindrical turret. The probe can be tilted at a fixed angle between about 30 and degrees relative to the membrane, preferably between 40 and 55 degrees, in order to optimize the examination by converging the reception of the signals

  ultrasound and that of stethoscopic signals.

  Advantageously, means for extending the probe 30 are provided in order to compensate for the inclination of the probe. The means for delivering the semi-solid product then form a bonding layer between the

  extension of the probe and the patient's skin.

  According to a preferred characteristic, the connecting duct is connected to the bottom of the horn, at the furthest from the membrane, and emerges substantially at the center of the upper face of the turret.

  Other advantages and characteristics of the invention will appear on reading the description which follows, relating to nonlimiting exemplary embodiments and accompanied by appended figures which

  represent: - Figure 1, an overall view, partially in section, of an example of apparatus according to the invention, in a first embodiment; - Figure 2, a sectional view of part of the connecting duct of the apparatus of Figure 1, in which an actuator button and the control circuits appear schematically; - Figure 3, a sectional view of the tip of this device in the stethoscopic operating position; - Figures 4 and 5, a sectional view according to Figure 3 in the Doppler operating position in which the balloon of the probe 15 is inflated and the probe emits and receives ultrasonic waves with, respectively, engagement and release of the actuator button; - Figures 6 to 9, a view similar to that of Figures 4 and 5, in which the actuation button toggles, to optimize the response of the Doppler signal, then is released, then is actuated again 20 to put the assembly processing circuits of the device off, and finally released to return to the stethoscopic operating position; - Figures 10a and 10b, two top and bottom perspective views of an apparatus housing according to the invention, in a second embodiment; - Figure 11, a sectional view of the housing according to Figures a and 10b in an exemplary embodiment adapted to the priority processing of the Doppler signal and the stethoscopic signal in audio mode; and

  - Figure 12, a sectional view of the housing in an embodiment suitable for priority processing of the Doppler signal and the stethoscopic signal in video mode.

  The device represented in FIG. 1 comprises a stethoscope tip E, the housing 100 of which is in the form of a conical horn 1 also delimited by a membrane 2 forming the large base of the horn, and comprising a connecting duct consisting of a connector 3 and a flexible pipe 33 35 communicating with two atria 4 in the conventional manner of a

  stethoscope S, and on which an electrical source is fixed 23.

  But unlike a usual stethoscope, it is provided as illustrated more precisely in Figure 2 and by the overall view of the nozzle in Figure 3, on the connector 3 a hole 5 with seal, in which passes a tube 6, opening into a balloon 7 covering the distal end 5 of an ultrasonic probe 8. The tube 6 is filled with liquid, for example water.

  In the hole 5 is engaged a cylinder 9 in which slides a piston 10 made of magnetic material, and which is surrounded by an electromagnetic coil 11. The piston 10 is capped with a disc 12 whose upper face 10 is integral with a rod 13. Rod 13 is mounted so

  telescopic on the rod 14 of an actuator button 18 by means of two rails 15, which can slide on two other rails 16, themselves integral with the rod 14, a spring 17 being interposed between the opposite faces of the rods 13 and 14. The actuator button 18 is connected to the upper face of the piston 10 by a spring 19.

  A gel reservoir 60 is disposed in the cylinder 9, between the piston 10 and the tubing 6. This reservoir is connected to a flexible tube 6a mounted in the tubing 6 then, emerging through sealed orifices in the latter and the connector 3 , along the conical wall of the horn 1. The end of the tube 6a is connected to an ejection nozzle 6b situated in contact with the external face of the membrane 2. Alternatively, the gel distribution system and its control can be mounted independently of the inflation system

of the balloon and its control.

  To the cylinder 9 are fixed four pulleys 20 over which 25 pass four cables 21, the ends of which are fixed at 22 to the probe 8.

  The other ends of the cables 21 are fixed to the disc 12.

  On the pipe 33 is mounted a rechargeable battery or battery 23 connected, by a line 24, to a charging socket 25 and to

a switch 26.

  Button 18 also controls a processing module

  electronics 27 by a push button 28 located under the control button 18, so that the latter drives the push button 28 when it is pressed. The electronic processing module comprises the transducer circuits for converting Doppler signals into sound and video signals.

  The electronic processing module 27 is connected to first and second circuits, 29 and 30, for electrical connection in particular to a microprocessor 31 and to a liquid crystal display device 32.

