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1
Oakley, RE, B. Olivier, GE Eyster, and JG Hauptman. "Experimental evaluation of central venous pressure monitoring in the dog." Journal of the American Animal Hospital Association 33, no. 1 (January 1, 1997): 77–82. http://dx.doi.org/10.5326/15473317-33-1-77.
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The measurement of central venous pressure (CVP) will provide objective information about intravascular blood volume. Limitations exist with direct and indirect methods of measuring CVP; however, the purpose of this study was to determine if such factors as catheter size, patient position, or measurements taken with either a water manometer or a strain-gauge transducer would affect the accuracy of CVP measurements. The study population consisted of six adult, mixed-breed dogs. Catheter sizes evaluated were 16- and 19-gauge. Patient positions evaluated were right and left lateral recumbencies. Right atrial pressures (RAPs) were used as the reference standards for CVP measurements. Measurements of RAP and CVP were obtained with a water manometer and a strain-gauge transducer. No significant differences were observed in measured CVPs for the effects of catheter size and right versus left lateral recumbency. A 2.7-mmHg difference in water manometry was demonstrated when compared to strain-gauge transducer measurements. Also, strain-gauge transducer measurements had less precision compared to water manometer measurements.
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Banner, Michael J., and Philip G. Boysen. "A Manometer to Measure Demand Valve Reference Pressure." Anesthesiology 62, no. 3 (March 1, 1985): 369. http://dx.doi.org/10.1097/00000542-198503000-00032.
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Eshpulatov, Nodir, Tolib Khalmuradov, Rakhmаnberdi Khalilov, Abdulkhay Obidov, and Madrakhim Allanazarov. "Electrical conductivity of whole and shredded plant tissue." E3S Web of Conferences 264 (2021): 04072. http://dx.doi.org/10.1051/e3sconf/202126404072.
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The article gives the electrical conductivity of whole and shredded plant tissue. An experimental study was made of the dependence of the resistivity value and the volume occupied by the pulp on the pressing time and specific pressures on the pulp while taking into account the amount of pressed juice. The electrical resistance (R) of whole and crushed plant tissue was experimentally studied, which, when processing the results, was recalculated to the specific electrical resistance (ρ) of the tissue. The specific pressure (P) on the tissue was determined using a reference manometer, and the deformation (ΔH) of the sample was measured with a dial indicator.
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Hall, Bradley D., Andrew M. Crotwell, Duane R. Kitzis, Thomas Mefford, Benjamin R. Miller, Michael F. Schibig, and Pieter P. Tans. "Revision of the World Meteorological Organization Global Atmosphere Watch (WMO/GAW) CO<sub>2</sub> calibration scale." Atmospheric Measurement Techniques 14, no. 4 (April 26, 2021): 3015–32. http://dx.doi.org/10.5194/amt-14-3015-2021.
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Abstract. The NOAA Global Monitoring Laboratory serves as the World Meteorological Organization Global Atmosphere Watch (WMO/GAW) Central Calibration Laboratory (CCL) for CO2 and is responsible for maintaining the WMO/GAW mole fraction scale used as a reference within the WMO/GAW program. The current WMO-CO2-X2007 scale is embodied by 15 aluminum cylinders containing modified natural air, with CO2 mole fractions determined using the NOAA manometer from 1995 to 2006. We have made two minor corrections to historical manometric records: fixing an error in the applied second virial coefficient of CO2 and accounting for loss of a small amount of CO2 to materials in the manometer during the measurement process. By incorporating these corrections, extending the measurement records of the original 15 primary standards through 2015, and adding four new primary standards to the suite, we define a new scale, identified as WMO-CO2-X2019. The new scale is 0.18 µmol mol−1 (ppm) greater than the previous scale at 400 ppm CO2. While this difference is small in relative terms (0.045 %), it is significant in terms of atmospheric monitoring. All measurements of tertiary-level standards will be reprocessed to WMO-CO2-X2019. The new scale is more internally consistent than WMO-CO2-X2007 owing to revisions in propagation and should result in an overall improvement in atmospheric data records traceable to the CCL.
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Barin, E. S., M. Cejnar, G. I. C. Nelson, and S. N. Hunyor. "Physical Characteristics and Clinical Evaluation of a New Disposable Fibreoptic Transducer-Tipped Catheter System." Anaesthesia and Intensive Care 15, no. 3 (August 1987): 323–29. http://dx.doi.org/10.1177/0310057x8701500313.
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A new disposable fibreoptic transducer-tipped catheter manometer system was evaluated to assess its accuracy, stability of accuracy under prolonged simulated intra-arterial conditions, and dynamic characteristics. Maximum errors observed in the measurement of static pressure using a sample of five catheters (with one display unit) were 2 mmHg at 0 mmHg reference pressure, 2 at 20 mmHg, 4 at 40 mmHg, 4 at 100 mmHg and 9 at 200 mmHg. An immersion artifact caused a shift in baseline of up to 2 mmHg. Exposure of the transducer to 24 hours of simulated intra-arterial conditions (pulsatile pressure at 40°C) resulted in errors of up to 7 mmHg for pressures up to 100 mmHg, and 11 mmHg for 200 mmHg, which were largely attributable to a drift in baseline pressure (up 6 mmHg by 24 hours). Consistent overestimation by the system suggested inappropriate gain setting within the display unit which, however, is not user-adjustable. The system exhibited uniform frequency response up to 33 Hz.
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Lira, Ignacio, and Dieter Grientschnig. "The Cosine Error: A Bayesian Procedure for Treating a Non-repetitive Systematic Effect." Measurement Science Review 16, no. 4 (August 1, 2016): 211–17. http://dx.doi.org/10.1515/msr-2016-0026.
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Abstract An inconsistency with respect to variable transformations in our previous treatment of the cosine error example with repositioning (Metrologia, vol. 47, pp. R1–R14) is pointed out. The problem refers to the measurement of the vertical height of a column of liquid in a manometer. A systematic effect arises because of the possible deviation of the measurement axis from the vertical, which may be different each time the measurement is taken. A revised procedure for treating this problem is proposed; it consists in straightforward application of Bayesian statistics using a conditional reference prior with partial information. In most practical applications, the numerical differences between the two procedures will be negligible, so the interest of the revised one is mainly of conceptual nature. Nevertheless, similar measurement models may appear in other contexts, for example, in intercomparisons, so the present investigation may serve as a warning to analysts against applying the same methodology we used in our original approach to the present problem.
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Vierron, Emilie, Jean-Michel Halimi, Jean Tichet, Beverley Balkau, Joel Cogneau, and Bruno Giraudeau. "Center Effect on Ankle–Brachial Index Measurement When Using the Reference Method (Doppler and Manometer): Results From a Large Cohort Study." American Journal of Hypertension 22, no. 7 (April 30, 2009): 718–22. http://dx.doi.org/10.1038/ajh.2009.78.
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Hashad, Ahmed Salama, Wladimir Sabuga, Sven Ehlers, and Thomas Bock. "Validation of a PTB force-balanced piston gauge primary pressure standard." ACTA IMEKO 10, no. 1 (March 31, 2021): 271. http://dx.doi.org/10.21014/acta_imeko.v10i1.821.
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Experimental methods using different pressure standards were applied to verify theoretical results obtained for the effective area of the piston-cylinder assembly (PCA) and for pressures measured with a force-balanced piston gauge (FPG). The theoretical effective area was based on the PCA’s dimensional properties defined via diameter, straightness and roundness measurements of the piston and cylinder, derived by gas-flow modelling using principles of the rarefied gas dynamics, and presented as two values: one obtained for absolute and the other for gauge pressure operation mode. Both values have a relative standard uncertainty of 5×10<sup>-6</sup>. The experimental methods chosen were designed to cover the entire operating pressure range of the FPG from 3 Pa to 15 kPa. Comparisons of the FPG with three different PTB pressure standards operated in different pressure ranges – a pressure balance, a mercury manometer and a static expansion system – were performed using the cross-float method and by a direct comparison of the generated pressures. For the theoretical and experimental effective area, as well as for pressures generated by the FPG and the reference standards, all the results demonstrated full agreement within the expanded uncertainties of the standards.
