Methods to Improve the Efficacy of Autoinflation Procedures and to Classify Eustachian Tube Patency

We describe three methods to improve the efficacy of autoinflation procedures. The subjects were examined after flight with otoscopy and tympanometry. If the middle ear pressures after flight were negative, the passengers were asked to perform a Valsalva maneuver after which tympanometry was repeated. If still negative, the passengers were instructed to perform an extended Valsalva maneuver. If middle ear pressure was still negative, the passenger then was instructed to perform autoinflation using a nasal balloon. Among the ears with initial negative middle ear pressure, 14% normalized the middle ear pressure after Valsalva’s maneuver. In the passengers with a remaining negative pressure, the pressure was equalized to zero or positive pressure in 46% following an extended Valsalva maneuvre. In the ears with remaining negative middle ear pressure after both Valsalva and extended Valsalva maneuver, 69% could normalize the middle ear pressure after nasal balloon inflation.

Preoperative Abdominal Computed Tomography at Rest and During Valsalva’s Maneuver to Evaluate Incisional Hernias

Background. Incisional hernias (IHs) can develop in up to 15% of patients who underwent an abdominal surgical procedure. Abdominal computed tomography (CT) is the best examination to evaluate these patients before surgical repair. The aim of this study is to assess the usefulness of the abdominal CT scan during Valsalva’s maneuver in patients who are candidates for surgery. Methods. A retrospective cohort analysis conducted on prospectively recorded data was performed on 26 consecutive patients affected by IHs who underwent a preoperative abdominal CT scan both at rest and during Valsalva’s maneuver between January 1, 2015, and December 31, 2016. Results. Five patients (19%) had IH classified as M1-M2, 10 (39%) as M3, and 11 (42%) as M4-M5. Both the median IH orifice area (IHOA) and the median volume of the IH increased during straining ( P = .001 and P < .001, respectively). The percentage of the difference in volume ratios increased as the localization of the IH moved caudally. At the binary logistic regression analysis M3 IH, body mass index >28, IHOA > 156 cm2 at rest, and IHOA > 138 cm2 during Valsalva’s maneuver were risk factors for posterior component separation. Conclusions. The preoperative CT scan both at rest and during Valsalva’s maneuver seemed useful to estimate the risk of difficult IH repairs. Moreover, it could allow surgeons to decide if the patient should be addressed to more specialized centers.

Effect of isosorbide dinitrate on sinoatrial node pacemaker activity in patients with stable angina pectoris of III and IV functional classes associated with hypertension

Aim. To study the effect of isosorbide dinitrate on heart rate variability in patients with III and IV functional classes of stable angina and concomitant essential hypertension. Methods. The study involved 122 patients with III and IV functional classes of stable angina and concomitant essential hypertension, mean age 58.4±5.8 years. All patients underwent electrocardiography, Doppler echocardiography, 24-hour ECG monitoring. Rhythmocardiography was performed in the morning before the drug intake (acetylsalycilic acid, beta-blockers, statins, angiotensin-converting enzyme inhibitors) and 1.5 hours after 10 mg isosorbide dinitrate intake. Results. There was a statistically significant increase in overall heart rate variability at Valsalva’s maneuver and active postural test in patients with III and IV functional classes of stable angina and concomitant essential hypertension, which was most likely due to the amplitude of humoral-metabolic waves. The amplitude of the sympathetic pacing fluctuations increased in all samples, while the parasympathetic pacing fluctuation amplitude decreased at Valsalva’s maneuver, Ashner’s test and while lying flat. There was a vegetative spectrum shift towards the humoral-metabolic effect in sympathetic active postural test, sympathetic shift in all tests except for sympathetic active postural test, and significant decrease in parasympathetic effect at Ashner’s test, sympathetic active postural test and while lying flat. Conclusion. In patients with III and IV functional classes of stable angina and concomitant essential hypertension there was an increase in the overall heart rate variability mainly due to the humoral-metabolic and sympathetic waves amplitude increase and parasympathetic amplitude decrease. Isosorbide dinitrate intake resulted in vegetative spectrum redistribution towards humoral and sympathetic metabolic regulation patterns and decrease of parasympathetic regulation pattern, which normally prevails.