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2.
World Neurosurg ; 133: e18-e25, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31394360

RESUMO

BACKGROUND: Intracranial pressure monitoring remains the foundation for prevention of secondary injury after traumatic brain injury and is most commonly performed using an external ventricular drain or intraparenchymal pressure monitor. The Integra Flex ventricular catheter combines an external ventricular catheter with a pressure transducer embedded in the tip of the catheter to allow continuous pressure readings while simultaneously draining cerebrospinal fluid. Discrepancies between measurements from the continuously reported internal pressure transducer and intermittently assessed and externally transduced ventricular drain prompted an analysis and characterization of pressures transduced from the same ventricular source. METHODS: More than 500 hours of high-resolution (125 Hz) continuous recordings were manually reviewed to identify 73 hours of simultaneous measurements (clamped external ventricular drain) from internal and external transducers in patients with traumatic brain injury. RESULTS: A significant positive bias was found in pressure readings obtained from external relative to internal measurements. The 2 methods of measurement generally correlated poorly with each other and variably. Although proportional bias was found with Bland-Altman analysis, coherence revealed rare shifts in the external transducer as a major source of discrepancy. Infrequent changes in the 0-level of the external transducer were found to be the primary source of discrepancy. Relative to the observed differences, no significant trend was observed over time between the 2 modalities. CONCLUSIONS: This study suggests that the internal pressure transducer may be a more reliable estimate of intracranial pressure relative to bedside external transducers due to the inherent behavioral requirement of leveling.


Assuntos
Lesões Encefálicas Traumáticas/fisiopatologia , Erros de Diagnóstico , Drenagem/instrumentação , Hipertensão Intracraniana/diagnóstico , Pressão Intracraniana , Manometria/instrumentação , Transdutores de Pressão , Lesões Encefálicas Traumáticas/complicações , Cateteres , Humanos , Hipertensão Intracraniana/etiologia , Hipertensão Intracraniana/prevenção & controle , Monitorização Fisiológica/instrumentação , Monitorização Fisiológica/métodos , Transdutores de Pressão/classificação
3.
Dis Mon ; 66(1): 100848, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30803725

RESUMO

Gastroesophageal reflux disease (GERD) is one of the most common diseases encountered by both internists and gastroenterologists. GERD can cause a wide variety of symptoms ranging from heartburn and regurgitation to more atypical symptoms such as cough, chest pain, and hoarseness. The diagnosis is often times made on the basis of history and clinical symptomatology. The prevalence of GERD is currently estimated to be 8-33% with the incidence of disease only expected to increase over time. Although most cases of GERD can be diagnosed based on symptoms and clinical presentation, the diagnosis of GERD can be challenging when symptoms are atypical. In this review, we provide a comprehensive summary of the epidemiology, pathophysiology, evaluation and diagnosis of gastroesophageal reflux disease.


Assuntos
Refluxo Gastroesofágico/diagnóstico , Asma/etiologia , Sulfato de Bário , Meios de Contraste , Tosse/etiologia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos , Endoscopia do Sistema Digestório , Monitoramento do pH Esofágico , Feminino , Alimentos/efeitos adversos , Refluxo Gastroesofágico/fisiopatologia , Predisposição Genética para Doença , Hérnia Hiatal/complicações , Humanos , Laringite/etiologia , Manometria , Obesidade/complicações , Gravidez , Complicações na Gravidez , Inibidores da Bomba de Prótons , Fatores de Risco , Fumar
4.
Arq Gastroenterol ; 56(4): 386-389, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31800734

RESUMO

BACKGROUND: The perception of bolus transit through the thoracic esophagus may be caused by altered esophageal anatomy and function. OBJECTIVE: To evaluate the hypothesis that, in healthy volunteers, swallows followed by perception of esophageal bolus transit are associated with changes in esophageal motility. METHODS: Simultaneous evaluation of motility and perception of esophageal bolus transit was performed in 22 healthy volunteers. Esophageal motility was evaluated by high-resolution manometry with a 32-channel solid state catheter. Each volunteer performed, in the sitting position, 10 swallows of a 5 mL bolus of saline and 10 swallows of pieces of 1 cm3 of bread, with an interval of at least 30 seconds between swallows. After each swallow the volunteers were asked about the perception of bolus transit through the esophagus. RESULTS: Perception of bolus transit occurred in 11.7% of liquid swallows and in 48.1% of solid swallows. In liquid swallows the perception was associated with higher distal contractile integral and shorter proximal contraction length. Perception of solid bolus transit was associated with a longer distal latency, longer proximal contraction length, lower proximal contractile integral and shorter proximal contraction duration. CONCLUSION: The perception of swallowed bolus transit through the esophagus in healthy individuals is more frequent with solid than liquid swallows and is associated with changes in proximal esophageal contractions.