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Szmigielska, Katarzyna, Anna Szmigielska-Kapłon, and Anna Jegier. "Blood pressure response to exercise in young athletes aged 10 to 18 years." Applied Physiology, Nutrition, and Metabolism 41, no. 1 (January 2016): 41–48. http://dx.doi.org/10.1139/apnm-2015-0101.
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The aim of the study was to determine arterial blood pressure response to exercise in young athletes. The study group comprised 711 young athletes (457 boys, 254 girls) aged 10 to 18 years (mean 13.41 ± 3.12 years) who had been training for an average of 7.62 ± 4.2 h per week for an average of 4.01 ± 2.5 years. Participants with elevated arterial blood pressure above the 90th percentile at rest were excluded from investigation. A symptom-limited, multistage exercise test to exhaustion was performed using a Monark cycle ergometer. Arterial blood pressure was measured with an aneroid manometer in the third minute of each stage of the test. Mean systolic arterial blood pressure during peak exercise was significantly higher in boys than in girls: 183.21 ± 27.97 mm Hg and 170.97 ± 21.4 mm Hg, respectively (p = 0.03). Multivariate linear regression analysis showed that age and workload had significant effects on arterial blood pressure during the test. Systolic arterial blood pressure during the exercise can be described with the following equations: boys, SBPex (mm Hg) = –1.92 × age (years) + 0.55 × workload (W) + 120.84; girls, SBPex (mm Hg) = –0.88 × age (years) + 0.48 × workload (W) + 111.22. The study results describe reference values of arterial blood pressure during the exercise test. The presented equations and figures can help to assess whether the arterial blood pressure at each stage of the exercise test exceeds the normal range or not.
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Côté-Daigneault, Justin, Pierre Leclerc, Josette Joubert, and Mickael Bouin. "High Prevalence of Esophageal Dysmotility in Asymptomatic Obese Patients." Canadian Journal of Gastroenterology and Hepatology 28, no. 6 (2014): 311–14. http://dx.doi.org/10.1155/2014/960520.
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BACKGROUND: Obesity is an important health problem affecting >500 million people worldwide. Esophageal dysmotility is a gastrointestinal pathology associated with obesity; however, its prevalence and characteristics remain unclear. Esophageal dysmotilities have a high prevalence among obese patients regardless of gastrointestinal symptoms.OBJECTIVE: To identify the prevalence of esophageal dysmotility among obese patients. The secondary goals were to characterize these pathologies in obese patients and identify risk factors.METHOD: A prospective study from January 2009 to March 2010 at the University of Montreal Hospital Centre (Montreal, Quebec) was performed. Every patient scheduled for bariatric surgery underwent preoperatory esophageal manometry and was included in the study. Manometry was performed according to a standardized protocol with the following measures: superior esophageal sphincter – coordination and release during deglutition; esophageal body – presence, propagation, length, amplitude and type of esophageal waves of contraction; lower esophageal sphincter – localization, tone, release, intragastic pressure and intraesophageal pressure. All reference values were those used in the digestive motility laboratory. A gastrointestinal symptoms questionnaire was completed on the day manometry was performed. Chart reviews were performed to identify comorbidities and treatments that could influence the results.RESULTS: A total of 53 patients were included (mean [± SD] age 43±10 years; mean body mass index 46±7 kg/m2; 70% female). Esophageal manometry revealed dysmotility in 51% (n=27) of the patients. This dysmotility involved the esophageal body in 74% (n=20) of the patients and the inferior sphincter in 11% (n=3). Mixed dysmotility (body and inferior sphincter) was found in 15% (n=4) of cases. The esophageal body dysmotilities were hypomotility in 85% (n=23) of the patients, either from insignificant waves (74% [n=20]), nonpropagated waves (11% [n=3]) or low-amplitude waves (33% [n=9]). Gastroesophageal symptoms were found in 66% (n=35) of obese patients, including heartburn (66% [n=23]), regurgitation (26% [n=9]), dysphagia (43% [n=15]), chest pain (6% [n=2]) and dyspepsia (26% [n=9]). Among symptomatic patients, 51% (n=18) had normal manometry and 49% (n=17) had abnormal manometry (statistically nonsignificant). Among asymptomatic patients (n=18), 44% (n=8) had normal manometry and 56% (n=10) had abnormal manometry (statistically nonsignificant). Furthermore, no statistical differences were found between the normal manometry group and the abnormal manometry group with regard to medication intake or comorbidities.CONCLUSION: Esophageal dysmotilities had a high prevalence in obese patients. Gastrointestinal symptoms cannot predict the presence of esophageal dysmotility. Hypomotility of the esophageal body is the most common dysmotility, especially from the absence of significant waves.
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Lu, Xi, and Steven R. Beaupré. "Optimized Volume Determinations and Uncertainties for Accurate and Precise Manometry." Radiocarbon 61, no. 4 (May 27, 2019): 1077–89. http://dx.doi.org/10.1017/rdc.2019.43.
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ABSTRACTPrecise manometric pressure, volume, and temperature (P-V-T) measurements of carbon in samples, standards, and blanks are critical for radiocarbon studies. While P and T uncertainties depend on instrument choice and environmental stability, V uncertainties depend on their method of measurement and are often overlooked. We used numerical simulations and error propagation to find optimum procedures for measuring “cold-finger” volumes equipped with capacitance diaphragm gauges (CDGs) by two common application of Boyle’s Law: cryogenic transfers and serial gas expansions with a reference flask of known volume. Minimum relative uncertainties of cold-finger volumes are comparable for these two methods (∼0.002), but the serial gas expansion method is preferred due to its convenience. Serial gas expansions can be performed to high precision by using dry air, an initial pressure ∼76% full-scale (e.g., 760 Torr), and a reference flask with an optimal volume based on preliminary estimates of cold-finger volumes and an empirical power function. The volumes of cold-fingers ≥ 12 cm3 can be determined with minimum achievable relative uncertainties of 0.0021 to 0.0023. This limit translates to minimum achievable relative uncertainties of 0.0026 to 0.0027 for P-V-T measurements of moles of gas simulated here.
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Heissam, Khaled, Nichola Abrehart, Caroline L. Hoad, Jeff Wright, Alex Menys, Kathryn Murray, Paul M. Glover, et al. "Measurement of fasted state gastric antral motility before and after a standard bioavailability and bioequivalence 240 mL drink of water: Validation of MRI method against concomitant perfused manometry in healthy participants." PLOS ONE 15, no. 11 (November 11, 2020): e0241441. http://dx.doi.org/10.1371/journal.pone.0241441.