  The first electrical circuit 29 supplies the electromagnetic coil 11, as well as the microprocessor and the screen. It energizes the probe 8 and a loudspeaker 34 disposed against a wall of the conical horn 1. The second electrical circuit 30 is a circuit which controls the recording of the Doppler signal

  by the microprocessor 31 and its display on the device 32.

  The module 27 has a decision table such that a first pressing of the button 28, by pressing the actuator 18, installs us in the configuration illustrated in FIG. 4. After having been released, a new pressing carries us into the configuration according to figure 6. A new relaxation followed by a new solicitation brings us to the

position of figure 8.

  The device operates as follows.

  With reference to FIG. 3, in which the balloon 7 is not inflated and the probe 8 is not energized (thumb 35 not active), the device functions like a stethoscope by providing a usual stethoscopic audio signal by propagation of the perceptible sound through the membrane 2, the horn 1 and the flexible pipe 33 to the atria 4.

  In FIG. 4, the button 18 is actuated by the thumb 35 (arrow F1). The finger 14 pushes the rod 13 which pushes the disc 12 downwards, which slides the piston 10 in the cylinder 9. The spring 17 is compressed. The liquid contained in the tubing 6 is discharged into the balloon 7, which comes into contact with the membrane 2. The gel 61 is diffused

  by the nozzle 6b between the membrane 2 and the patient's skin.

  At the same time, the button 18 pressed the button 28 for the first time, so that the first electrical circuit 29 is energized. The electromagnetic coil 11 is energized and keeps the piston 10 of magnetic material in place, so that the liquid contained in the tubing 6 remains discharged and that the balloon 7 remains inflated. The

  microprocessor 31 and screen 32 are powered up.

  From piezoelectric elements, the probe 8, also energized, emits ultrasound De through the membrane 2 and receives, in return, the reflected ultrasound Dr supplemented with a Doppler frequency interval to form the Doppler signal. The device then functions as a Doppler ultrasound device. The Doppler signal is converted by the processing module 27 to provide a sound signal via the loudspeaker 34. The sound is then amplified in the horn, 5 propagated in the connection conduit, 3 and 33, then listened to at level of the atria 4. It is thus possible to perform a Doppler examination by stethoscopic listening.

  In FIG. 5, the button 18 has ceased to be pressed (arrow F2), but the piston 10 has remained in position because the coil 11 is energized, the button 28 being returned upwards by the spring 17.

  In Figure 6, there is shown in phantom a tilting of the button 18 by the thumb 35 to optimize the reception of the Doppler signal.

  This tilting of the button 18 also results in a tilting of the disc 12. It follows that some of the cables 21 are pulled by the disc 12, and 15 cause the end of the probe to tip 8. Listening through the earpiece 4 , a sound is heard which, in a certain orientation of the button 18 and therefore of the probe 8, reaches a maximum. When this orientation is reached, the button 18 is pressed again, while retaining its orientation. He presses the button 28, which powers up the second circuit 30. We record the Doppler signal by the microprocessor 31 and we read the result on

display 32.

  The microprocessor can be controlled by software for interpreting Doppler and stethoscopic results. The stethoscopic results are entered by dedicated keys or by the touch screen. 25 When the results differ, the Doppler result is predominant in

  interpretation. The final diagnosis is displayed in the form of a positive result (pathology), negative (no anomaly) or an uninterpretable result when the signals are not sufficiently identified or safe. In the case where only the Doppler signal cannot be used, the diagnosis is that - positive or negative 30 - provided by the stethoscopic signal.

  In Figure 7, we have stopped pressing button 18 (arrow F2). The piston 10 remains held by the electromagnetic coil 11, so that the balloon 7 remains inflated. The display of the recording on the device 32 continues. In FIG. 8, the button 18 is pressed again (arrow FI), 35 which presses the button 28. The first and second circuits are thus cut

  29 and 30, and thus turns off the coil 1.

  In FIG. 9, the button 18 has ceased to be pressed. The piston 10, which is no longer retained by the coil 11 rises, under the effect of the springs 17 and 19. The liquid contained in the tube 6 is sucked . The balloon 7 deflates. Probe 8 has stopped transmitting. If desired, the switch 26 for switching off the whole apparatus can be pressed 5 to save the battery 23.

  Figures 10a and 10b illustrate the views of an apparatus housing according to the invention in a second embodiment. In this second mode, the probe 8 is housed in the housing 100, outside of the horn 1 ′ in the form of a dome.