Assuntos
Deglutição/fisiologia , Esôfago/fisiologia , Sensação/fisiologia , Adulto , Esôfago/fisiopatologia , Feminino , Voluntários Saudáveis , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Valores de Referência , Adulto Jovem
5.
Mayo Clin Proc ; 94(12): 2455-2466, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31806099

RESUMO

OBJECTIVE: To investigate the factors that are associated with the effect of metformin on endothelial dysfunction in polycystic ovary syndrome (PCOS). PATIENTS AND METHODS: From March 24, 2014, to November 18, 2016, 48 women with PCOS were randomly assigned to 1500 mg/d of metformin (N=29) or no treatment (N=13) for 3 months; 42 patients (29 in the initial treatment group and 13 in the no treatment group) completed the study. Study variables were measured at baseline and after 3 months. Participants who did not receive metformin initially were then treated with metformin for another 3 months, and study variables were measured again. Endothelial function was measured as reactive hyperemia-peripheral arterial tonometry (RH-PAT) from the index finger. RESULTS: The age and baseline endothelial function (mean ± SD) of the participants were 32.7±6.9 years and 1.8±0.5, respectively. No notable change was observed in endothelial function after 3 months with metformin compared with no treatment. However, after stratifying participants who received metformin based on baseline endothelial function, there was a significant improvement following metformin treatment in participants with abnormal baseline endothelial function (1.3±0.3 vs 1.7±0.3; P<.001) but not in those with normal baseline endothelial function (2.1±0.4 vs 2.0±0.5; P=.11). CONCLUSION: Metformin improves endothelial function in women with PCOS and endothelial dysfunction independent of changes in glucose metabolism, dyslipidemia, or presence of prediabetes. Metformin has a direct effect on endothelial function in PCOS, and measurement of endothelial function can stratify and follow response to metformin treatment in PCOS. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT02086526.


Assuntos
Endotélio Vascular/efeitos dos fármacos , Endotélio Vascular/fisiopatologia , Hipoglicemiantes/uso terapêutico , Metformina/uso terapêutico , Síndrome do Ovário Policístico/tratamento farmacológico , Adulto , Feminino , Humanos , Manometria , Síndrome do Ovário Policístico/fisiopatologia , Vasodilatação/efeitos dos fármacos , Vasodilatação/fisiologia
6.
Z Gastroenterol ; 57(12): 1481-1486, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31826279

RESUMO

INTRODUCTION: Distal esophageal spasm (DES), a relatively rare condition, is characterized by simultaneous contractions of the distal esophagus and manifested by dysphagia and chest pain. Several treatment options are recommended, such as pharmacological therapy, endoscopic interventions, and surgical myotomy. Recently, per-oral endoscopic myotomy (POEM) has been adopted as an effective and less-invasive treatment due to its excellent short-term clinical outcomes. Nevertheless, few reports describe its long-term effects. CASE PRESENTATION: A 65-year-old woman complained of chest pain accompanied with dysphagia and weight loss for 4 months. A series of examinations suggested that she was suffering from DES and then POEM was performed. During the 2.5-year follow-up, we observed an exciting long-term outcome. Interestingly, hematoxylin and eosin staining verified a large number of eosinophils in the muscularis externa, which was absent in the mucosa of the esophagus of the patient. CONCLUSIONS: We herein report a case of DES who underwent POEM to eliminate persistent esophageal contractions. Eckardt score, esophageal emptying test, and high-resolution manometry were assumed to monitor the efficacy of POEM. During treatment and 2.5 years after operation, esophageal muscle biopsies and/or mucosal tissues were obtained. This case has been presented to describe that POEM could be a strategy for DES with a long-term curative effect and that eosinophils in the muscle layer of the esophagus might be involved in the pathogenesis of DES. What is more, we reviewed literature to find similar cases reported in the past.