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Objective The gastrointestinal environment in which drug products need to disintegrate before the drug can dissolve and be absorbed has not been studied in detail due to limitations, especially invasiveness of existing techniques. Minimal in vivo data is available on undisturbed gastrointestinal motility to improve relevance of predictive dissolution models and in silico tools such as physiologically-based pharmacokinetic models. Recent advances in magnetic resonance imaging methods could provide novel data and insights that can be used as a reference to validate and, if necessary, optimize these models. The conventional method for measuring gastrointestinal motility is via a manometric technique involving intubation. Nevertheless, it is feasible to measure gastrointestinal motility with magnetic resonance imaging. The aim of this study was is to develop and validate a magnetic resonance imaging method using the most recent semi-automated analysis method against concomitant perfused manometry method. Material and methods Eighteen healthy fasted participants were recruited for this study. The participants were intubated with a water-perfused manometry catheter. Subsequently, stomach motility was assessed by cine-MRI acquired at intervals, of 3.5min sets, at coronal oblique planes through the abdomen and by simultaneous water perfused manometry, before and after administration of a standard bioavailability / bioequivalence 8 ounces (~240mL) drink of water. The magnetic resonance imaging motility images were analysed using Spatio-Temporal Motility analysis STMM techniques. The area under the curve of the gastric motility contractions was calculated for each set and compared between techniques. The study visit was then repeated one week later. Results Data from 15 participants was analysed. There was a good correlation between the MRI antral motility plots area under the curve and corresponding perfused manometry motility area under the curve (r = 0.860) during both antral contractions and quiescence. Conclusion Non-invasive dynamic magnetic resonance imaging of gastric antral motility coupled with recently developed, semi-automated magnetic resonance imaging data processing techniques correlated well with simultaneous, ‘gold standard’ water perfused manometry. This will be particularly helpful for research purposes related to oral absorption where the absorption of a drug is highly depending on the underlying gastrointestinal processes such as gastric emptying, gastrointestinal motility and availability of residual fluid volumes. Clinical trial This trial was registered at ClinicalTrials.gov as NCT03191045.
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Huang, Ling, and Liang Chang. "Study on Wind-Resistant Design for Super High-Rise Building Envelop." Advanced Materials Research 368-373 (October 2011): 2089–93. http://dx.doi.org/10.4028/www.scientific.net/amr.368-373.2089.
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A brief introduction of Nanchang International Financial mansion manometry test model was stated first, And based on the Fluent software platforms, Wind pressure on the surface of high-rise building with the influence of adjacent buildings is simulated by computation fluid dynamics (CFD) methods. The results show that the numerical wind tunnel to some extent, more in line with the measurement results, but the errors in some parts are still large, relevant results will provide references for the research and the engineering practice.
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Flores, Francisco Javier, and Jorge C. Torres. "Cross-floating calibration study. Trim masses: on the standard balance or on the balance under calibration." ACTA IMEKO 7, no. 1 (April 1, 2018): 86. http://dx.doi.org/10.21014/acta_imeko.v7i1.498.
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<span style="font-family: 'Arial',sans-serif; font-size: 11pt; mso-fareast-font-family: 'Times New Roman'; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-GB; mso-fareast-language: DE; mso-bidi-language: AR-SA;" lang="EN-GB">The pressure balances are used as reference standards to calibrate secondary manometers and other balances. There are different types and models of pressure balances that cover measuring ranges from 3 kPa to 1 GPa. The pressure balances are designed to measure relative, absolute or differential pressure and some balances can measure all types of pressure. This paper presents the results of a study of high accuracy pressure balances cross-floating calibration comparing trim masses on the standard balance or on the balance under calibration.</span>
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Awad, Richard A., and Santiago Camacho. "Reference values for stationary and 24-hour ambulatory esophageal manometry and pH data in hispanic population." Archives of Medical Research 34, no. 5 (September 2003): 388–93. http://dx.doi.org/10.1016/s0188-4409(03)00074-2.
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Manu, Kavya, Seema S. Aceves, Mark A. Valasek, and David C. Kunkel. "Sa1135 - Baseline Impedance on High-Resolution Impedance Manometry Correlates with Severity of Eosinophilic Esophagitis Endoscopic Reference Score." Gastroenterology 154, no. 6 (May 2018): S—253. http://dx.doi.org/10.1016/s0016-5085(18)31216-2.
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Hveem, K., W. M. Sun, G. Hebbard, M. Horowitz, S. Doran, and J. Dent. "Relationship between ultrasonically detected phasic antral contractions and antral pressure." American Journal of Physiology-Gastrointestinal and Liver Physiology 281, no. 1 (July 1, 2001): G95—G101. http://dx.doi.org/10.1152/ajpgi.2001.281.1.g95.
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The relationships between gastric wall motion and intraluminal pressure are believed to be major determinants of flows within and from the stomach. Gastric antral wall motion and intraluminal pressures were monitored in five healthy subjects by concurrent antropyloroduodenal manometry and transabdominal ultrasound for 60 min after subjects drank 500 ml of clear soup. We found that 99% of antral contractions detected by ultrasound were propagated aborally, and 68% of contractions became lumen occlusive at the site of the ultrasound marker. Of the 203 contractions detected by ultrasound, 53% were associated with pressure events in the manometric reference channel; 86% of contractions had corresponding pressure events detectable somewhere in the antrum. Contractions that occluded the lumen were more likely to be associated with a pressure event in the manometric reference channel ( P < 0.01) and to be of greater amplitude ( P < 0.01) than non-lumen-occlusive contractions. We conclude that heterogeneous pressure event patterns in the antrum occur despite a stereotyped pattern of contraction propagation seen on ultrasound. Lumen occlusion is more likely to be associated with higher peak antral pressure events.
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Vieira, Marcelo Adriano da Cunha Silva, Maria do Amparo Salmito Cavalcanti, Dorcas Lamounier Costa, Kelsen Dantas Eulálio, Otoni Cardoso do Vale, Chrystiany Placido de Brito Vieira, and Carlos Henrique Nery Costa. "Visual evoked potentials show strong positive association with intracranial pressure in patients with cryptococcal meningitis." Arquivos de Neuro-Psiquiatria 73, no. 4 (April 2015): 309–13. http://dx.doi.org/10.1590/0004-282x20150002.
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Objective : To verify the relationship between intracranial pressure and flash visual evoked potentials (F-VEP) in patients with cryptococcal meningitis. Method The sample included adults diagnosed with cryptococcal meningitis admitted at a reference hospital for infectious diseases. The patients were subjected to F-VEP tests shortly before lumbar puncture. The Pearson’s linear correlation coefficient was calculated and the linear regression analysis was performed. Results : Eighteen individuals were subjected to a total of 69 lumbar punctures preceded by F-VEP tests. At the first lumbar puncture performed in each patient, N2 latency exhibited a strong positive correlation with intracranial pressure (r = 0.83; CI = 0.60 - 0.94; p < 0.0001). The direction of this relationship was maintained in subsequent punctures. Conclusion : The intracranial pressure measured by spinal tap manometry showed strong positive association with the N2 latency F-VEP in patients with cryptococcal meningitis.
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Colizzo, Jason, Steven Clayton, Ambuj Kumar, and Joel Richter. "Intrabolus Pressure Has Better Correlation Than Eosinophilia with Dysphagia Severity in Fibrostenotic Eosinophilic Esophagitis: A Pilot Study." Gastrointestinal Disorders 1, no. 1 (August 13, 2018): 3–14. http://dx.doi.org/10.3390/gidisord1010002.
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Eosinophilic esophagitis is characterized by dysphagia with esophageal eosinophilia. We sought to determine if intrabolus pressure measurements on high-resolution manometry had any correlation with dysphagia improvement following standard therapy for patients with fibrostenotic eosinophilic esophagitis. Consecutive patients were prospectively enrolled at our swallowing center. Dysphagia scores, esophageal eosinophil counts, endoscopic reference scores, and intrabolus pressure measurements were compared at baseline and following therapy with 8 weeks of a proton-pump inhibitor and serial bougie dilation to a luminal diameter of 17 mm. Five patients were included in the study. The median age was 38 years. The average endoscopic reference score improved from 5.0 to 2.4 (p = 0.007). The mean esophageal diameter improved from 10.8 mm to 17.2 mm (p = 0.001). Dysphagia severity scores improved from a mean value of 34.2 to 10.8 (p = 0.004). Mucosal eosinophilia had no correlation with dysphagia severity. Mean intrabolus pressure improved from 21.8 mmHg to 11 mmHg (p = 0.001). There was strong correlation between a decrease in intrabolus pressure and improvement in dysphagia severity; however, this was not significant (p = 0.108). Intrabolus pressure has strong correlation with dysphagia severity following therapy for fibrostenotic eosinophilic esophagitis. Bougie dilation provides improvement in dysphagia despite persistent mucosal eosinophilia.
