374 VIDEO ESOPHAGOGRAM CORRELATES OF DYSPHAGIA IN PATIENTS WITH NORMAL LOWER ESOPHAGEAL SPHINCTER

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
D Razia ◽  
L Giulini ◽  
R Bremner ◽  
S Mittal
Keyword(s):  
Prone Position ◽  
Transit Time ◽  
Esophageal Wall ◽  
Bolus Transit ◽  
Esophageal Transit ◽  
Dysphagia Score ◽  
Esophageal Spasm ◽  
Number Of Patients ◽  
The Difference ◽  
Barium Esophagogram

Abstract   Dysphagia is a common foregut symptom. However, there is poor association between non-obstructive dysphagia and esophageal body peristaltic parameters in patients with normal lower esophageal sphincters (LES). The objective of this retrospective study was to study bolus transit patterns noted on barium esophagogram in patients experiencing dysphagia. Methods After IRB approval, we queried our esophageal database for patients with normal manometric LES. Jackhammer esophagus, esophageal spasm, previous foregut surgery, and unavailable foregut symptom questionnaires were exclusion criteria. Patients were grouped based on reported dysphagia: 0 = None; 1 = Mild; 2 = Moderate; 3 = Severe/very severe. All barium esophagograms were re-evaluated. Bolus esophageal transit time was studied with patients in both upright and prone positions, using live time stamps at bolus entry/exit. “Barium residue” was defined as persistent contrast on the esophageal wall after bolus exit. “Retrograde escape” referred to barium escaping proximally from the bolus into previously cleared esophagus. ANOVA and χ2 were used. Results In all, 150 patients met inclusion criteria. 76 (50.1%) were women. Mean age and body mass index were 58.4 ± 14.7 years and 22.9 ± 10.4 kg/m2, respectively. The number of patients in each dysphagia group (0, 1, 2, and 3) were 82(54.7%), 29(19.3%), 25(16.7%) and 14(9.3%), respectively. The difference in mean bolus transit time among dysphagia groups was statistically significant in prone-position swallows (39.3 ± 36.7, 75 ± 74.8, 98.8 ± 85 and 69.6 ± 43.7 seconds; p < 0.001) but not in upright-position swallows (14.6 ± 22, 12.4 ± 8.1, 14.3 ± 8.8 and 12.6 ± 8.2 seconds; p = 0.929; Fig. 1). The prevalence of residual contrast and retrograde escape in prone swallows were comparable among patients reporting dysphagia (p = 0.444, p = 0.173). Conclusion Bolus transit time in prone-position barium swallows is simple to assess, and correlates with dysphagia reported by patients with normal lower esophageal sphincters. However, further studies with comprehensive dysphagia score are needed.

807 ASSOCIATION OF BOLUS TRANSIT TIME ON BARIUM ESOPHAGOGRAM WITH ESOPHAGEAL PERISTALSIS

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Deepika Razia ◽  
Amy Trahan ◽  
Luca Giulini ◽  
Komeil M Baboli ◽  
Sumeet K Mittal
Keyword(s):  
Transit Time ◽  
Rate Of Change ◽  
Esophageal Peristalsis ◽  
Bolus Transit ◽  
Minimal Impact ◽  
High Resolution Manometry ◽  
Ineffective Esophageal Motility ◽  
Esophageal Spasm ◽  
Study Association ◽  
Barium Esophagogram