Assuntos
Transtornos de Deglutição/etiologia , Divertículo Esofágico/cirurgia , Transtornos da Motilidade Esofágica/cirurgia , Espasmo Esofágico Difuso/diagnóstico por imagem , Espasmo Esofágico Difuso/cirurgia , Esofagoscopia/métodos , Miotomia/métodos , Idoso , Transtornos de Deglutição/diagnóstico , Divertículo Esofágico/complicações , Transtornos da Motilidade Esofágica/fisiopatologia , Espasmo Esofágico Difuso/complicações , Feminino , Humanos , Manometria , Resultado do Tratamento
7.
Zhonghua Yi Xue Za Zhi ; 99(44): 3494-3499, 2019 Nov 26.
Artigo em Chinês | MEDLINE | ID: mdl-31826568

RESUMO

Objective: To analyze the relationship between the severity of esophageal acid reflux and esophageal motility, esophageal mucosal injury and morphological anatomy of gastroesophageal junction (GEJ) in patients with gastroesophageal reflux disease (GERD). Methods: The clinicaldata of GERD patients who underwent 24 h pH-impedance monitoring, gastroscopy and high-resolution manometry (HRM) from January 2016 to January 2019 in the Gastroesophageal Surgery Department of PLA Rocket Force Characteristic Medical Center were retrospectively analyzed. The patients were divided into non-pathological acid reflux group, mild pathological acid reflux group and moderate to severe pathological acid reflux group according to the DeMeester score. The gender and age of each group were matched, with 60 cases in each group. Statistical analysiswas performed to analyze thedifferences in upper esophageal sphincter pressure, lower esophageal sphincter pressure (LES), LES length, length of ventral LES, percentage of ineffective swallowing, esophagitis, Hill grade of GEJ, and hiatus hernia (HH) in each group. The comparison and correlation analysis are also carried out between the groups. Results: The male-female ratio was 33/27, and the age was (57±13) years in each group. Non-parametric analysis showed that the LES pressure and the length of the ventral LES decreased with the severity of acid reflux, and there was a statistical difference (P= 0.033, P=0.015). The detection rate of HH by HRM increased significantly (χ(2)=0.001) as well. Esophagitis score increased with the severity of acid reflux and there was statistical difference (P<0.001).The detection rate of esophagitis increased significantly (χ(2)<0.001) as well. Hill grading score of GEJ increased with the severity of acid reflux, and there was statistical difference (P<0.001).The detection rate of HH by endoscopy increased significantly (χ(2)<0.001) as well. The correlation between DeMeester score and LES pressure, length of ventral LES, percentage of ineffective swallowing, esophagitis score, and Hill grade score were statistically significant (P<0.05). Conclusions: The esophageal low motility (such as low LES pressure) and anatomical abnormalities (abdominal esophageal shortening, GEJ flabbiness, and even HH formation) of the GEJ regionare significantly associated with the severity of acid reflux. These factors may be important causes of increased acid reflux. In addition, the aggravation of acid reflux can also increase the incidence and severity of esophagitis.


Assuntos
Transtornos da Motilidade Esofágica , Esofagite Péptica , Refluxo Gastroesofágico , Hérnia Hiatal , Adulto , Idoso , Feminino , Azia , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Estudos Retrospectivos
8.
PLoS One ; 14(12): e0226709, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31856244

RESUMO

Non-invasive devices used to estimate central (aortic) systolic pressure (cSBP), pulse pressure (cPP) and forward (Pf) and backward (Pb) wave components from blood pressure (BP) or surrogate signals differ in arteries studied, techniques, data-analysis algorithms and/or calibration schemes (e.g. calibrating to calculated [MBPc] or measured [MBPosc] mean pressure). The aims were to analyze, in children, adolescents and young-adults (1) the agreement between cSBP, cPP, Pf and Pb obtained using carotid (CT) and radial tonometry (RT) and brachial-oscillometry (BOSC); and (2) explanatory factors for the differences between approaches-data and between MBPosc and MBPc.1685 subjects (mean/range age: 14/3-35 y.o.) assigned to three age-related groups (3-12; 12-18; 18-35 y.o.) were included. cSBP, cPP, Pf and Pb were assessed with BOSC (Mobil-O-Graph), CT and RT (SphygmoCor) records. Two calibration schemes were considered: MBPc and MBPosc for calibrations to similar BP levels. Correlation, Bland-Altman tests and multiple regression models were applied. Systematic and proportional errors were observed; errors´ statistical significance and values varied depending on the parameter analyzed, methods compared and group considered. The explanatory factors for the differences between data obtained from the different approaches varied depending on the methods compared. The highest cSBP and cPP were obtained from CT; the lowest from RT. Independently of the technique, parameter or age-group, higher values were obtained calibrating to MBPosc. Age, sex, heart rate, diastolic BP, body weight or height were explanatory factors for the differences in cSBP, cPP, Pf or Pb. Brachial BP levels were explanatory factors for the differences between MBPosc and MBPc.