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Jarvi, Kristiina, Antti Koivusalo, Risto J. Rintala, and Mikko P. Pakarinen. "Anorectal manometry with reference to operative rectal biopsy for the diagnosis/exclusion of Hirschprung’s disease in children under 1 year of age." International Journal of Colorectal Disease 24, no. 4 (December 16, 2008): 451–54. http://dx.doi.org/10.1007/s00384-008-0612-z.
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Santonicola, Antonella, Luigi Angrisani, Antonio Vitiello, Salvatore Tolone, Nigel John Trudgill, Carolina Ciacci, and Paola Iovino. "Hiatal hernia diagnosis prospectively assessed in obese patients before bariatric surgery: accuracy of high-resolution manometry taking intraoperative diagnosis as reference standard." Surgical Endoscopy 34, no. 3 (May 28, 2019): 1150–56. http://dx.doi.org/10.1007/s00464-019-06865-0.
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Młyńczak, Marcel, Maciej Rosoł, Antonino Spinelli, Adam Dziki, Edyta Wlaźlak, Grzegorz Surkont, Magda Krzycka, et al. "Obstetric Anal Sphincter Injury Detection Using Impedance Spectroscopy with the ONIRY Probe." Applied Sciences 11, no. 2 (January 11, 2021): 637. http://dx.doi.org/10.3390/app11020637.
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Anal sphincter injuries occurring during natural deliveries are often a reason for severe complications, including fecal incontinence. Currently, approximately 80% of these injuries remain unrecognized. Therefore, it is crucial to focus on finding a way to diagnose such injuries as early as possible to apply the tailored treatment. This study aimed to assess the accuracy of impedance spectroscopy in the diagnostics of obstetric anal sphincter injuries (OASIs) using a specially designed rectal probe called the ONIRY Probe. The protocol of the clinical trials is described at NCT03769792. Twenty women after natural delivery were enrolled in the study and divided into two groups referring to the stage of a perineal tear (Group A: 1- or 2-degrees, and Group B: 3- or 4-degrees of a perineal tear; without or with sphincter injury, respectively). The study design included three visits during which a number of diagnostic tests were performed, including impedance spectroscopy, and 3-dimensional endoanal ultrasound, anorectal manometry, and physical examination as a reference. Statistical analysis comprised raw data analysis, as well as post-processing with the Synthetic Minority Oversampling Technique (SMOTE) method, as the output reference grade was highly imbalanced. A variety of machine learning techniques were applied for the OASI classification (≤2 vs. >2), and Wexner scale (=0 vs. >0). The best efficacies were obtained using Random Forest and k-Nearest Neighbors methods. Best accuracies were 93.3% and 99.6%, for raw and re-analyzed data, respectively, for ultrasound assessed by the OASI classification; and 79.8% and 97.0%, respectively, for clinical evaluation using the Wexner scale. Impedance spectroscopy performed using the ONIRY Probe appears to be a promising diagnostic technique for anal sphincter injury detection but requires further investigation (the next phase of the pilot clinical trial is described at NCT04181840).
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Młyńczak, Marcel, Maciej Rosoł, Antonino Spinelli, Adam Dziki, Edyta Wlaźlak, Grzegorz Surkont, Magda Krzycka, et al. "Obstetric Anal Sphincter Injury Detection Using Impedance Spectroscopy with the ONIRY Probe." Applied Sciences 11, no. 2 (January 11, 2021): 637. http://dx.doi.org/10.3390/app11020637.
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Anal sphincter injuries occurring during natural deliveries are often a reason for severe complications, including fecal incontinence. Currently, approximately 80% of these injuries remain unrecognized. Therefore, it is crucial to focus on finding a way to diagnose such injuries as early as possible to apply the tailored treatment. This study aimed to assess the accuracy of impedance spectroscopy in the diagnostics of obstetric anal sphincter injuries (OASIs) using a specially designed rectal probe called the ONIRY Probe. The protocol of the clinical trials is described at NCT03769792. Twenty women after natural delivery were enrolled in the study and divided into two groups referring to the stage of a perineal tear (Group A: 1- or 2-degrees, and Group B: 3- or 4-degrees of a perineal tear; without or with sphincter injury, respectively). The study design included three visits during which a number of diagnostic tests were performed, including impedance spectroscopy, and 3-dimensional endoanal ultrasound, anorectal manometry, and physical examination as a reference. Statistical analysis comprised raw data analysis, as well as post-processing with the Synthetic Minority Oversampling Technique (SMOTE) method, as the output reference grade was highly imbalanced. A variety of machine learning techniques were applied for the OASI classification (≤2 vs. >2), and Wexner scale (=0 vs. >0). The best efficacies were obtained using Random Forest and k-Nearest Neighbors methods. Best accuracies were 93.3% and 99.6%, for raw and re-analyzed data, respectively, for ultrasound assessed by the OASI classification; and 79.8% and 97.0%, respectively, for clinical evaluation using the Wexner scale. Impedance spectroscopy performed using the ONIRY Probe appears to be a promising diagnostic technique for anal sphincter injury detection but requires further investigation (the next phase of the pilot clinical trial is described at NCT04181840).
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Manigrasso, Michele, Marcella Pesce, Marco Milone, Pietro Anoldo, Anna D’Amore, Giovanni Galasso, Nicola Gennarelli, et al. "Long-Term Functional Results of a Modified Caudal-to-Cranial Approach in Laparoscopic Segmental Left Colectomy for Diverticular Disease." Gastroenterology Research and Practice 2021 (January 11, 2021): 1–5. http://dx.doi.org/10.1155/2021/8940682.
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A modified caudal-to-cranial approach to perform laparoscopic left colectomy for benign diseases has been recently designed to facilitate the low-tie mesenteric dissection. A chart review has been performed including all consecutive patients with uncomplicated diverticulitis who have been treated by segmental left colectomy with a caudal-to-cranial approach. A total of 34 patients were included in the study. 21 patients were male, mean age was 54.1 ± 11.3 , and mean BMI was 26 ± 5.5 . Patients with ASA Score I were 7, with ASA II were 9, and with ASA Score III were 5. Incontinence Score (IS) resulted in an average of 5 ± 2 , 2 grade of incontinence and the CS score showed an average of 10 ± 3 , 2 grade of constipation. Health status, evaluated by Short Form-36 questionnaire, was demonstrated in these patients’ great physical function, role, general health, and social function. The anorectal manometry performed 6 months after surgery showed a normal value in terms of the anal resting pressure ( 47 ± 13 mmHg) and an increased volume to stimulate desire to defecate ( 197 ± 25 ml). The length of the anal sphincter was normal compared to the reference value ( 37 ± 5.4 mm). Although further studies are required to obtain definitive conclusions, our results are encouraging to propose low-tie segmental colectomy as the standard procedure for the treatment of uncomplicated diverticulitis, and our modified surgical approach could be considered useful to facilitate the surgical approach.
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Manohar, Murli, and Thomas E. Goetz. "l-NAME does not affect exercise-induced pulmonary hypertension in Thoroughbred horses." Journal of Applied Physiology 84, no. 6 (June 1, 1998): 1902–8. http://dx.doi.org/10.1152/jappl.1998.84.6.1902.