Abstract   The threshold criteria for diagnosing ineffective esophageal motility (IEM) has changed over the years and is based on the proportion of failed and weak peristalses. Bolus transit time (BTT) on barium esophagogram (BE) can intuitively be the ‘gold standard' for assessing the effectiveness of esophageal peristalsis. The aim of this study was to associate upright and prone BTT with esophageal peristalsis and dysphagia in patients with normal lower esophageal sphincter (LES) parameters. Methods Patients with normal LES on high-resolution manometry (HRM) who also had a standard-protocol BE from 2017 to 2020 were included. Patients with previous foregut surgery, hiatal hernia, jackhammer esophagus, distal esophageal spasm, fragmented peristalsis, and those with < or > 10 single swallows on HRM were excluded. Based on the number of normal swallows (DCI >450 mmHg.s.cm), the patients were divided into 11 groups (10 normal to 0 normal). Upright and prone BTT were measured on BE. Fractional polynomial and logistic regression analysis were used to study association (along with rate of change) between BTT, dysphagia, and peristalsis. Results In total, 146 patients met the inclusion criteria. Prone BTT increased in tandem with a decrease in the number of normal peristalses (p < 0.001), but no difference was noted in upright BTT (p = 0.317). Two deflection points were noted on the association between peristalsis and prone BTT at 50%, 40 seconds and 30%, 80 seconds on the y and x-axes, respectively, after which declining peristaltic function was independent of prone BTT. Patients with prone BTT >40 seconds had nearly 6-fold higher odds of having zero normal peristalses (p = 0.002). Increasing prone BTT was associated with increasing dysphagia (p < 0.05). Conclusion Prone, but not upright BTT, correlates with the proportion of normal esophageal peristalses and dysphagia. The phenotype of abnormal swallows (failed, weak) appears to have minimal impact on BTT. The current perspective of manometric classification may need to be adjusted to use the proportion of normal peristalses as a criterion.

373 ESOPHAGEAL BODY PERISTALSIS IN PATIENTS WITH NORMAL LOWER ESOPHAGEAL SPHINCTER: ARE VIDEO ESOPHAGOGRAM AND HIGH-RESOLUTION MANOMETRY IN AGREEMENT?

2020 ◽  
Vol 33 (Supplement_1) ◽  
Author(s):  
D Razia ◽  
L Giulini ◽  
R Bremner ◽  
S Mittal
Keyword(s):  
High Resolution ◽  
Lower Esophageal Sphincter ◽  
Prone Position ◽  
Transit Time ◽  
Bolus Transit ◽  
High Resolution Manometry ◽  
Esophageal Body ◽  
Esophageal Clearance ◽  
Esophageal Spasm ◽  
Esophageal Sphincter

Abstract   Peristaltic disorders of the esophageal body have been categorized according to how they appear on high-resolution manometry. Abnormalities in peristalsis may lead to abnormal esophageal clearance and dysphagia. The aim of our retrospective analysis was to study bolus transit patterns on barium esophagogram in patients with various grades of esophageal body peristalsis as diagnosed by high-resolution manometry. Methods After Institutional Review Board approval, we queried an esophageal center database to identify patients with normal lower esophageal sphincter parameters. Patients with jackhammer esophagus, esophageal spasm, previous foregut surgery, hiatal hernia, and fragmented peristalsis were excluded. Remaining patients were divided into 11 groups based on their percentages of normal swallows out of 10 swallows (0%–100% swallows normal, DCI > 450 mmHg.s.cm). All previously obtained video esophagograms were re-evaluated in blinded fashion. Bolus transit time through the esophagus was measured in upright and prone positions, using live time stamps at the entry and exit of the bolus. ANOVA and χ2 were used. Results In total, 146 patients were included in the analysis. 73 (50%) were men. Mean age and body mass index were 58.4 ± 14.7 years and 22.8 ± 10.4 kg/m2, respectively. Bolus transit time in prone-position swallows increased in tandem with increases in number of abnormal swallows (11.3 ± 3.7, 22 ± 15.5, 29.5 ± 24.3, 42.7 ± 39.5, 42.4 ± 46.9, 64 ± 70.8, 59.4 ± 34.6, 58.8 ± 37.9, 110 ± 66.6, 83.2 ± 49.6 and 105.6 ± 72.5 seconds, p < 0.0001) but no difference was noted in upright-position bolus transit time (p = 0.317). There was a dropoff in level of significance at Group 5 (60% swallows normal) compared to Group 11 (absent contractility), after which there were no inter-group differences (Fig. 1). Conclusion Bolus transit time in prone-position swallows progressively increases as percentage of normal swallows decreases. Further work associated with symptoms to define a cutoff between normal and ineffective peristalsis would be useful.

scholarly journals Esophageal contractions, bolus transit and perception of transit after swallows of liquid and solid boluses in normal subjects