Assuntos
Pressão Sanguínea , Adolescente , Adulto , Análise de Variância , Aorta/fisiologia , Variação Biológica da População , Monitores de Pressão Arterial/normas , Artéria Braquial/fisiologia , Calibragem , Artérias Carótidas/fisiologia , Criança , Feminino , Humanos , Masculino , Manometria/métodos , Manometria/normas , Artéria Radial/fisiologia
10.
Best Pract Res Clin Anaesthesiol ; 33(2): 127-138, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31582093

RESUMO

Arterial blood pressure monitoring is a major part of the decision-making process for every anesthetic. It is important to recognize the advantages, disadvantages, and limitations of available measurement modalities as well as have some understanding of the engineering principles on which these measurements are based. Oscillometry is by far the most common modality used but is limited by its intermittent nature and inaccuracy during hypotension and hypertension. Arterial catheterization is the gold standard for measuring blood pressure but is an invasive procedure that is expensive and not without risk of harm to the patient. Volume clamp and tonometric technologies are relatively new and allow for continuous noninvasive monitoring of the blood arterial waveform, but their accuracy when compared with oscillometry is not well described, and they have not been widely incorporated into standard practice. Additional research is needed to determine whether continuous noninvasive blood pressure monitors can improve outcomes.


Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea/fisiologia , Manometria/métodos , Monitorização Intraoperatória/métodos , Assistência Perioperatória/métodos , Determinação da Pressão Arterial/instrumentação , Humanos , Manometria/instrumentação , Monitorização Intraoperatória/instrumentação , Assistência Perioperatória/instrumentação
11.
Clin Exp Rheumatol ; 37 Suppl 119(4): 108-114, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31587696

RESUMO

OBJECTIVES: The aim of our study was to assess the role of videofluorography (VFG) in the evaluation of swallowing and oesophageal peristalsis in patients with systemic sclerosis (SSc). METHODS: From June 2014 to September 2017, 55 consecutive SSc patients, defined according to the 2013 ACR/EULAR classification criteria, underwent VFG study using a remote-controlled digital device. In order to evaluate possible abnormalities, 18 dynamic parameters were chosen, dividing the act of swallowing into three phases: oral, pharyngeal and oesophageal phases. The following dynamic radiological findings were considered: veil motility in phonation, leakage, drooling, salivation and presence of residues in the oral cavity, pharyngeal residues, penetration, aspiration, altered motility of the upper oesophageal sphincter, efficacy of primary peristaltic contractions, oesophageal clearance capacity, reflux, oesophagitis and motility of the lower oesophageal sphincter. RESULTS: The VFG study was well tolerated in all patients. Dysfunctions of oesophageal motility were common and included abnormal motility of UES (12.7%) and LES (76.4%), inadequate primary peristalsis (52.7%), abnormal secondary peristalsis (29.1%) and non-peristaltic contractions (40%). A defective oesophageal clearance was observed in 69.4% of patients. Moreover, most patients presented signs of oesophageal reflux (63.6%), oesophagitis (81.8%) and hiatal hernia (80%). Pharyngeal abnormalities were less common and involved up to 50% of patients. Oesophageal dysfunction and defective clearance were associated with dcSSc and pulmonary involvement. CONCLUSIONS: The VFG study is a useful technique for the morphological and functional evaluation of swallowing in SSc patients.


Assuntos
Cinerradiografia/métodos , Transtornos de Deglutição , Fluoroscopia/métodos , Escleroderma Sistêmico , Transtornos de Deglutição/diagnóstico por imagem , Transtornos de Deglutição/etiologia , Feminino , Refluxo Gastroesofágico , Humanos , Masculino , Manometria , Pessoa de Meia-Idade , Peristaltismo , Escleroderma Sistêmico/complicações , Escleroderma Sistêmico/diagnóstico por imagem
12.
Vestn Oftalmol ; 135(4): 27-32, 2019.
Artigo em Russo | MEDLINE | ID: mdl-31573554

RESUMO

PURPOSE: To study peculiarities of intraocular pressure (IOP) measurement by different methods in patients with changes in corneal biomechanical properties. MATERIAL AND METHODS: The study enrolled 154 patients (290 eyes) divided into 3 groups according to the condition of their corneas in terms of biomechanical properties. Group I consisted of 84 patients (168 eyes) with conditionally 'normal' cornea and corneal thickness ranging from 470 to 660 µm. Group II included 44 patients (70 eyes) with keratokonus. Group III consisted of 26 patients (52 eyes) after LASIK. IOP pressure was measured in each patient by pneumotonometry, Maklakov tonometry, and dynamic bidirectional pneumo-applanation of the cornea. Biomechanical properties were evaluated with dynamic pneumo-impression method. RESULTS: The study revealed that in patients of groups I and III, corneal biomechanics affected indices of corneal compensated IOP and Maklakov's IOP to a lesser extent, as opposed to measurements of Goldman tonometry and pneumotonometry. In group II, Maklakov's tonometry had less IOP measurement inaccuracies in comparison to other evaluated methods due to larger applanation surface. CONCLUSION: Changes in biomechanical properties of the cornea can complicate interpretation of the results of different methods of IOP measurement. Accurate determination of IOP requires consideration of biomechanical properties of the cornea, as well as anamnesis data on past corneal diseases or keratorefractive surgeries.