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The present study was carried out to examine the effects of nitric oxide synthase inhibition with N ω-nitro-l-arginine methyl ester (l-NAME) on the right atrial as well as on the pulmonary arterial, capillary, and venous blood pressures of horses during rest and exercise performed at maximal heart rate (HRmax). Experiments were carried out on seven healthy, sound, exercise-trained Thoroughbred horses. Using catheter-tip manometers, with signals referenced at the point of the shoulder, we determined phasic and mean right atrial and pulmonary vascular pressures in two sets of experiments [control (no medications) and l-NAME (20 mg/kg iv given 10 min before exercise studies)]. The studies were carried out in random order 7 days apart. Measurements were made at rest and during treadmill exercise performed on a 5% uphill grade at 6, 8, and 14.2 m/s. Exercise on a 5% uphill grade at 14.2 m/s elicited HRmax and could not be sustained for >90 s. In quietly standing horses,l-NAME administration caused a significant rise in right atrial, as well as pulmonary arterial, capillary, and venous pressures. This indicates that nitric oxide synthase inhibition modifies the basal pulmonary vasomotor tone. In both treatments, exercise caused progressive significant increments in right atrial and pulmonary vascular pressures, but the values recorded in the l-NAME study were not different from those in the control study. The extent of exercise-induced tachycardia was significantly decreased in thel-NAME study at 6 and 8 m/s but not at 14.2 m/s. Thus, l-NAME administration may not modify the equine pulmonary vascular tone during exercise at HRmax. However, as indicated by a significant reduction in heart rate,l-NAME seems to modify the sympathoneurohumoral response to submaximal exercise.
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Greendyke, William, Alexandra Hill-Ricciuti, Matthew Oberhardt, Daniel Green, Fann Wu, Susan Whittier, Lisa Saiman, and E. Yoko Furuya. "1252. A Challenging Burkholderia Outbreak Investigation Across Multiple Units at an Academic Medical Center From June 2017 to February 2018." Open Forum Infectious Diseases 5, suppl_1 (November 2018): S381. http://dx.doi.org/10.1093/ofid/ofy210.1085.
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Abstract Background Most outbreak investigations involve short-term, geographically localized clusters. However, some organisms can form environmental reservoirs leading to more prolonged, widespread outbreaks. We describe a prolonged outbreak of Burkholderia at our institution. Methods An epidemiological investigation was conducted. Burkholderia isolates were genotyped using pulsed-field gel electrophoresis (PFGE) and recA gene sequencing. Initial isolates were sent to a national reference laboratory for multilocus sequence typing (MLST). Results 32 patients on 12 units (see figure) had ≥1 positive culture for Burkholderia from June 2017 to February 2018. 21 had B. cenocepacia (PFGE pattern A, recA allele 365) and 11 had B. cepacia (PFGE pattern C, recA allele 53). MLST revealed that isolates with recA allele 365 were unique compared with previously identified B. cenocepacia strains. Of 32 patients, 28 (88%) had positive respiratory cultures. Of 32 patients, 3 (9%) had bacteremia. Thirty-day mortality was 4/29 (14%). A case–control study did not reveal a common point source. All surveillance cultures from asymptomatic patients were negative (n = 53). Two of nine sink drains in rooms of cases were positive for an unrelated strain of B. cepacia. Other environmental cultures were negative for Burkholderia (n = 49). Cases continued despite routine interventions (see figure), with some incident cases detected long after potential exposures. Ventilator/respiratory equipment (V/RE) cleaning was investigated. Multiple V/RE interventions were implemented: (1) ensuring a sterilization process for ventilator temperature probes (used in heated humidification) was occurring; (2) using disposable manometers on contact isolation patients; (3) reinforcing ventilator cleaning, including those in radiology suites after use. Conclusion No definitive source of the outbreak was found. New cases continued after reinforcement of basic infection control practices, but subsided after focused attention on V/RE cleaning practices. Control of this outbreak was challenging due to the complexity of a prolonged “latency period” for Burkholderia, difficulty identifying reservoirs, and multiple possible modes of transmission, especially for organisms like Burkholderia that can persist on environmental surfaces and equipment. Disclosures All authors: No reported disclosures.
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Jadcherla, Sudarshan R., Vanessa N. Parks, Juan Peng, Samuel Dzodzomenyo, Soledad Fernandez, Reza Shaker, and Mark Splaingard. "Esophageal sensation in premature human neonates: temporal relationships and implications of aerodigestive reflexes and electrocortical arousals." American Journal of Physiology-Gastrointestinal and Liver Physiology 302, no. 1 (January 2012): G134—G144. http://dx.doi.org/10.1152/ajpgi.00067.2011.
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Electrocortical arousal (ECA) as an effect of visceral provocation or of its temporal relationships with aerodigestive reflexes in premature neonates is not known. We tested the hypothesis that esophageal provocation results in both esophageal reflex responses and ECAs during sleep and that ECAs are dependent on the frequency characteristics of esophageal neuromotor responses. We defined the spatiotemporal relationship of ECAs in relation to 1) spontaneous pharyngoesophageal swallow sequences and gastroesophageal reflux (GER) events and 2) sensory-motor characteristics of esophageal reflexes. Sixteen healthy premature neonates born at 27.9 ± 3.4 wk were tested at 36.8 ± 1.9 wk postmenstrual age. Ninety-five midesophageal and 31 sham stimuli were given in sleep during concurrent manometry and videopolysomnography. With stimulus onset as reference point, we scored the response latency, frequency occurrence and duration of arousals, peristaltic reflex, and upper esophageal sphincter contractile reflex (UESCR). Changes in polysomnography-respiratory patterns and esophageal sensory-motor parameters were scored by blinded observers. Significantly (for each characteristic listed, P < 0.05), swallow sequences were associated with arousals and sleep state changes, and arousals were associated with incomplete peristalsis, response delays to lower esophageal sphincter relaxation, and prolonged esophageal clearance. GER events (73.5%) provoked arousals, and arousals were associated with response delays to peristaltic reflexes or clearance, sleep state modification, and prolonged respiratory arousal. Midesophageal stimuli (54%) provoked arousals and were associated with increased frequency, prolonged latency, prolonged response duration of peristaltic reflexes and UESCR, and increased frequency of sleep state changes and respiratory arousals. In human neonates, ECAs are provoked upon esophageal stimulation; the sensory-motor characteristics of esophageal reflexes are distinct when accompanied by arousals. Aerodigestive homeostasis is defended by multiple tiers of aerodigestive safety mechanisms, and when esophageal reflexes are delayed, cortical hypervigilance (ECAs) occurs.
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Wakefield, Thomas W. "Neutrophils in Deep Venous Thrombosis." Blood 124, no. 21 (December 6, 2014): SCI—29—SCI—29. http://dx.doi.org/10.1182/blood.v124.21.sci-29.sci-29.