2012 ◽  
Vol 49 (4) ◽  
pp. 250-254 ◽  
Author(s):  
Juciléia Dalmazo ◽  
Lilian Rose Otoboni Aprile ◽  
Roberto Oliveira Dantas
Keyword(s):  
Area Under The Curve ◽  
Random Order ◽  
Normal Subjects ◽  
Bolus Transit ◽  
Esophageal Transit ◽  
Solid Bolus ◽  
Asymptomatic Volunteers ◽  
The Difference ◽  
Liquid Bolus ◽  
Esophageal Contraction

CONTEXT: Esophageal dysphagia is the sensation that the ingested material has a slow transit or blockage in its normal passage to the stomach. It is not always associated with motility or transit alterations. OBJECTIVES: To evaluate in normal volunteers the possibility of perception of bolus transit through the esophagus after swallows of liquid and solid boluses, the differences in esophageal contraction and transit with these boluses, and the association of transit perception with alteration of esophageal contraction and/or transit. METHODS: The investigation included 11 asymptomatic volunteers, 4 men and 7 women aged 19-58 years. The subjects were evaluated in the sitting position. They performed swallows of the same volume of liquid (isotonic drink) and solid (macaroni) boluses in a random order and in duplicate. After each swallow they were asked about the sensation of bolus passage through the esophagus. Contractions and transit were evaluated simultaneously by solid state manometry and impedance. RESULTS: Perception of bolus transit occurred only with the solid bolus. The amplitude and area under the curve of contractions were higher with swallows of the solid bolus than with swallows of the liquid bolus. The difference was more evident in swallows with no perception of transit (n = 12) than in swallows with perception (n = 10). The total bolus transit time was longer for the solid bolus than for the liquid bolus only with swallows followed by no perception of transit. CONCLUSION: The results suggest that the perception of esophageal transit may be the consequence of inadequate adaptation of esophageal transit and contraction to the characteristics of the swallowed bolus.

scholarly journals Two different volume of local anaesthetic in subarachnoid block for Minipercutaneous Nephrolithotomy in prone position

2012 ◽  
Vol 1 (1) ◽  
pp. 10-15
Author(s):  
BR Shrestha ◽  
S Khadgi ◽  
S Shrestha ◽  
P Thapa
Keyword(s):  
Prone Position ◽  
Local Anaesthetic ◽  
Spinal Block ◽  
Sensory Level ◽  
Hyperbaric Bupivacaine ◽  
Subarachnoid Block ◽  
Number Of Patients ◽  
Group A ◽  
The Difference ◽  
Group B

Aims: To see the maximum sensory level in supine and prone position after subarachnoid block in patients undergoing Minipercutaneous Nephrolithotomy with two different volumes of local anaesthetic. Methods: Prospective randomized comparative study in 500 patients undergoing Minipercutaneous Nephrolithotomy for finding out the extensiveness of sensory level spread after spinal anaesthesia using two different volumes of local anaesthetic before and after keeping patients in prone position. Patients were divided into two groups: Group A (three ml hyperbaric Bupivacaine) and Group B (four ml hyperbaric Bupivacaine) consisted of 250 patients each. Spinal block was performed in sitting position. Sensory level and hemodynamic measurements were carried out at different time points while patients were on supine and on prone position. Results: Patients attaining T4 sensory level at five minutes in Group B was significantly higher than in Group A (p=0.001). After 10-15 minutes of spinal block, greater number of patients in Group B reached T4 sensory level while being in supine position than those in Group A and the difference was statistically significant (p=0.000). After keeping the patients in prone position for in 10-15 minutes the number of patients reaching T4 level was found to be significantly higher in group A than in Group B (p=0.063). Decrease in heart rate and blood pressure in prone position were significant from baseline value and while during supine (p<0.05). Conclusion: Prone positioning extends the sensory level of subarachnoid block to higher level (T4) when three ml of hyperbaric solution is used. DOI: http://dx.doi.org/10.3126/jkmc.v1i1.7249 Journal of Kathmandu Medical College, Vol. 1, No. 1, Issue 1, Jul.-Sep., 2012 pp.10-15