  The housing 100 has a turret shape, substantially cylindrical and of ovoid section. The turret is limited by an upper outlet face Fs, in the center of which emerges the fitting 3, and by an open lower face Fi of application, where the plane membrane 15 2 of the horn and the end face 8a are placed. an extension 8b of the inclined probe 8. This extension is made of solid or semi-solid material conducting ultrasonic waves, for example silicone gel. In the example illustrated, it has a cylindrical shape with flat end faces and

  sectioned at suitable angles.

  The probe is inclined towards the central axis X'X of symmetry of the horn, by a fixed angle of about 50 degrees relative to the plane of the

  membrane 2. This type of tilt optimizes the Doppler examination.

  The end face 8a of the extended probe is covered with a gel 61 to form a continuous bonding layer between the end 8a and the patient's skin. An insulating membrane 2 ′, pierced so as to leave the end 8a free, can advantageously close the underside of the

  turret to prevent penetration of the gel inside the turret.

  The gel is controlled by a piston 36 accessible from the upper face Fs. A switch 38 for energizing the probe 8 and a display module 39 are also disposed on the housing, the module

  display being on the upper face Fs in the example illustrated.

  The switch 38 also serves as a multifunctional control as

  described with reference to the first embodiment.

  The sectional view illustrated in FIG. 11 presents a version 35 suitable for priority processing of signals in audio mode.

  In this exemplary embodiment, as in the following, the gel 61 comes from a reservoir 60 disposed in the housing. The gel is delivered through a flexible tube 6a by an ejection nozzle 6b, located in contact with the underside Fi of the turret. In the case where an insulating membrane 2 'is used, the nozzle 6b passes through it through an orifice around which a seal is provided.

  The thrust of the piston 36, mounted telescopically as before or simply on a return spring, makes it possible to dose the adequate quantity of gel delivered by the nozzle. The reservoir can be refilled through a flexible hose 62 which connects the reservoir 60 to a

  restocking mouthpiece 63 integrated into the housing.

  Still in this example, the probe 8 is connected to a loudspeaker 34, mounted on an external face of the horn 1 'via the transducer circuit 37. The Doppler signal is converted by the transducer circuit 37 to supply an audio signal from the loudspeaker. speaker 34. As before, the sound is amplified in the horn, propagated in the connection conduit, 3 and 33, then

listened to at the earbuds.

  The results of the stethoscopic and Doppler listening can be entered and stored, after evaluation by the operator, in interpretation software. This software controls the microprocessor of a microcomputer (not shown) to be connected to an output 101 provided on the housing 100. Alternatively or cumulatively, the Doppler signal, after conversion by circuit 37, is also transmitted to the microcomputer and stored in the form of video signal through output 101. The micro25 computer is equipped with a screen which displays the graph of the Doppler signal.

  The software is based on an algorithm which provides a diagnosis based on listening assessments and the video Doppler signal. The display module 39 is equipped with three light-emitting diodes. It is mounted on the upper face Fs of the housing 100 and coupled to the transducer circuit 37. 30 This module makes it possible to view the interpretation. The interpretation algorithm

  favors the Doppler diagnosis when the interpretations are divergent.

  The diodes emit red, orange and green light respectively: - the emission of the red diode means that the diagnosis is positive (existence of a pathology), - the emission of the green diode means that the diagnosis is negative ( no pathology), and

  - the emission of the orange diode means that the result is uninterpretable, due to the existence of too "limit" measurements.

  FIG. 12 more particularly illustrates another version of the second embodiment, suitable for priority processing of signals in video mode. In this example, a microphone 40 is affixed against the external wall of the connector 3. Alternatively, it can be arranged in the connecting duct, insofar as this position does not cause the intensity of the direct sound signal to be attenuated , or against the wall of the acoustic horn 1 ', or more generally on any suitable location

  located on the sound path formed by the horn.

  This microphone makes it possible to collect the sound stethoscopic signal and is connected to the transduction circuit 37 in order to transmit it, in the form of an electrical signal, and to output a video signal. In addition, the

  Doppler signal received by probe 8 is also converted into video signal.

  The video signals are transmitted to a microcomputer, as in the previous example (illustrated in FIG. 11) by the output 101, and / or to a viewing and printing module 50, located remotely. To this end, an antenna 41 is provided for transmitting the video signals in radio waves. A signal H is then picked up by the receiver 51 of the display module, then processed in a demodulator 52 and in an adapter.

display 53.