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Abstract Neutrophils are involved in venous thrombogenesis, through P-selectin and neutrophil endothelial traps (NETS). In order to determine the importance of neutrophils to thrombogenesis, neutrophil depletion was performed in our rat model of stasis-induced deep venous thrombosis (DVT). Animals were treated with control serum or rabbit anti-rat PMN serum administered perioperatively and sacrificed at two and seven days. At two days, neutropenic rats had 1.6-fold larger thrombi (P = 0.04) and 1.4-fold higher femoral venous pressures by manometry (P = 0.008) without a difference in thrombus neovascularization. By seven days, DVT sizes were similar, but vein wall injury persisted in neutropenic rats with a two-fold increase in vein wall stiffness by microtensiometry (P < 0.05), as well as a 1.2-fold increased thickness (P = 0.04). Vein wall and intrathrombus uPA by Western immunoblotting, as well as intrathrombus MMP-9 gelatinase activity was significantly less in neutropenic rats than controls (P < 0.001). Conversely, MMP-2 was significantly elevated in neutropenic inferior vena cava (IVC) at two days after DVT.1 P-selectin inhibition has been found to limit venous thrombosis in mice. Animals with high circulating levels of sP-selectin (^CT) were compared to selectin gene-deleted animals (PKO, EPKO) and wild-type (WT) mice. ^CT mice showed a significant 50% increase in thrombosis in our IVC ligation model while EPKO mice had the smallest thrombi. A significant difference was noted between ^CT and EPKO for neutrophils, monocytes, and total inflammatory cells at day two. Microparticle (MP) analysis revealed that in the ^CT, WT and PKO mice, a mixed leukocyte (MAC-1) and platelet (CD41) MP population was present. EPKO mice (with the smallest thrombi) revealed primarily a platelet-derived MP population, suggesting the importance of leukocyte-derived MPs in venous thrombogenesis. Of interest, the ^CT mice with the highest TM showed an elevated level of mean channel fluorescence for MAC-1 antibody, indicative of leukocyte derived MPs.2 Through processes that also involve the initial activation of leukocytes and platelets, neutrophils initiate and amplify thrombosis through the formation of NETS, which are extracellular fragments of DNA containing histones and antimicrobial proteins.3,4 In vitro and in vivo, NETs provide a scaffold and stimulus for thrombus formation.5 In order to investigate if plasma DNA (surrogate for NETS) is elevated in patients with DVT and to determine correlations with other biomarkers of DVT, we studied patients presenting to our diagnostic vascular laboratory. From December 2008 to August 2010, patients were divided into three distinct groups: (1) DVT positive, patients symptomatic for DVT confirmed by ultrasound (n = 47); (2) DVT negative, patients with leg pain but negative by ultrasound (n = 28); and (3) control healthy non-pregnant volunteers without signs or symptoms of active or previous DVT (n = 19). Blood was collected for biomarkers and the Wells score risk of DVT was assessed. Results showed that circulating DNA was significantly elevated in DVT patients, compared with both DVT-negative patients (57.7 vs. 17.9 ng/mL; P < 0.01) and controls (57.7 vs. 23.9 ng/mL; P < 0.01). There was a strong positive correlation with C-reactive protein (P < 0.01), D-dimer (P < 0.01), VWF (P < 0.01), Wells score (P < 0.01) and MPO (P < 0.01), along with a strong negative correlation with ADAMTS13 (P < 0.01) and the ADAMTS13/VWF ratio. The logistic regression model showed a strong association between plasma DNA and the presence of DVT (ROC curve 0.814) suggesting a role for DNA in venous thrombogenesis.6 References: 1. Varma MR, Varga AJ, Knipp BS, Sukheepod P, Upchurch GR, Kunkel SL, Wakefield TW, Henke PK. Neutropenia impairs venous thrombosis resolution in the rat. J Vasc Surg. 2003;38:1090-1098 2. Myers DD, Hawley AE, Farris DM, Wrobleski SK, Thanaporn P, Schaub RG, Wagner DD, Kumar A, Wakefield TW. P-selectin and leukocyte microparticles are associated with venous thrombogenesis. J Vasc Surg.2003;38:1075-1089 3. Fuchs TA, Brill A, Duerschmied D, Schatzberg D, Monestier M, Myers DD, Wrobleski SK, Wakefield TW, Hartwig JH, Wagner DD. Extracellular DNA traps promote thrombosis. Proceedings of the National Academy of Sciences. 2010;107:15880-15885 4. von Brühl M-L, Stark K, Steinhart A, Chandraratne S, Konrad I, Lorenz M, Khandoga A, Tirniceriu A, Coletti R, Köllnberger M. Monocytes, neutrophils, and platelets cooperate to initiate and propagate venous thrombosis in mice in vivo. The Journal of Experimental Medicine. 2012;209:819-835 5. Massberg S, Grahl L, von Bruehl M-L, Manukyan D, Pfeiler S, Goosmann C, Brinkmann V, Lorenz M, Bidzhekov K, Khandagale AB. Reciprocal coupling of coagulation and innate immunity via neutrophil serine proteases. Nature Medicine. 2010;16:887-896 6. Diaz JA, Fuchs TA, Jackson TO, Kremer Hovinga JA, Lämmle B, Henke PK, Myers Jr DD, Wagner DD, Wakefield TW. Plasma DNA is elevated in patients with deep vein thrombosis. J Vasc Surg. 2013;1:341-348 Disclosures No relevant conflicts of interest to declare.
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Slocum, Alexander H., Samuel C. Duffley, Jaime M. Gamazo, Adrienne Watral, Joan E. Spiegel, and Alexander H. Slocum. "Design, Manufacture, and Testing of the Easycuff™ Pressure Measuring Syringe." Journal of Medical Devices 6, no. 3 (August 20, 2012). http://dx.doi.org/10.1115/1.4007250.
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A pressure measuring syringe, known as the EasyCuff™, has been designed and manufactured to provide physicians with a tool to accurately measure the pressure inside the distal cuff of endotracheal tube tubes (ETTs). The syringe, identical in size to a standard 10 cc syringe, has four components: a seal, a plunger, a barrel, and a silicone-rubber bellows (the pressure measuring component). A finite-element model of the bellows was created using ADINA™; silicone rubber bellows were then produced and shown to correlate linearly with the model to within ±5% up to a load equivalent to an internal pressure of 200 cm H2O. 20 of these bellows were then assembled into EasyCuff™ syringes and tested to assess their accuracy and repeatability. The experimental setup used a currently-available manometer, which the EasyCuff™ is designed to replace, as a reference tool. The data show that the relationship between measured pressure and bellows deflection is linear, with a correlation factor of R2 = 0.99; additionally, environmental testing showed that the EasyCuff™ is unaffected by temperature cycling between −15 °F and +170 °F.
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Siboni, Stefano, Davide Ferrari, Carlo Galdino Riva, Marco Sozzi, Veronica Lazzari, Valentina Milani, and Luigi Bonavina. "Reference high‐resolution manometry values after magnetic sphincter augmentation." Neurogastroenterology & Motility, March 27, 2021. http://dx.doi.org/10.1111/nmo.14139.
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MARIOTTO, Rogério, Fernando A. M. HERBELLA, Vera Lucia Ângelo ANDRADE, Francisco SCHLOTTMANN, and Marco G. PATTI. "VALIDATION OF A NEW WATER-PERFUSED HIGH-RESOLUTION MANOMETRY SYSTEM." ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 33, no. 4 (2020). http://dx.doi.org/10.1590/0102-672020200004e1557.
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ABSTRACT Background: High-resolution manometry is more costly but clinically superior to conventional manometry. Water-perfused systems may decrease costs, but it is unclear if they are as reliable as solid-state systems, and reference values are interchangeable. Aim: To validate normal values for a new water-perfusion high-resolution manometry system. Methods: Normative values for a 24-sensors water perfused high-resolution manometry system were validated by studying 225 individuals who underwent high resolution manometry for clinical complaints. Patients were divided in four groups: group 1 - gastroesophageal reflux disease; group 2 - achalasia; group 3 - systemic diseases with possible esophageal manifestation; and group 4 - dysphagia. Results: In group 1, a hypotonic lower esophageal sphincter was found in 49% of individuals with positive 24 h pH monitoring, and in 28% in pH-negative individuals. In groups 2 and 3, aperistalsis was found in all individuals. In group 4, only one patient (14%) had normal high-resolution manometry. Conclusions: The normal values determined for this low-cost water-perfused HRM system with unique peristaltic pump and helicoidal sensor distribution are discriminatory of most abnormalities of esophageal motility seen in clinical practice.
