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Chest Dec 2004Pleural manometry during large-volume thoracentesis can prevent the development of excessively negative pleural pressures, which have been associated with re-expansion...
INTRODUCTION
Pleural manometry during large-volume thoracentesis can prevent the development of excessively negative pleural pressures, which have been associated with re-expansion pulmonary edema; can diagnose an unexpandable lung; and can predict pleurodesis success. We currently perform pleural manometry simultaneously with both a vertical-column water manometer with an interposed resistive element, and a hemodynamic transducer connected to a standard physiologic system. We present the technique as well as the advantages and disadvantages of both systems in measuring pleural liquid pressures.
TECHNIQUE
A flexible thoracentesis catheter is inserted in the most dependent portion of the pleural effusion. The water manometer consists of two lengths of IV tubing connected through a 22-gauge needle inserted into an injection terminal. The system is connected to the zeroing port of the pressure transducer, and both are carefully purged of air. The electronic system is zeroed at the level the thoracentesis catheter is introduced into the patient. Measurements are performed initially and after each 250 mL of fluid that is withdrawn. ACCURACY OF THE WATER MANOMETER: Forty consecutive patients who underwent therapeutic thoracentesis had pressure measurements. Pleural fluid removed ranged from 50 to 4,200 mL (mean, 1,445 mL). A total of 291 pressure measurements were acquired and analyzed. Mean pleural liquid pressure obtained by the water manometer had a strong positive correlation with the values obtained by a standard physiologic system (r = 0.97, p < 0.001).
CONCLUSION
An overdamped water manometer is a valid method to measure mean pleural liquid pressure. Coughing invalidates pressure measurements with the water manometer; however, with the electronic method, periods of quiet breathing can be identified, allowing for the measurement of pleural pressure.
Topics: Adult; Aged; Aged, 80 and over; Female; Humans; Male; Manometry; Middle Aged; Paracentesis; Pleural Effusion; Pressure
PubMed: 15596671
DOI: 10.1378/chest.126.6.1764 -
Revista Espanola de Enfermedades... Jun 2015Normal values for water-perfused esophageal high-resolution manometry have still not been established in our environment, despite its generalized use and the...
BACKGROUND
Normal values for water-perfused esophageal high-resolution manometry have still not been established in our environment, despite its generalized use and the recommendation to determine reference values for each Motility Unit based on their equipment. Normal values established with solid-state highresolution manometry are currently being used as reference values for water-perfused high-resolution manometry.
OBJECTIVES
To obtain normal values for water-perfused esophageal high-resolution manometry, based on the esophageal motility analysis of healthy subjects.
METHODS
16 healthy volunteers without history of digestive complaints or esophageal symptoms were included. 22-channel water-perfused high-resolution manometry was performed.
RESULTS
Normal values were calculated as 5th-95th percentile ranges for the following parameters; upper esophageal sphincter resting pressure (UESRP) (40-195 mmHg); upper esophageal sphincter residual pressure (UESResP) (30-115 mmHg), contractile front velocity (CFV) (2.4-7.1 cm/s), distal contractile integral (DCI) (285-2820 mmHg.s.cm), distal contraction latency (DL) (6.1-10.9 s), intrabolus pressure (IBP) (7-19 mmHg), integrated relaxation pressure (IRP 4s) (2-20 mmHg), lower esophageal sphincter resting pressure(LESRP) (5-54 mmHg), esophageal shortening (Es) (0.3-1.3 cm) and lower esophageal sphincter lift (LESL) (0,1-1,2 cm).
CONCLUSION
Normal values for the most important parameters (such as IRP 4s, DL and CFV), obtained using a 22-channel waterperfused system resemble previously published data from other perfusion devices. However, there exist small but significant variations compared with values established with solid-state highresolution manometry. Thus, when using water-perfused catheters, caution is required when normative values are used that were established with solid-state catheters.
Topics: Adult; Esophagus; Female; Healthy Volunteers; Humans; Male; Manometry; Middle Aged; Pressure; Reference Values; Water
PubMed: 26031863
DOI: No ID Found -
Gastrointestinal Endoscopy Aug 2012
Review
Topics: Catheters; Esophageal Diseases; Esophageal pH Monitoring; Humans; Manometry; Plethysmography, Impedance; United States
PubMed: 22657403
DOI: 10.1016/j.gie.2012.02.022 -
Journal of Pediatric Gastroenterology... Nov 2011We previously showed that approximately 10% of patients with intractable constipation have spinal abnormalities without any other physical findings. Given that spinal...