  Furthermore, a headphone output 42 is also provided in this example in order to allow stethoscopic listening from the sound picked up by the microphone, or from the Doppler signal converted into an audio signal by the circuit 37. The hearing headphones can be presented under a shape

  conventional earpiece 4 typed stethoscope.

  As in the previous example, the video (or audio after manual input) signals are evaluated in the interpretation software of the

  microprocessor or displayed on the microcomputer screen.

  The display module with three light-emitting diodes 39 allows cross-interpretation from the Doppler and stethoscopic video signals, the Doppler signal being preponderant in the event of divergence.

  The invention is not limited to the embodiments described and shown. It is for example possible to provide, in the second embodiment, the microprocessor and the display module as arranged in the first embodiment, or to provide the diode display module in any example described above.

  A second probe can also be housed in the housing. Each of the two probes is then dedicated to a particular area of the body, for example the upper part (upper limbs or neck) and lower part (lower limbs) of the patient. The respective signals of the probes are set to a dedicated frequency, for example 4 and 8 MHz. Other probes can also be provided, the ends of which are, for example, inscribed in a peripheral ring, inside or outside the acoustic horn. It is then possible to provide an annular envelope 15 to form a single annular probe with transmitters and receivers

multiple piezoelectric.

  In addition, a headphone output can also be provided in order to connect a headphone cable in place of or in addition to the stethoset connection conduit, in any example. A system for recording and viewing the Doppler or stethoscopic video signal can be provided in any embodiment, by wireless link, for example radio or infrared, between the electronic processing circuit and a module.

viewing or printing.

  The semi-solid product control piston can be accessed from the housing, the probe voltage switch

  also being arranged in any suitable location located on the housing.

  Furthermore, in the second embodiment, the fixed inclination of the probe can be adjusted around at least one axis of

  rotation by any appropriate adjustment and locking means.

Claims (38)