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Vriesman, M. H., C. S. de Jonge, S. Kuizenga-Wessel, B. Adler, A. Menys, A. J. Nederveen, J. Stoker, M. A. Benninga, and C. Di Lorenzo. "Simultaneous assessment of colon motility in children with functional constipation by cine-MRI and colonic manometry: a feasibility study." European Radiology Experimental 5, no. 1 (February 10, 2021). http://dx.doi.org/10.1186/s41747-021-00205-5.
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Abstract Background Colonic manometry is the current reference standard for assessing colonic neuromuscular function in children with intractable functional constipation (FC). Recently, cine magnetic resonance imaging (cine-MRI) has been proposed as a non-invasive alternative. We compared colonic motility patterns on cine-MRI with those obtained by manometry in children, by stimulating high-amplitude propagating contractions (HAPCs) with bisacodyl under manometric control while simultaneously acquiring cine-MRI. Methods After Institutional Review Board approval, adolescents with FC scheduled to undergo colonic manometry were included. A water-perfused 8-lumen catheter was used for colonic manometry recordings. After an intraluminal bisacodyl infusion, cine-MRI sequences of the descending colon were acquired for about 30 min simultaneously with colonic manometry. Manometry recordings were analysed for HAPCs. MRI images were processed with spatiotemporal motility MRI techniques. The anonymised motility results of both techniques were visually compared for the identification of HAPCs in the descending colon. Results Data regarding six patients (three males) were analysed (median age 14 years, range 12–17). After bisacodyl infusion, three patients showed a total of eleven HAPCs with colonic manometry. Corresponding cine-MRI recorded high colonic activity during two of these HAPCs, minimal activity during seven HAPCs, while two HAPCs were not recorded. In two of three patients with absent HAPCs on manometry, colonic activity was recorded with cine-MRI. Conclusions Simultaneous acquisition of colonic cine-MRI and manometry in children with FC is feasible. Their motility results did not completely overlap in the identification of HAPCs. Research is needed to unravel the role of cine-MRI in this setting.
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PINTO, Rodrigo Ambar, Isaac José Felippe CORREA-NETO, Leonardo Alfonso BUSTAMANTE-LOPEZ, Caio Sergio R. NAHAS, Carlos Frederico S. MARQUES, Carlos Walter SOBRADO-JUNIOR, Ivan CECCONELLO, and Sergio Carlos NAHAS. "ANORECTAL MANOMETRY STANDARD OF A BRAZILIAN POPULATION AT PRODUCTIVE AGE WITHOUT PELVIC FLOOR DISORDERS: A PROSPECTIVE VOLUNTEERED STUDY." ABCD. Arquivos Brasileiros de Cirurgia Digestiva (São Paulo) 34, no. 1 (2021). http://dx.doi.org/10.1590/0102-672020210001e1580.
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ABSTRACT Background: Due to the lack of normal standards of anorectal manometry in Brazil, data used are subject to normality patterns described at different nationalities. Aim: To determine the values and range of the parameters evaluated at anorectal manometry in people, at productive age, without pelvic floor disorders comparing the parameters obtained between male and female. Methods: Prospective analysis of clinical data, such as gender, age, race, body mass index (BMI) and anorectal manometry, of volunteers from a Brazilian university reference in pelvic floor disorders. Results: Forty patients were included, with a mean age of 45.5 years in males and 37.2 females (p=0.43). According to male and female, respectively in mmHg, resting pressures were similar (78.28 vs. 63.51, p=0.40); squeeze pressures (153.89 vs. 79.78, p=0.007) and total squeeze pressures (231.27 vs. 145.63, p=0.002). Men presented significantly higher values of anorectal squeeze pressures, as well as the average length of the functional anal canal (2.85 cm in male vs. 2.45 cm in female, p=0.003). Conclusions: Normal sphincter pressure levels in Brazilians differ from those used until now as normal literature standards. Male gender has higher external anal sphincter tonus as compared to female, in addition a greater extension of the functional anal canal
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Alcala Gonzalez, Luis G., Renske A. B. Oude Nijhuis, Andreas J. P. M. Smout, and Albert J. Bredenoord. "Normative reference values for esophageal high‐resolution manometry in healthy adults: A systematic review." Neurogastroenterology & Motility 33, no. 1 (July 26, 2020). http://dx.doi.org/10.1111/nmo.13954.
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Perry, Kyle A., and Vivian L. Wang. "Gastroesophageal Reflux Disease and Hiatal Hernia." DeckerMed Surgery, February 25, 2020. http://dx.doi.org/10.2310/surg.2046.
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Gastroesophageal reflux disease (GERD) is common, affecting approximately 18 to 27% of adult Americans, and can have a considerable impact on quality of life. Hiatal hernias are present in 80% of patients with symptomatic GERD. This review covers the basic pathophysiology, evaluation, and treatment algorithms for patients with GERD and hiatal hernia. Figures show normal gastroesophageal junction anatomy, treatment algorithm for patients with symptomatic GERD, schematic and endoscopic images of long segment Barrett's esophagus, a normal barium esophagogram, esophageal intraluminal pressures assessed by esophageal manometry, test results from a 48-hour wireless pH study, laparoscopic Nissen fundoplication, laparoscopic gastroesophageal junction reinforcement, classification of paraesophageal hernia, and endoscopic view of Cameron ulcers at the level of the diaphragm in the setting of a type III paraesophageal hernia. Tables list risk factors for GERD and a standardized approach to Nissen fundoplication. This review contains 10 figures, 3 tables, and 68 references. Keywords: Gastroesophageal reflux disease, GERD, hiatal hernia, paraesophageal hernia, anti-reflux surgery, Nissen fundoplication, Barrett's esophagus, manometry, pH study
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Perry, Kyle A., and Vivian L. Wang. "Gastroesophageal Reflux Disease and Hiatal Hernia." DeckerMed Transitional Year Weekly Curriculum™, February 25, 2020. http://dx.doi.org/10.2310/tywc.2046.
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Gastroesophageal reflux disease (GERD) is common, affecting approximately 18 to 27% of adult Americans, and can have a considerable impact on quality of life. Hiatal hernias are present in 80% of patients with symptomatic GERD. This review covers the basic pathophysiology, evaluation, and treatment algorithms for patients with GERD and hiatal hernia. Figures show normal gastroesophageal junction anatomy, treatment algorithm for patients with symptomatic GERD, schematic and endoscopic images of long segment Barrett's esophagus, a normal barium esophagogram, esophageal intraluminal pressures assessed by esophageal manometry, test results from a 48-hour wireless pH study, laparoscopic Nissen fundoplication, laparoscopic gastroesophageal junction reinforcement, classification of paraesophageal hernia, and endoscopic view of Cameron ulcers at the level of the diaphragm in the setting of a type III paraesophageal hernia. Tables list risk factors for GERD and a standardized approach to Nissen fundoplication. This review contains 10 figures, 3 tables, and 68 references. Keywords: Gastroesophageal reflux disease, GERD, hiatal hernia, paraesophageal hernia, anti-reflux surgery, Nissen fundoplication, Barrett's esophagus, manometry, pH study
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Knowles, Charles H. "Constipation: Diagnosis and Investigation." DeckerMed Surgery, May 15, 2018. http://dx.doi.org/10.2310/surg.2385.