BACKGROUND AND OBJECTIVE
We previously showed that approximately 10% of patients with intractable constipation have spinal abnormalities without any other physical findings. Given that spinal magnetic resonance imaging is costly and often requires deep sedation in children, it would be useful to find a screening tool to determine who has a higher likelihood of having a spinal abnormality. The aim of the study was to determine whether anorectal manometry is a useful screening test in predicting which patients will have abnormal spinal MRIs.
PATIENTS AND METHODS
This is a case-control study comparing the anorectal manometries of 10 children with constipation who had abnormal spinal MRIs (cases) to the manometries of 10 age-matched children with normal MRIs (controls).
RESULTS
The maximum relaxation of the sphincter after balloon distention was achieved with a significantly smaller balloon in the cases as compared with the controls (35 ± 20 vs 60 ± 23 mL; P = 0.02). The dose-response curve of sphincter relaxation at different balloon distention was shifted to the left in patients with spinal lesions. Anal spasms after balloon distention were noted in 60% of the patients with abnormal magnetic resonance images compared with 0% of the controls (P < 0.003). There were no other differences.
CONCLUSIONS
Patients with spinal cord abnormalities may show changes in anorectal manometry. Anal spasms on anorectal manometry are significant predictors of spinal abnormalities. Also, patients with spinal abnormalities have maximum sphincter relaxations with smaller balloon sizes. Further studies are needed to determine the utility of anorectal manometry as a screening test for spinal abnormalities in patients with constipation.
Topics: Anal Canal; Case-Control Studies; Catheterization; Child; Child, Preschool; Constipation; Humans; Infant; Magnetic Resonance Imaging; Manometry; Retrospective Studies; Spinal Cord; Spinal Cord Diseases
PubMed: 21613965
DOI: 10.1097/MPG.0b013e31822504e2 -
Current Gastroenterology Reports Apr 2007Perfusion manometry of the sphincter of Oddi has been the standard for the investigation of patients with presumed sphincter of Oddi dysfunction (SOD). Microtransducer... (Review)
Review
Perfusion manometry of the sphincter of Oddi has been the standard for the investigation of patients with presumed sphincter of Oddi dysfunction (SOD). Microtransducer manometry (MTM) of the sphincter of Oddi represents an alternative to perfusion manometry. The technical success and reproducibility of MTM are as good as for perfusion manometry. Current data suggest that the upper limit for normal of basal sphincter of Oddi pressures measured with MTM lies at approximately 35 mm Hg. Pancreatitis risk after MTM in patients with SOD compares favorably with that after perfusion manometry. Low cost and ease of handling make MTM of the sphincter of Oddi an attractive alternative.
Topics: Humans; Manometry; Pancreatitis; Sphincter of Oddi Dysfunction; Transducers
PubMed: 17418064
DOI: 10.1007/s11894-007-0013-4 -
The American Journal of Gastroenterology Jun 1996In summary, GERD patients are usually well managed using a careful medical history, endoscopy, and empirical trials of antireflux medications. Extended esophageal pH... (Review)
Review
In summary, GERD patients are usually well managed using a careful medical history, endoscopy, and empirical trials of antireflux medications. Extended esophageal pH monitoring is unnecessary in most patients but can be of considerable value in managing patients with typical or atypical symptoms who are refractory to standard therapy for GERD. Furthermore, the test can be useful in documenting abnormal reflux in an individual without esophagitis being evaluated for antireflux surgery. The test is done with compact, portable data loggers, miniature pH electrodes, and computerized data analysis. The pH electrode should be positioned 5 cm above the manometrically defined upper limit of the LES, and patients should undergo the test on an unrestricted diet. In terms of data analysis, the total percentage time of pH < 4 provides as much information as any other scheme of quantifying esophageal acid exposure, but symptom association is essential when evaluating atypical or sporadic symptoms. Enthusiasm for 24-h pH monitoring must, however, be tempered with an analysis of its proven clinical utility in patient management with its utility rightfully compared with that of an empirical trial of anti-reflux therapy. Ambulatory pH monitoring is probably most useful in examining patients without typical reflux symptoms or patients who have either partially or completely failed a trial of anti-reflux therapy. To date, there have not been any prospective, controlled clinical trials evaluating these uses. Suggested clinical indications for ambulatory pH monitoring are listed in Table 5 (53).