Planning for End of Life

2021 ◽  
pp. 104990912110141
Author(s):  
Natasha Ansari ◽  
Eric Johnson ◽  
Jennifer A. Sinnott ◽  
Sikandar Ansari
Keyword(s):  
End Of Life ◽  
Treatment Options ◽  
Stage Iv ◽  
P Value ◽  
Life Planning ◽  
Number Of Patients ◽  
End Of Life Planning ◽  
The Difference ◽  
Alternative Medications ◽  
Patient’S Perception

Background: Oncology provider discussions of treatment options, outcomes of treatment, and end of life planning are essential to care for patients with advanced malignancies. Studies have shown that despite this, many patients do not have adequate care planning, including end of life planning. It is thought that the accessibility of information outside of clinical encounters and individual factors and/or beliefs may influence the patient’s perception of disease. Aims: The objective of this study was to evaluate if patient understanding of treatment goals matched the provider and if there were areas of discrepancy. If a discrepancy was found, the survey inquired further into more specific aspects. Methods: A questionnaire-based survey was performed at a cancer hospital outpatient clinic. 100 consecutive and consenting patients who had stage IV non-curable lung, gastrointestinal (GI), or other cancer were included in the study. Patients must have had at least 2 visits with their oncologist. Results: 40 patients reported their disease might be curable and 60 reported their disease was not curable. Patients who reported their disease was not curable were more likely to be 65 years or older (P-value: 0.055). They were more likely to report that their doctor discussed the possibility of their cancer getting worse (78.3% VS 55%; P-value 0.024), that their doctor discussed end of life plans (58.3% VS 30%; P- value: 0.01), and that they had appointed a health care decision-maker (86.7% VS 62.5%; P-value: 0.01). 65% of patients who thought their disease might be curable reported that their doctor said it might be curable, compared with only 6.7% of patients who thought their disease was not curable (p < 0.001). Or, equivalently, 35% of patients who thought their disease might be curable reported that their doctor’s opinion was that it was not curable, compared with 93% of patients who thought their disease was not curable (p < 0.001). Patients who had lung cancer were more likely to believe their cancer was not curable than patients with gastrointestinal or other cancer, though the difference was not statistically significant (p = 0.165). Patients who said their disease might be curable selected as possible reasons that a miracle (50%) or alternative medicine (66.7%) would get rid of the cancer, or said their family wanted them to believe the cancer would go away (16.7%) or that another doctor said it would (4.2%). Patients who said their disease might be curable said they did so due to alternative medications, another doctor, or their family. Restricting to the 70 patients who reported their doctors telling them their disease was not curable, 20% of them still said that they personally felt their disease might be curable. Patients below 65 years of age were more likely to disagree with the doctor in this case (P-value: 0.047). Conclusion: This survey of patients diagnosed with stage IV cancer shows that a significant number of patients had misunderstandings of the treatment and curability of their disease. Findings suggest that a notable proportion kept these beliefs even after being told by treating physicians that their disease is not curable.

scholarly journals Home Mechanical Ventilation: A Patient’s Perspective Survey Study

2021 ◽  
Vol 18 (8) ◽  
pp. 4048
Author(s):  
Magdalena Kwiatosz-Muc ◽  
Bożena Kopacz
Keyword(s):  
Health Care ◽  
Mechanical Ventilation ◽  
Alternative Methods ◽  
Survey Study ◽  
Home Mechanical Ventilation ◽  
Patient’S Satisfaction ◽  
Satisfaction Index ◽  
Number Of Patients ◽  
The Difference

Background: An increasing number of patients included in home mechanical ventilation (HMV) care has been under observation for many years. The study aimed to assess the patients opinion concerning the expected and perceived quality of care in an HMV system and a patient’s satisfaction with care. Methods: In 2017, patients treated with HMV were surveyed in Poland with the modified SERVQUAL questionnaire. Results: One hundred correctly completed surveys were analyzed. Patient Satisfaction Index was high. In every examined area, the expectations were statistically significant larger than the perception of the services. The biggest gap was in the tangibility dimension and the smallest gap was in the empathy dimension. Perceived respect and understanding for a patient’s needs are close to the expectations. Conclusions: The level of satisfaction with health care among patients treated with HMV in majority of investigated components is high. Moreover, the difference between perceived and expected quality of health care in the HMV system was relatively small in the opinion of the patients themselves. Further investigations with alternative methods are needed.