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Although constipation is no longer treated primarily with surgery, surgeons continue to regularly see patients with constipation in ward and ambulatory settings. It is therefore critical that surgeons have a practical approach to the patient with constipation in respect of diagnosis, investigation, and management. This review covers background knowledge in terms of the definition, classification, epidemiology, and etiology of constipation. It then addresses the clinical evaluation and investigation of the patient with chronic constipation. A subsequent review follows on to cover medical and surgical management. This review contains 6 figures, 8 tables and 59 references Key Words: chronic constipation, constipation, defecation disorder, defecography, dyssynergia, intussusception, manometry, proctography, rectocele, slow-transit
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Wei, Benjamin, and Michael Frank Gleason. "The Esophagus." DeckerMed Medicine, June 22, 2017. http://dx.doi.org/10.2310/im.2247.
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The esophagus is a tubular structure spanning from the posterior pharynx, through the thorax, and terminating in the stomach. It arises from endodermal foregut tissue. Its submucosal muscular layers are initially striated, transitioning to smooth muscle in more distal areas. Due to the distance in the body it traverses, the esophagus derives its blood and nerve supply from several structures. The role as a conduit from mouth to stomach necessitates secretory and barrier functions, as well as sphincters for protection from anterograde flow. Various modalities of esophageal test exist, ranging from fluoroscopy, to invasive endoscopy capable of obtaining tissue samples, to probes that detect pH and muscle tone, all of which play roles in identifying various pathologic processes. This review contains 12 figures, and 22 references. Key words: abdomen, endoscopy, esophagography, esophagus, impedance, lower sphincter, manometry, upper sphincter
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Szachnowicz, S., L. Lopes, F. Fernandes, B. Edno Tales, R. Sallum, and I. Cecconello. "356 DIVERTICULECTOMY WITH EXTEND MYOTOMY AND ANTERIOR FUNDOPLICATION AS TREATMENT OF INTRATHORACIC ESOPHAGEAL DIVERTICULUM. CASE REPORT AND REVIEW!" Diseases of the Esophagus 33, Supplement_1 (September 2020). http://dx.doi.org/10.1093/dote/doaa087.81.
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Abstract Diverticula of the thoracic esophagus are uncommon disorders and its most appropriate treatment continues unclear. The majority of these diverticula are results of underlying esophageal motility disorders, but some cases are results of periesophageal inflammation. The patients can be asymptomatic, or present dysphagia, regurgitation, aspirated pneumonia, retrosternal pain and weight loss. The barium esophagogram is considered the best study to show and evaluate these cases. Esophageal manometry allow study the esophageal motility abnormality. Methods Patients with small and asymptomatic diverticula could not require any treatment. Patients with symptomatic or big diverticula should be submitted a diverticulectomy and often with an esophageal myotomy. However the necessity, the esophageal extension and local of the myotomy are still unclear. We describe a case of a 70 yo woman with a intrathoracic esophageal diverticulum. She presented progressive dysphagia to solids in the last two years, associated to regurgitation, retrosternal pain, nausea and weight loss of 10 kilograms. She has no history of aspirated pneumonia. Results The upper GI endoscopy showed the diverticulum in middle esophagus (25 cm from superior dental arch) and the size in barium esophagogram was 6,5 x 4,8 cm. The high resolution esophageal manometry was normal and the patient had no tuberculosis history. She was submitted a thoracoscopic diverticulectomy with extend myotomy (intrathoracic and abdominal) and Dor’s fundoplication. She was able to resume a liquid diet by day 3, after a normal barium esophagogram, and was discharged at the 4 post-operative day. After 9 months the patient remains asymptomatic. Conclusion In our experience, the diverticulectomy associated with an extend myotomy bring excellent results at the esophageal function, allowing an adequate emptying of the esophagus, avoiding severe complications as mediastinitis or esophageal leakage even in patients without severe motility disorder. References 1. Altorki N K, Sunagawa M, Skinner D B. Thoracic esophageal diverticula. Why is operation necessary? J Thorac Cardiovasc Surg 1993 Feb; 105(2): 260–4. 2. Rice T W, Baker M E. Midthoracic esophageal diverticula. Semin Thorac Cardiovasc Surg 1999 Oct; 11(4): 352–7.
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Valente, Michael A., and Tracy L. Hull. "Pelvic Floor Dysfunction." DeckerMed Surgery, February 10, 2015. http://dx.doi.org/10.2310/surg.2127.
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Pelvic floor dysfunction encompasses a broad spectrum of disorders and symptoms, including pelvic organ prolapse, fecal incontinence, dysfunctional bowel and/or bladder evacuation, urinary incontinence, and chronic pain. Challenges in treating these patients are due, in part, to inconsistent definitions and diagnostic criteria, an underreporting of symptoms, and complexities in understanding the underlying pathophysiology. Pelvic floor dysfunction is a multisystem process requiring a multidisciplinary team approach. This review describes the incidence, prevalence, and etiologic factors relating to pelvic floor dysfunction, as well as the clinical evaluation process, which includes history, physical examination, physiologic and neurophysiologic assessment, and anatomic assessment. Management of pelvic floor dysfunction is discussed. Tables include potential contributing factors in the development of pelvic floor dysfunction and anatomic and physiologic tests for pelvic floor dysfunction. Figures show an anal manometry apparatus; anorectal physiology report for a patient with fecal incontinence; pudendal nerve-stimulating electrode; pudendal nerve terminal motor latency tracing; surface electrode electromyography; anorectal ultrasound equipment; sonogram of the middle anal canal; ultrasound view of the puborectalis muscle; sonogram showing a defect in the external anal sphincter; defecography showing normal anatomy, rectocele and enterocele, sigmoidocele, and rectoanal intussusception; colonic transit study; rectocele; and enterocele. This review contains 19 figures, 2 tables, and 81 references.
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Costantini, A., R. Salvador, L. Provenzano, G. Capovilla, L. Nicoletti, E. Pierobon, L. Moletta, M. Valmasoni, S. Merigliano, and M. Costantini. "75 LONG-TERM OUTCOME OF LAPAROSCOPIC HELLER–DOR OPERATION: RESULTS AT A MEDIAN 20-YEAR FOLLOW UP." Diseases of the Esophagus 33, Supplement_1 (September 2020). http://dx.doi.org/10.1093/dote/doaa087.11.
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Abstract Since its introduction in 1993, Laparoscopic Heller-Dor (LHD) operation has been the gold standard treatment for esophageal achalasia. Little is known, however, of the natural story of the operated patients in the long run. The aim of this study was to assess the long-term outcome of patients who underwent LHD more than 20 years ago, in order to provide benchmark data to which new techniques should compare. Methods All the patients who underwent LHD from 1992 to 1999 at our Institution were evaluated. Patients with previous endoscopic treatment with pneumatic dilations (PD) or Botox were included, whereas patients with previous myotomy were ruled out. Symptoms were prospectively collected and scored using a detailed questionnaire. Barium swallow, endoscopy and manometry were performed before and 6–12 months after the operation, when also pH-metry was performed. Endoscopy was then suggested every 2 years. Treatment failure was defined as a postoperative symptom score > 10th percentile of the preoperative score (i.e. > 8) or the need for further treatment. Results Eighty-seven patients with a minimum 10-year follow-up were evaluated (median f/u 20 years). One patient died for esophageal cancer 11.5 years after LHD; 8 patients died 11–24 years after LHD for unrelated causes. All were highly satisfied with the results of the operation. Symptoms recurred in 23 patients (26.4%) 1 month to 13.5 years after LHD: all received 1 to 6 PD, effective in 16: 3 required revisional myotomy and 3 need periodic PD. Good long-term outcome was recorded in 73.6% of patients, and in 92% with combined treatment. Post-operative reflux (pH and/or endoscopy-proven) developed in 10 patients only (11.5%). Conclusion LHD can durably relieve symptoms in the majority of patients, though some of them may require complementary PD to maintain effective symptom control. LHD confirms to be an excellent long-term treatment for achalasia and these results represent the reference point for all other treatments.