Topics: Esophageal Diseases; Esophagus; Humans; Hydrogen-Ion Concentration; Manometry; Monitoring, Ambulatory
PubMed: 8651151
DOI: No ID Found -
Neurogastroenterology and Motility Sep 2013Esophageal high-resolution manometry (HRM) is a novel method to assess esophageal motility. Several software and hardware systems are currently available. A set of...
BACKGROUND
Esophageal high-resolution manometry (HRM) is a novel method to assess esophageal motility. Several software and hardware systems are currently available. A set of normal values for HRM parameters was established in the US, using proprietary tactile-sensing catheter technology (Given Imaging). We wished to determine normal values for HRM performed with another type of catheter (Unisensor).
METHODS
Fifty-two healthy volunteers underwent supine HRM. Each subject swallowed 10 liquid water boluses. Esophageal contraction parameters were evaluated and normal values were calculated (defined as 5th and 95th percentile of values).
KEY RESULTS
The normal range for the following parameters was calculated; distal contractile integral (mean 1319.44, with a 5-95th percentile range [185.65-3407.60]), contractile front velocity (mean 3.98, 5-95th percentile range [2.40-6.50]), Intrabolus pressure (mean 9.68, range [1.00-19.00]), contraction amplitude measured 5 cm above the esophagogastric junction (EGJ; mean 78.76, range [23.00-146.00]), contraction amplitude 15 cm above the EGJ (mean 43.66, range [3.60-96.00]), transition zone (TZ) length (mean 1.34, range [0.00-5.63]), upper esophageal sphincter (UES) pressure (mean 81.63, range [19.50-165.10]), EGJ length (mean 2.97, range [2.17-4.00]), EGJ resting pressure (mean 29.35, range [8.95-51.40]), EGJ relaxation pressure (mean 16.79, range [1.00-39.35]), IRPs4 (mean 13.42, range [2.59-28.28]), and gastric pressure (mean 5.06, range [0.00-9.46]).
CONCLUSIONS & INFERENCES
Overall, the normal values of esophageal HRM parameters obtained with the Unisensor catheter resemble those of the previously published series. Marked differences in upper limits of normal were found for parameters related to the esophageal sphincters and TZ length. Users of HRM should be aware of these differences and define pathology based on comparison to appropriate normal values.
Topics: Adolescent; Adult; Catheters; Esophageal Motility Disorders; Esophagus; Female; Humans; Male; Manometry; Middle Aged; Muscle Contraction; Muscle, Smooth; Reference Values; Young Adult
PubMed: 23803156
DOI: 10.1111/nmo.12167 -
Clinical Gastroenterology and... Apr 2016Esophageal manometry is the standard for the diagnosis of esophageal motility disorders. Variations in the performance and interpretation of esophageal manometry result...
BACKGROUND & AIMS
Esophageal manometry is the standard for the diagnosis of esophageal motility disorders. Variations in the performance and interpretation of esophageal manometry result in discrepant diagnoses and unnecessary repeated procedures, and could have negative effects on patient outcomes. We need a method to benchmark the procedural quality of esophageal manometry; as such, our objective was to formally develop quality measures for the performance and interpretation of data from esophageal manometry.
METHODS
We used the RAND University of California Los Angeles Appropriateness Method (RAM) to develop validated quality measures for performing and interpreting esophageal manometry. The research team identified potential quality measures through a literature search and interviews with experts. Fourteen experts in esophageal manometry ranked the proposed quality measures for appropriateness via a 2-round process on the basis of RAM.
RESULTS
The experts considered a total of 29 measures; 17 were ranked as appropriate and were as follows: related to competency (2), assessment before the esophageal manometry procedure (2), the esophageal manometry procedure itself (3), and interpretation of data (10). The data interpretation measures were integrated into a single composite measure. Eight measures therefore were found to be appropriate quality measures for esophageal manometry . Five other factors also were endorsed by the experts, although these were not ranked as appropriate quality measures.