  1. Apparatus for medical screening and diagnosis by double detection of the stethoscopic and Doppler signals, comprising a connecting conduit (3, 33) for sound transmission connected, on one end, to a housing (100) at least partially forming a horn acoustic (1,1 ') provided with a membrane (2) and, on the other end, at least one earpiece (4) for a stethoscopic signal coming from the horn, characterized in that the housing ( 100) houses at least one ultrasonic probe (8), arranged so as to allow convergence in reception of the ultrasonic and stethoscopic signals and connected to a transducer processing circuit (37) capable of   supply, from a Doppler signal, an audio signal by coupling the processing circuit (37) to a loudspeaker (34) in contact with the horn (1, 1 ′) for stethoscopic listening, and a video signal by coupling the processing circuit (37) to display means (31, 32, 39) to provide visual information.   2. A medical screening and diagnostic apparatus according to the preceding claim, in which means are provided for delivering (60, 6a) and forming (6b) a film of semi-solid product (61) on the skin of the patient, in particular a gel, to make intimate skin / housing contact 20 and channel the propagation of the waves.   3. A medical screening and diagnostic device according to claim 1 or 2, in which a loudspeaker (34) is provided which is arranged substantially against the acoustic horn (1, 1 ′) so that the audio signal is amplified by the horn. and makes the stethoscopic listening perceptible at the level of the atrium (4) via the connection duct (3, 33), in the same way as in a stethoscope.   4. A medical screening and diagnostic apparatus according to any one of claims 1 to 3, in which a microphone (40) is provided coupled to the horn (1,1 ') in order to collect the sound stethoscopic signal and transmit it. , in the form of an electrical signal, to the processing circuit (37) and produce a video signal.   5. A medical screening and diagnostic apparatus as claimed in any one of the preceding claims, in which the display means are in the form of a liquid crystal screen (32), allowing the graphic display of a stethoscopic signal and Doppler   or in the form of a light-emitting diode module (39).   6. medical screening and diagnostic apparatus according to any one of the preceding claims, characterized in that it comprises a microprocessor controlled by an interpretation algorithm and coupled to the processing circuit (37) to allow analysis and combination 10 stethoscopic and / or Doppler measurements, delivered by the   treatment (37) or captured from stethoscopic monitoring, and for   ability to provide stethoscopic, Doppler, and / or cross diagnosis.   7. A medical screening and diagnostic apparatus according to any one of the preceding claims, characterized in that it comprises a display module with three light-emitting diodes (39) mounted on the   box (100), which displays the interpretation and provides a diagnosis based on the measurement of the Doppler signal or a cross-diagnosis based on the interpretation algorithm by favoring the Doppler diagnosis when the interpretations are divergent, each diode of the module (39 ) emitting in a specific color corresponding, respectively, to a positive diagnosis, a negative diagnosis or an uninterpretable result in the case where at least the   Doppler measurement is uninterpretable.   8. Medical diagnostic apparatus according to the preceding claim, characterized in that, instead of visualizing an uninterpretable result when at least the Doppler measurement is, the diagnosis is in   this case based on the measurement of the stethoscopic signal, each diode of the module (39) emitting in the specific color corresponding, respectively, to a positive diagnosis, a negative diagnosis, or an uninterpretable result in the case where the stethoscopic signal is uninterpretable, the diagnosis then being based on the stethoscopic sound signal.   9. A medical screening and screening and diagnostic apparatus according to any one of the preceding claims, wherein   a Doppler or stethoscopic video signal recording and display system is provided by wireless link between the processing circuit   electronics (37) and a display or printing module (50).   10. Medical screening and diagnostic apparatus according to any one of the preceding claims, wherein outputs   peripherals (101, 42) are provided to allow connection to a microcomputer and optionally to a hearing headset.   11. A medical screening and diagnostic apparatus according to any one of the preceding claims, in which, in order to simply carry out the commissioning of the probe, in particular using a finger (35),   an electrical circuit (29) for energizing the ultrasonic probe (8) is provided, controlled by an actuator (18, 28, 38) which can be mounted   on the connecting duct (3, 33) or on the housing (100).   12. The medical screening and diagnostic apparatus as claimed in claim 15, in which the actuator is a multifunctional switch which also serves as selective control for the means for delivering diagnoses (29) stethoscopic, Doppler or crossed by the display means ( 31, 32, 39), to the means for triggering the diagnosis (30) from measurements delivered by the processing circuit (37) 20 or entered on the basis of monitoring, as well as to the recording and display system at distance (50), the multifunction being produced by different stages, a decision table or a logic for programming the connections of the circuits as a function of the number of actuator stresses (18, 28, 38).   13. Medical screening and diagnostic apparatus according to one   any of the preceding claims, wherein feeding by   battery or rechargeable battery (23) is also provided.   14. A medical screening and diagnostic apparatus according to any one of the preceding claims, in which the housing (100) forms the acoustic horn (1) housing the ultrasonic probe (8), in particular   in a centered manner, and in that contact means (7) are provided for temporarily interposing between the ultrasonic probe (8) and the membrane (2) of the acoustic horn (1), to transmit a Doppler signal to the circuit of processing (37) coupled to the speaker (34) which transmits the amplified audio signal in the acoustic horn (1).   15. A medical screening and diagnostic device according to the preceding claim, in which the interposition means comprise an inflatable balloon (7) covering the distal end of the probe (8) and a   device for inflating (10) the balloon (7) with liquid.   16. A medical screening and diagnostic apparatus according to claim 10, in which the inflation device comprises a tube (6) putting the balloon (7) in communication with a source of liquid, and means (10) intended to discharge liquid from the source in the tubing (6).   17. Medical screening and diagnostic apparatus according to any one of claims 14 to 16, wherein the means   between (7) the probe (8) and the membrane (2) are controlled by   the outside of the horn (1) by the actuator button (18).   