Assuntos
Pressão Intraocular , Tonometria Ocular , Fenômenos Biomecânicos , Córnea , Humanos , Manometria
13.
Acta otorrinolaringol. esp ; 70(5): 265-271, sept.-oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-186369

RESUMO

Objetivo: Evaluación del grado de severidad de la disfunción tubárica crónica mediante la adaptación al español del Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) y mediante el empleo de la tubomanometría (TMM). Materiales y métodos: Validación española del cuestionario ETDQ-7. Muestra: Estudio prospectivo de cohortes compuesto por 125 pacientes, de ellos 75 con enfermedad ótica compatible con la existencia de disfunción tubárica crónica. Medidas de evaluación: administración de la versión española del ETDQ-7 tras traducción y retrotraducción y establecimiento de su fiabilidad y consistencia interna. Evaluación de la utilidad de la TMM junto con el ETDQ-7 en el estudio de una posible disfunción de la trompa de Eustaquio. Resultados: La adaptación española del ETDQ-7 muestra fiabilidad y consistencia interna elevada. La unión de la TMM aumenta la sensibilidad y la especificidad en el diagnóstico de la disfunción de la trompa de Eustaquio. Conclusión: La adaptación del ETDQ-7 al español es válida, fiable y puede ser utilizada en la evaluación clínica para cuantificar el impacto y la severidad de la disfunción tubárica crónica en el paciente. Un test nuevo formado por la suma del ETDQ-7 y la TMM podrían convertirse en un método exploratorio de rutina en el diagnóstico de la disfunción de la trompa de Eustaquio


Objective: Evaluation of the severity of Eustachian tube dysfunction using the Spanish validation of the Eustachian Tube Dysfunction Questionnaire-7 (ETDQ-7) and tubomanometry (TMM). Materials and methods: Spanish validation of the ETDQ-7. Patients: Prospective study with 125 patients, 75 of whom reported symptoms compatible with Eustachian tube dysfunction. Outcome measures: The Spanish version of the ETDQ-7 was administered after translation and back-translation. Internal consistency and reliability were established. Usefulness evaluation of TMM plus ETDQ-7 in the study of Eustachian tube dysfunction. Results: The Spanish adaptation of the ETDQ-7 showed high reliability and internal consistency. TMM and ETDQ-7 together showed increased sensitivity and specificity in the diagnosis of Eustachian tube dysfunction. Conclusions: The Spanish adaptation of the ETDQ-7 is valid, reliable and can be used in a clinical setting to quantify the impact and severity of chronic dysfunction on patients' lives. A new test formed by combining ETDQ-7 and TMM could be a routine test in the diagnosis of Eustachian tube dysfunction


Assuntos
Humanos , Tuba Auditiva/fisiopatologia , Manometria , Autorrelato , Otopatias/fisiopatologia , Doenças Nasais/fisiopatologia , Estudos Prospectivos , Reprodutibilidade dos Testes , Sensibilidade e Especificidade , Avaliação de Sintomas , Traduções
15.
Pediatr Surg Int ; 35(11): 1255-1263, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31494699

RESUMO

PURPOSE: Single-incision laparoscopic-assisted anorectoplasty (SILAARP) was compared to posterior sagittal anorectoplasty (PSARP) for treating intermediate-type anorectal malformations (ARMs) with rectobulbar fistula. METHODS: Between December 2011 and January 2016, 48 children with intermediate-type ARMS were treated with SILAARP (n = 34) or PSARP (n = 14) in our centre. Data including demographics, complications, and long-term outcomes were retrospectively compared. RESULTS: No significant difference was observed between both groups in terms of median operative time and complications. The length of postoperative hospital stay was shorter in the SILAARP group than in the PSARP group (6.15 ± 1.10 vs 9.64 ± 4.13 days; p = 0.008). After a mean follow-up of 59.38 ± 13.68 months, the rates of voluntary bowel movements, soiling, and constipation were similar in both groups. Anorectal manometry was performed in 15 and 7 children from the SILAARP and PSARP groups, respectively. Although there were no significant differences in the presence of rectoanal relaxation reflex and high-pressure-zone length, anal canal resting pressure was higher in the SILAARP group than in the PSARP group (33.35 ± 12.95 vs 23.06 ± 8.40 mmHg; p = 0.039). CONCLUSIONS: Both SILAARP and PSARP seemed feasible and effective for treating intermediate-type ARMs with rectobulbar fistula in children. However, SILAARP significantly reduced the length of postoperative hospital stay and improved anal canal resting pressure.