CONCLUSIONS
We identified 8 formally validated quality measures for the performance and interpretation of data from esophageal manometry on the basis of RAM. These measures represent key aspects of a high-quality esophageal manometry study and should be adopted uniformly. These measures should be evaluated in clinical practice to determine how they affect patient outcomes.
Topics: Adult; Aged; Esophageal Motility Disorders; Female; Humans; Male; Manometry; Middle Aged; Quality of Health Care
PubMed: 26499925
DOI: 10.1016/j.cgh.2015.10.006 -
Neurogastroenterology and Motility Oct 2020We compared the utility of existing and modified versions of high-resolution manometry for diagnosing defecatory disorders (DD).
BACKGROUND
We compared the utility of existing and modified versions of high-resolution manometry for diagnosing defecatory disorders (DD).
METHODS
In 64 healthy and 136 constipated women, we compared left lateral (LL) and seated manometry, and analyzed with existing (ManoView™) and new methods, for discriminating between constipated patients with normal and prolonged rectal balloon expulsion time (BET). In both positions, the rectoanal gradient (RAG) and, for the new analysis, the pressure topography pattern during evacuation were used to discriminate between constipated patients without and with DD.
KEY RESULTS
The BET was prolonged, suggestive of a DD, in 52 patients (38%). During evacuation, rectoanal pressures and the RAG were greater in the seated than the LL position (P≤.001). The new analysis identified 4 rectoanal pressure patterns. In the seated position, the BET was associated with the pattern (P=.0001), being prolonged in, respectively, 45%, 15%, 53%, and 0% of patients with minimal change, anal relaxation, paradoxical contraction, and transmission. Within each pattern, the RAG was greater (ie, less negative, P<.0001) in patients with a normal than a prolonged BET. Compared to the ManoView™ RAG in the LL position, the integrated analysis (ie, pattern and new RAG) in the LL position (P<.01) and the seated ManoView™ gradient (P=.02) were more effective for discriminating between constipated patients without and with DD.
CONCLUSIONS & INFERENCES
Anorectal HRM ideally should be performed in the more physiological seated position and analyzed by a two-tier approach, which incorporates the overall pattern followed by the rectoanal gradient. These findings reinforce the utility of manometry for diagnosing DD.
Topics: Adult; Anal Canal; Chronic Disease; Constipation; Defecation; Female; Humans; Manometry; Middle Aged; Rectum
PubMed: 32613711
DOI: 10.1111/nmo.13910 -
Dysphagia Jun 2012Manofluorography, that is, the concurrent use of manometry and videofluorography for the evaluation of pharyngeal dysphagia, has not been widely used clinically,... (Review)
Review
Manofluorography, that is, the concurrent use of manometry and videofluorography for the evaluation of pharyngeal dysphagia, has not been widely used clinically, partially because of various limitations of conventional manometry. Technological advancements in recent years have led to substantial improvements in manometric devises, which can now overcome many of the shortcomings of standard manometry. In parallel with this, studies examining the utility of high-resolution manometry for the evaluation of pharyngeal disorders of swallowing have begun to emerge. This review summarizes the technological developments in manometry and the existing literature on pharyngeal high-resolution manofluorography with pressure topography. The article also discusses the potential clinical value of high-resolution pharyngeal-esophageal pressure topography and suggests directions for future investigations. Studies conducted so far have shown heterogeneous approaches to utilizing high-resolution manofluorography. These studies have revealed important information regarding its diagnostic potential and researchers have devised innovative methods of measurements. However, substantial research is required to transform manofluorography into a clinically useful tool. There is a need to conduct validation studies, correlating manometric measures with structural changes in the swallow seen on videofluorography and devise diagnostic methods that utilize the advantages of both tools. Furthermore, studies comparing healthy and clinical populations are needed to identify measures most clinically significant in order to develop diagnostic paradigms.
Topics: Deglutition Disorders; Fluoroscopy; Humans; Manometry; Oropharynx; Video Recording
PubMed: 22527220
DOI: 10.1007/s00455-012-9405-1