scholarly journals The effect of resistant starch on colon function in humans

1990 ◽  
Vol 64 (2) ◽  
pp. 589-595 ◽  
Author(s):  
J. Tomlin ◽  
N. W. Read
Keyword(s):  
Transit Time ◽  
Resistant Starch ◽  
Bacterial Flora ◽  
Random Order ◽  
Observable Effect ◽  
Total Carbohydrate ◽  
Diet Supplements ◽  
Significant Difference ◽  
Dietary Period ◽  
The Difference

Starch that is resistant to human amylases forms during the cooking and subsequent cooling of some foods, and may therefore be a substrate for the bacterial flora of the colon. It is thus possible that resistant starch (RS) will affect colon function in a similar manner to non-starch polysaccharides. To test this theory, a group of eight volunteers took two diet supplements for 1 week each in a random order with a 1 week separation. One supplement comprised mainly 350 g Cornflakes/d and the other 380 g Rice Krispies/d, providing 10.33 and 0.86 g RS/.d respectively. The amounts of amylase-digestible starch, non-starch polysaccharides, total carbohydrate, energy, protein and fat were balanced between the two periods by giving small amounts of Casilan, wheat bran, butter and boiled sweets. The volunteers made faecal collections during day 3 to day 7 of each period. Whole-gut transit time was calculated using the continuous method. Stool consistency and ease of defaecation were assessed by the volunteers. All episodes of flatulence noticed were recorded in a diary, along with food intake. Serial breath hydrogen measurements were made at 15 min intervals for 8 h on day 1 of each supplement. Questionnaires regarding colon function were completed at the end of each dietary period. There were no significant differences in the stool mass, frequency or consistency, ease of defaecations, transit time or flatulence experienced during the two supplements (P > 0.05). Significantly more H2 (area under curve) was produced while eating Cornflakes than Rice Krispies (P < 0.05). The difference of 9.47 g RS/d between the two diets was over three times the calculated normal daily RS intake of 2.76 g/d. As the only significant difference observed was in the breath H2 excretion on day 1, we suggest that either RS is rapidly and completely fermented to end-products including H2 gas, which is subsequently excreted via the lungs and has little influence on colon function, or that bacterial adaptation removed any observable effect on faecal mass and transit time by day 3.

Validation of cerebral arteriovenous malformation hemodynamics assessed by DSA using quantitative magnetic resonance angiography: preliminary study

2017 ◽  
Vol 10 (2) ◽  
pp. 156-161 ◽  
Author(s):  
Sophia F Shakur ◽  
Denise Brunozzi ◽  
Ahmed E Hussein ◽  
Andreas Linninger ◽  
Chih-Yang Hsu ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Magnetic Resonance Angiography ◽  
Transit Time ◽  
Internal Carotid ◽  
Flow Measurements ◽  
Quantitative Magnetic Resonance ◽  
Transit Times ◽  
Before And After ◽  
Preliminary Study ◽  
The Difference

BackgroundThe hemodynamic evaluation of cerebral arteriovenous malformations (AVMs) using DSA has not been validated against true flow measurements.ObjectiveTo validate AVM hemodynamics assessed by DSA using quantitative magnetic resonance angiography (QMRA).Materials and methodsPatients seen at our institution between 2007 and 2016 with a supratentorial AVM and DSA and QMRA obtained before any treatment were retrospectively reviewed. DSA assessment of AVM flow comprised AVM arterial-to-venous time (A-Vt) and iFlow transit time. A-Vt was defined as the difference between peak contrast intensity in the cavernous internal carotid artery and peak contrast intensity in the draining vein. iFlow transit times were determined using syngo iFlow software. A-Vt and iFlow transit times were correlated with total AVM flow measured using QMRA and AVM angioarchitectural and clinical features.Results33 patients (mean age 33 years) were included. Nine patients presented with hemorrhage. Mean AVM volume was 9.8 mL (range 0.3–57.7 mL). Both A-Vt (r=−0.47, p=0.01) and iFlow (r=−0.44, p=0.01) correlated significantly with total AVM flow. iFlow transit time was significantly shorter in patients who presented with seizure but A-Vt and iFlow did not vary with other AVM angioarchitectural features such as venous stenosis or hemorrhagic presentation.ConclusionsA-Vt and iFlow transit times on DSA correlate with cerebral AVM flow measured using QMRA. Thus, these parameters may be used to indirectly estimate AVM flow before and after embolization during angiography in real time.