Assuntos
Malformações Anorretais/cirurgia , Procedimentos Cirúrgicos do Sistema Digestório/métodos , Laparoscopia , Fístula Retal/cirurgia , Canal Anal/fisiologia , Feminino , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Masculino , Manometria , Pressão , Estudos Retrospectivos
16.
Int J Colorectal Dis ; 34(10): 1819-1822, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31471700

RESUMO

PURPOSE: Colonic manometry (CM) can be of additive value in the diagnostic workup of colonic motility in chronic constipated patients. However, it is claimed that colonic motor disturbances occur in normal-transit constipation (NTC) and slow-transit (STC) constipation, as measured using a radio-opaque marker study, and therefore, the relationship between colonic motor disturbances on CM and colonic transit time (CTT) remains unclear. Our aim was to compare results from colonic marker study with the outcome of CM in patients with treatment-refractory chronic constipation (CC). METHOD: Eighty-seven CC patients and 12 healthy volunteers, undergoing both a CTT study and a 24-h CM in a Dutch tertiary referral center, were included. CTT was measured using radio-opaque markers (X-ray at day 4 after ingestion of 20 markers at day 0). CM was performed using a catheter with 6 solid-state pressure sensors, endoscopically clipped to the mucosa in the right colon. CM was defined as normal when at least three high-amplitude propagating contractions (HAPCs), i.e., propagating waves with amplitude ≥ 80 mmHg over at least three sensors, were identified. RESULTS: In total, 70 patients showed STC on CTT, of which 21 (30%) showed normal CM. All 17 NTC patients and healthy volunteers showed normal CM. The negative predictive value of CTT for normal CM was 100%. CONCLUSION: Colonic manometry should be considered in therapy-refractory STC patients in order to further delineate colonic motility. However, in this exploratory study, for patients presenting with NTC on a radio-opaque marker study, colonic manometry does not appear to have added value.


Assuntos
Colo/fisiopatologia , Constipação Intestinal/fisiopatologia , Trânsito Gastrointestinal/fisiologia , Manometria , Adulto , Estudos de Casos e Controles , Doença Crônica , Feminino , Humanos , Masculino
17.
Pregnancy Hypertens ; 17: 75-81, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31487661

RESUMO

OBJECTIVES: Overwhelming clinical evidence exists on disturbed vascular and endothelial function in the pathophysiology of preeclampsia (PE). In a non-pregnant (NP) population, L-FMC (low-flow mediated constriction) provides insight in the 'resting' endothelial capacity in contrast to the gold standard of flow mediated dilatation (FMD), reflecting endothelial nitric oxide bioavailability. STUDY DESIGN: Longitudinal follow-up of 100 healthy pregnant (HP) women, 33 PE women and 16 NP controls with non-invasive vascular assessments. HP women were evaluated at 12 and 35 weeks of gestation and at 6 months postpartum. PE patients were assessed at diagnosis (mean 30 weeks) and 6 months postpartum. MAIN OUTCOME MEASURES: Endothelial function (L-FMC, FMD, peripheral arterial tonometry (PAT)) and arterial stiffness (pulse wave velocity (PWV) and analysis (PWA)) were measured at the different visits and compared between groups. RESULTS: Overall endothelial dysfunction is present in PE (FMD HP 9.09 ±â€¯4.20 vs PE 5.21 ±â€¯4.47, p = 0.0004; L-FMC HP -1.90 ±â€¯2.66 vs PE -0.40 ±â€¯2.09, p = 0.03). L-FMC gradually elevates during the course of a HP (1st trim -0.31 ±â€¯1.75 vs 3rd trim -1.97 ±â€¯3.02, p < 0.0001) and is present in 85% of women in the third trimester. In NP, only 27% of women has L-FMC. In PE, L-FMC is present in 50% of cases. Arterial stiffness is increased in PE (all p < 0.0001). There is no correlation between L-FMC and other markers of vascular function (p > 0.05). CONCLUSION: PE is characterized by dysfunction of both resting and recruitable endothelial capacity. This study offers new insights in different aspects of endothelial function in pregnancy, since L-FMC reflects an adaptation in HP that is absent in PE.


