He described them using unusual daily examples, such as "whistling of little birds", "crackling of salt on a heated dish", "cooing of the woodpidgeon", etc., but he soon realized that he was unable to use the term in front of his patients because it conjured the association of le râle de la mort, which translates to " the death rattle", the noise that people who are about to die make when they can no longer clear secretions. Therefore, at the bedside, he used the Latin word rhonchus, which originally meant a snore. That was not clearly understood by his translator, John Forbes, and the terminology became very confusing after the publication in the 1830s of Forbess English translation of Laennecs De LAuscultation Mediate. The difficulty of translating râle itself had been remarked upon in a British review of Laennecs work in 1820.The terminology of "rales" and "rhonchi" in English remained variable until 1977, when a standardization was established by the American Thoracic Society and American College of Chest Physicians. As a result, the term râles was abandoned, and "crackles" became its recommended substitute. The term "rales" is still common in English-language medical literature, but cognizance of the ATS/CHEST guidelines calls for "crackles". In 2016, the European Respiratory Society reported on a study of various physicians listening to audiovisual recordings of auscultation findings and interobserver variation was analyzed. The study found that broad descriptions agreed better than detailed descriptions. Sound
Crackles are caused by explosive opening of small airways and are discontinuous, nonmusical, and brief.
Pharmacokinetics
Testosterone undecanoate has a very long elimination half-life and mean residence time when given as a depot intramuscular injection. Its elimination half-life is 20.9 days and its mean residence time is 34.9 days in tea seed oil, while its elimination half-life is 33.9 days and its mean residence time is 36.0 days in castor oil. These values are substantially longer than those of testosterone enanthate (which, in castor oil, has values of 4.5 days and 8.5 days, respectively). Testosterone undecanoate is administered via intramuscular injection once every three months or so. Chemistry
Testosterone undecanoate, or testosterone 17β-undecanoate, is a synthetic androstane steroid and a derivative of testosterone. It is an androgen ester; specifically, it is the C17β undecylate (undecanoate) ester of testosterone. A related testosterone ester with a similarly very long duration is testosterone buciclate. History
In the late 1970s, testosterone undecanoate was introduced for oral use in Europe, although intramuscular testosterone undecanoate had already been in use in China for several years. Intramuscular testosterone undecanoate was not introduced in Europe and the United States until much later, in the early to mid 2000s and 2014, respectively. Testosterone undecanoate was approved in the United States after three previous rejections due to safety concerns. Society and culture
Generic names
Testosterone undecanoate is the generic name of the drug and its USAN and BAN. It is also referred to as testosterone undecylate.