18. A medical screening and diagnostic apparatus according to any one of claims 14 to 17, in which means controlled from outside the horn (1) and intended to tilt the probe (8) are   provided in conjunction with the actuator button (18).   19. A medical screening and diagnostic apparatus according to any one of claims 14 to 18, in which the means intended to tilt the probe (8) comprise at least one cable (21), one end of which is fixed to the probe end (8), and means (12)   intended to pull the other end of the cable (21) and tilt the end of the probe to orient it towards the most audible sound response to the headset.   20. Medical screening and diagnostic apparatus according to any one of claims 14 to 19, in which there is provided a circuit for energizing (29) the ultrasonic probe (8) controlled by the button. actuator (18).   21. Screening and diagnostic apparatus according to one of the preceding claims, in which a circuit (30) is provided.   recording of the Doppler signal controlled by the actuator button (18).   22. Screening and diagnostic apparatus according to any one of claims 14 to 21, wherein the actuator buttons   form a single button, and means (11) are provided for maintaining the delivery of the liquid when the actuating button is released, the holding means comprising a piston (10) made of a magnetic material for delivery of the liquid, and an electromagnetic coil (11) applying a magnetic holding force to the piston (10).   23. Medical screening and diagnostic apparatus according to any one of claims 1 to 13, wherein the probe (8) is housed in the housing (100) and outside the horn (1 '), the housing forming a turret substantially cylindrical.   24. Medical screening and diagnostic device according to the   previous claim, in which the probe (8) is inclined towards the central axis (X'X) of the horn at a fixed angle chosen between 30 and 70 degrees relative to the plane of the membrane (2), preferably between 40 and 55 degrees, in order to optimize the examination by making the reception of the ultrasonic signals converge with that of the stethoscopic signals.   25. A medical screening and diagnostic apparatus according to claim 23 or 24, wherein the housing (100) has a turret shape, substantially cylindrical and of ovoid section, the turret is limited by an upper face (Fs), in the center from which the connecting conduit emerges (3, 33), and through an open underside (Fi), where the   membrane (2) of the horn (1 ') and the end (8a) of the probe.   26. The medical screening and diagnostic apparatus as claimed in claim 23, in which the probe is extended and means are provided (60, 6a, 6b) for the semi-solid product (61). form a bonding layer between the end (8a) of the extension (8b) of the probe (8) and the patient's skin.   27. A medical screening and diagnostic apparatus according to the preceding claim, characterized in that it comprises a piston (36) which controls the semi-solid product and is accessible from the housing (100), in particular from the upper face (Fs ), the switch (38) for tensioning the probe 8 is also arranged on the housing. 28. A medical screening and diagnostic apparatus according to the preceding claim, characterized in that it comprises a reservoir (60) disposed in the housing (100), the gel being delivered through a flexible tube (6a) by a nozzle d ejection (6b) located in contact with the lower face (Fi) of the turret (100) and the thrust of the piston (36) making it possible to dose the quantity   adequate gel delivered by the nozzle (6b).   29. A medical screening and diagnostic apparatus according to any one of claims 23 to 28, in which the probe (8) is connected to a speaker (34), mounted on an external face of the horn (1 ') via the circuit 15 transducer (37), the Doppler signal is converted by the transducer circuit (37)   to supply an audio signal through the loudspeaker (34), the sound being amplified in the horn, propagated in the connection conduit (3, 33) then listened to at the level ear cups (4).   30. The medical screening and diagnostic apparatus according to claim 20, in which the interpretation software which controls the microprocessor of a microcomputer to be connected to an output (101) provided on the housing (100), comprises means of seizure and   memory for the results of stethoscopic and / or Doppler listening.   31. A medical screening and diagnostic apparatus according to claim 25, in which the microcomputer is equipped with a screen which displays the graph of the Doppler signal after the Doppler signal has been converted by the circuit (37) and also transmitted to the microcomputer and   stored as a video signal through the output (101).   32. The medical screening and diagnostic apparatus as claimed in claim 30 or 31, wherein the software provides a diagnosis on the basis of the evaluations entered and stored, using the display module with three light-emitting diodes (39), mounted on the housing (100) and coupled to   transducer circuit (37) for viewing the interpretation.   33. A medical screening and diagnostic apparatus according to any one of claims 23 to 32, in which the microphone (40) is arranged on the sound path formed by the horn (1 ') in order to collect the signal   sound stethoscope and is connected to the transduction circuit (37) in order to transmit it, in the form of an electrical signal, and to output a video signal, the Doppler signal received by the probe (8) being also converted into video signal.   34. A medical screening and diagnostic apparatus according to the preceding claim, in which the video signals are transmitted to the microcomputer by the output (101) and / or to a display module and   printing (50), located at a distance.   35. Screening and diagnostic apparatus according to claim 33 or 34, in which an antenna (41) is provided for transmitting the video signals picked up by the receiver (51) of the display module (50), then processed in a demodulator (52) and in an adapter display (53).   36. A medical screening and diagnostic apparatus according to any of claims 33 to 35, wherein a headphone output (42)   is also provided to allow stethoscopic listening from the sound picked up by the microphone or from the Doppler signal converted into a signal audio through the circuit (37).   37. A medical screening and diagnostic apparatus according to any one of claims 35 to 36, in which the video signals, and   possibly audio after input, are transmitted to the microprocessor (100)   for evaluation and displayed on the microprocessor screen.   38. A medical screening and diagnostic apparatus according to any one of claims 33 to 37, in which the display module with three light-emitting diodes (39) displays a direct interpretation or   crossed from the Doppler and stethoscopic video signals according to claim 7 or 8.