Assuntos
Endotélio Vascular/fisiopatologia , Pré-Eclâmpsia/diagnóstico , Diagnóstico Pré-Natal , Rigidez Vascular , Adulto , Biomarcadores , Feminino , Humanos , Manometria , Projetos Piloto , Pré-Eclâmpsia/fisiopatologia , Valor Preditivo dos Testes , Gravidez , Terceiro Trimestre da Gravidez , Fluxo Sanguíneo Regional
18.
Rehabilitación (Madr., Ed. impr.) ; 53(3): 146-154, jul.-sept. 2019. ilus, tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185551

RESUMO

Objetivo: demostrar si un protocolo reducido de 6 sesiones de ejercicios tónicos y fásicos es capaz de mejorar la calidad de vida y la fuerza muscular en los pacientes con incontinencia urinaria (IU). Material y métodos: se realizó un estudio prospectivo tipo antes y después a 67 pacientes con IU remitidos al Departamento de Rehabilitación del Hospital Universitario de Santa Cristina, Madrid, España. El estudio se realizó de enero del 2016 a diciembre del 2018. En la evaluación inicial, se registraron los datos de filiación, los factores predisponentes y el tipo de IU. Los pacientes recibieron recomendaciones de estilo de vida y los cuestionarios/escalas ICIQ-SF/I-QOL que debían rellenarse al inicio/final del tratamiento. La evaluación manométrica fue registrada en la evaluación inicial/final por el equipo MYOMED(R) 932 ENRAF NONIUS (CE 0197). El protocolo consistió en una sesión de 30 min de ejercicios tónicos/fásicos (15 min cada uno) 2 veces a la semana durante un máximo de 6 sesiones, supervisadas por un fisioterapeuta. Resultados: la edad media fue de 52,1±12,7 años. Mujeres 94% (n=63). La fuerza máxima y media de la contracción del suelo pélvico fue de 26,4±15,6 y 5,3±3,9mmHg, respectivamente, y aumentó significativamente después del tratamiento a 35,5±19,6 y 7,6±4,4mmHg (p<0,0001). El ICIQ-SF fue de 10,1±5 y disminuyó significativamente a 6,6±4,6 (p<0,0001). La I-QOL aumentó significativamente de 66,1±21,9 a 77,9±18,1 puntos (p<0,0001). La subescala I-QOL limitación de actividad se elevó de 63,7±22,6 a 77,3±17,8 (p<0,0001); la subescala I-QOL efecto psicosocial aumentó de 73,8±23,9 a 82,5±18,7 (p=0,0004); y la subescala I-QOL vergüenza social se incrementó de 56,5±23,7 a 70,5±22,1 (p<0,0001). Conclusión: el biofeedback manométrico es capaz de disminuir la IU y mejorar la calidad de vida y los valores manométricos. Este protocolo reducido de 6 sesiones podría aplicarse a otras instituciones públicas y privadas y podría tener un impacto económico en el sistema de salud y en la economía de los pacientes


Objective: to determine whether a short 6-session protocol of tonic/ phasic exercises can enhance quality of life and muscular strength in patients with urinary incontinence (UI). Material and methods: a prospective before-after study was performed in 67 patients with UI referred to the Rehabilitation Department of the Santa Cristina University Hospital in Madrid, Spain. In the initial assessment, the patient's personal details, predisposing factors and type of UI were registered. Patients received lifestyle recommendations. The ICIQ-SF/I-QOL questionnaires/scales were completed at the beginning and end of treatment. The manometric evaluation was registered in the first and last assessment by the MYOMED(R) 932 equipment. The protocol consisted of a 30-minute session of tonic/phasic exercises (15minutes each) twice weekly for a maximum of 6 sessions, supervised by a physiotherapist. Results: the mean age was 52.1±12.7 years and 94% of the patients (n=63) were women. The maximum and mean strength of the pelvic floor contraction was 26.4±15.6 and 5.3±3.9mmHg, respectively, which significantly increased after treatment to 35.5±19.6 and 7.6±4.4mmHg (P<.0001). The ICIQ-SF score was 10.1±5 and significantly decreased to 6.6±4.6 (P<0.0001). The I-QOL score significantly increased from 66.1±21.9 to 77.9±18.1 points (P<.0001). The I-QOL ALB subscale (avoidance and limiting behaviour) increased from 63.7±22.6 to 77.3±17.8 (P<.0001); the I-QoL PSI subscale (psychosocial impact) increased from 73.8±23.9 to 82.5±18.7 (P=.0004); and the I-QOL SE subscale (social embarrassment) increased from 56.5±23.7 to 70.5±22.1 (P<.0001). Conclusion: manometric feedback reduces UI and improves both quality of life and manometric values. This short 6-session protocol could be applied in other public and private centres and could provide economic benefits to the health system and to patients