Progress of leukoaraiosis is inhibited by correction of platelet hyper-aggregability

2005 ◽  
Vol 17 (4) ◽  
pp. 689-698 ◽  
Author(s):  
Shigekiyo Fujita ◽  
Tetsuro Kawaguchi ◽  
Toshiyuki Uehara ◽  
Kazuhito Fukushima
Keyword(s):  
Group Versus ◽  
Adenosine Diphosphate ◽  
White Matter Hyperintensity ◽  
Number Of Patients ◽  
Mri Scans ◽  
The Mean ◽  
The Difference ◽  
Magnetic Resonance Imaging Mri ◽  
Observation Period

Background: Platelet hyper-aggregability is an important risk factor for leukoaraiosis. In this study we investigated whether aggravation of leukoaraiosis can be controlled by means of long-term correction of platelet hyper-aggregability.Methods:Twenty-one patients with leukoaraiosis and uncorrected platelet hyper-aggregability were compared with 21 controls matched for age, grade of leukoaraiosis and observation period whose platelet hyper-aggregability was corrected. Platelet aggregability was estimated by an optical analytical method with a nine-stage display using two different concentrations each of adenosine diphosphate (ADP) and collagen (the double ADP method).Results:The mean observation period between two magnetic resonance imaging (MRI) scans for both groups was 4.1 years. In the non-corrected group, moderate to severe aggravation of leukoaraiosis was observed in a large number of patients. In the corrected group, only a small number of patients showed generally mild aggravation of leukoaraiosis. The number of patients showing aggravation of periventricular hyperintensity (PVH) was 7 in 21 in the non-corrected group versus 1 in 21 (p=0.022) in the corrected group, and for aggravation of deep white-matter hyperintensity, these values were 9 in 21 versus 4 in 21, respectively. Thus, the difference was more significant if the degree of aggravation was taken into account.Conclusion:The progress of leukoaraiosis is greatly inhibited by long-term correction of platelet hyper-aggregability.

Biological Variation in Urinary Excretion of Pyridinium Crosslinks: Recommendations for the Optimum Specimen

1996 ◽  
Vol 33 (1) ◽  
pp. 36-42 ◽  
Author(s):  
M Panteghini ◽  
F Pagani
Keyword(s):  
Early Morning ◽  
Reference Intervals ◽  
Biological Variation ◽  
Creatinine Ratio ◽  
Pyridinium Crosslinks ◽  
Number Of Patients ◽  
Analytical Imprecision ◽  
Optimum Specimen ◽  
The Difference ◽  
Urine Specimens

We assessed the analytical and biological variation of pyridinium crosslinks in early morning, 2 h fasting, and 24 h urine specimens from 14 healthy adults over a 1 month period. The results were expressed both in terms of pyridinoline concentration and pyridinoline/creatinine ratio. The data obtained were used to select the optimum specimen for clinical purposes. We found that: ( a) early morning specimens are preferred; ( b) results should be expressed as pyridinoline/creatinine ratio; ( c) reference intervals should be stratified according to gender; ( d) the necessary analytical imprecision (CV≤ 9%), derived from biological variation, is not easily achieved by current methods; ( e) the difference between serial results from an individual must be > 50% to be statistically significant; and ( f) assessment of risk for osteoporotic fracture by means of the pyridinium crosslink assay would, in a significant number of patients, require analysis of multiple urine specimens.

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