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Manometria/métodos , Terapia por Exercício/métodos , Incontinência Urinária/reabilitação , Força Muscular/fisiologia , Estudos Prospectivos , Resultado do Tratamento , Estudos Controlados Antes e Depois/métodos , Retroalimentação Fisiológica
19.
Zhonghua Yi Xue Za Zhi ; 99(30): 2337-2343, 2019 Aug 13.
Artigo em Chinês | MEDLINE | ID: mdl-31434413

RESUMO

Objective: To explore the effect of biofeedback training combined with pelvic floor muscle exercise on the recovery of anorectal function in patients with middle and low rectal cancer undergoing sphincter-preserving surgery, and to find the best way to prevent low anterior resection syndrome. Methods: A single-center prospective randomized controlled study was conducted. One hundred and nine patients with mid-low rectal cancer in Sun Yat-sen University Cancer Centre from June 2015 to December 2016 were enrolled in the study, who were going to undergo sphincter-preserving surgery or preventive ostomy after preoperative chemoradiotherapy. They were divided into three groups: blank control group, pelvic floor muscle exercise group and biofeedback training combined with pelvic floor muscle exercise group. Intervention and follow-up were conducted for 16 months. High-resolution anorectal manometry was used to measure the objective anorectal pressure and sensory index of patients, and the Chinese version of MSKCC Intestinal Function Questionnaire was used to evaluate the intestinal function of patients. The differences of objective anorectal manometry index and subjective intestinal function between the three groups were compared, and the occurrence of low anterior rectal resection syndrome was evaluated. Results: At the end of the intervention, the total scores of anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time, initial rectal volume, rectal fecal sensory capacity, rectal maximum tolerance capacity, rectal compliance, anorectal hypertensive zone and total score of intestinal function in the biofeedback training combined with pelvic floor muscle exercise group were (44.83±9.01) mmHg, (4.31±1.75) mmHg, (130.46±10.00) mmHg, (19.94±4.30) s, (32.71±5.00) ml, (74.26±8.30) ml, (188.4±12.68) ml, (5.69±1.18) ml/kPa, (3.31±0.96) cm and (68.09±6.38) points respectively. The main effects of the changes of five indices, including anal resting pressure, rectal resting pressure, anal maximum systolic pressure, anal maximum systolic time and anal high pressure zone, were time. Significant differences were found in initial rectal capacity, sensory capacity of rectal defecation, maximum tolerance capacity of rectum, rectal compliance and total score of intestinal function in every time point of measurement in the biofeedback training group combined with pelvic floor muscle exercise group. They were significantly higher than those in the blank control group (P<0.05); the score of the biofeedback training group combined with pelvic floor muscle exercise group at one month after operation, perioperative period and 3 months after operation were significantly higher than those in pelvic floor muscle exercise group (P<0.05). Biofeedback training combined with pelvic floor muscle exercise reduced the incidence of low anterior resection syndrome of rectum (P<0.05). Conclusion: Biofeedback training combined with pelvic floor muscle exercise can significantly improve the sensory indicators of patients with mid-low rectal cancer, promote the recovery of intestinal function, and alleviate low anterior resection syndrome of rectal cancer patients, which is worthy of popularization and application.


Assuntos
Incontinência Fecal , Neoplasias Retais , Canal Anal , Biorretroalimentação Psicológica , Exercício , Humanos , Manometria , Músculo Esquelético , Diafragma da Pelve , Complicações Pós-Operatórias , Estudos Prospectivos , Neoplasias Retais/cirurgia , Síndrome
20.
HNO ; 67(12): 940-947, 2019 Dec.
Artigo em Alemão | MEDLINE | ID: mdl-31407018

RESUMO

The findings of functional endoscopy (upper esophageal sphincter insufficiency, cardia insufficiency, esophagitis, gastric heterotopia, axial sliding hernia, and visible aerosols) can be traced back to pharyngeal acid exposure by oropharyngeal pH measurement. Significantly increased pharyngeal acid loads are seen in gastric heterotopy and axial sliding hernia. For all measured statistics, the pharyngeal acid load is in the pathological or even very pathological range. The value of functional endoscopy in the context of laryngopharyngeal reflux diagnosis is clearly documented. The findings "heterotopic gastric mucosa" and "axial sliding hernia" may cause marked airway symptoms and a pathogenetic relationship with otorhinolaryngologic reflux-associated symptoms must be postulated for these entities.


Assuntos
Esofagite Péptica , Esofagoscopia , Refluxo Laringofaríngeo , Faringe/patologia , Esofagite Péptica/complicações , Esofagite Péptica/fisiopatologia , Humanos , Refluxo Laringofaríngeo/complicações , Refluxo Laringofaríngeo/fisiopatologia , Manometria
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