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PubMed2002

Oesophageal motor and sensitivity abnormalities in non-obstructive dysphagia.

OBJECTIVES: To evaluate oesophageal sensitivity to balloon distension in patients with non-obstructive dysphagia (NOD), and to determine its relationship with the motility pattern in response to food ingestion. PATIENTS AND METHODS: Twenty-one healthy volunteers and 19 consecutive patients complaining of NOD with normal standard manometry were included. An oesophageal sensitivity test was carried out before the manometry study with liquid and solid swallows. RESULTS: The median threshold to distension was 9 ml in control subjects and 5 ml in patients (P < 0.002). Dysphagia or odynophagia were reproduced in 15/19 (78.9%) patients during manometry with solid swallows only. The percentage of swallows with abnormal motility patterns was higher in patients than control subjects (P < 0.001). Compared with control values, sensitivity abnormality was defined by a distension threshold of < 6 ml. Motor abnormality was defined by > 19% of swallows occurring with one or more abnormal motor profiles. A total of 8/19 (42%) patients presented with the association of an abnormal sensitivity threshold and an abnormal motor pattern; 5/19 (26%) presented with isolated motor abnormalities; 4/19 (21%) patients presented with isolated abnormal sensitivity thresholds; and 2/19 (11%) patients presented without any abnormality. CONCLUSION: Manometry with solid swallows and oesophageal balloon distension are useful in characterizing NOD.

Adult↗
PubMed2005

Characteristics of oesophageal bolus transport in patients with mild oesophagitis.

OBJECTIVE: Patients with gastroesophageal reflux disease (GORD) frequently have oesophageal motility disturbance. However, detailed data about bolus transport characteristics in these patients are still lacking. In the present study the new technology of concurrent impedance manometry was applied for characterization of oesophageal motor function in patients with mild GORD. METHODS: Oesophageal motility testing was performed in 25 patients with mild GORD (group 1) as compared to 25 healthy subjects (group 2) employing the technique of concurrent impedancometry and manometry. Oesophageal motility as well as patterns and parameters of bolus transport after the swallowing of saline or yogurt were analysed. RESULTS: According to manometry the velocity of the contraction wave was similar in both groups. Mid-distal contraction amplitude in group 1 was still in the normal range but significantly lower than in group 2 (57.4+/-4.5 mmHg vs 91.4+/-7.5 mmHg for saline, and 47+/-4.1 vs 80.7+/-9.4 mmHg for yogurt). According to impedance measurements, bolus transport was significantly slower (3.6+/-0.1 vs 4.0+/-0.1 cm/s for saline and 3.0+/-0.1 vs 3.2+/-0.1 cm/s for yogurt), and post-deglutitive impedance was significantly lower in group 1: 2110 omega+/-116 omega versus 2542 omega+/-152 omega (P<0.01) with saline and 1862 omega+/-108 omega versus 2348 omega+/-148 omega with yogurt (P<0.01). GORD patients showed several pathological bolus transport patterns, which were not observed in healthy subjects. Gastroesophageal liquid reflux was observed between the swallows. CONCLUSIONS: In patients with mild GORD concurrent impedancometry and manometry is sufficiently sensitive for the detection of minor oesophageal dysmotility. Several pathological features have been characterized including delayed bolus transport, impaired propulsive volume clearance, pathological transport patterns and pathological reflux patterns.

Adult↗
PubMed2003

Impedance characteristics of normal oesophageal motor function.

OBJECTIVE: To obtain detailed data about the correlation between oesophageal peristalsis and bolus transport for clinical oesophageal motility testing. METHODS: Oesophageal motility testing was performed in 25 healthy subjects by using the newly developed technique of concurrent impedancometry and manometry. Parameters of oesophageal motility and bolus transport as well as the correlation between transit and motility were analysed after swallowing saline or yogurt. RESULTS: Detailed data about bolus transport and oesophageal motility could be obtained during a single investigation step. Air was observed in front of the bolus in 76% of the swallows. Resting baseline impedance was significantly higher in the oesophagus than in the stomach (2832+/-118 Omega vs 688+/-119 Omega). The deglutitive impedance gradient was 222+/-26 Omega for saline and 482+/-38 Omega for yogurt. Bolus propagation velocity and bolus transit time as impedance parameters of bolus transport discriminated fluid from semisolid bolus (4.0+/-0.1 cm/s vs 3.2+/-0.1 cm/s and 9.9+/-0.2 s vs 11.5+/-0.2 s, for saline vs yogurt), while contraction wave amplitude as a manometry parameter of oesophageal motor function did not (91.4+/-7.5 mmHg vs 80.7+/-9.4 mmHg, for saline vs yogurt). There was a poor correlation between bolus propagation velocity and contraction wave amplitude. CONCLUSIONS: Impedance parameters of normal oesophageal motor function have been characterized. Impedancometry and manometry provide different but complementary data about oesophageal motor function. Concurrent impedancometry and manometry allows detailed monitoring of oesophageal motility and bolus transit, which may open new perspectives for comprehensive oesophageal motility testing.

Adult↗
PubMed2004

Investigation of the utility of colorectal function tests and Rome II criteria in dyssynergic defecation (Anismus).

Although 30-50% of constipated patients exhibit dyssynergia, an optimal method of diagnosis is unclear. Recently, consensus criteria have been proposed but their utility is unknown. To examine the diagnostic yield of colorectal tests, reproducibility of manometry and utility of Rome II criteria. A total of 100 patients with difficult defecation were prospectively evaluated with anorectal manometry, balloon expulsion, colonic transit and defecography. Fifty-three patients had repeat manometry. During attempted defecation, 30 showed normal and 70 one of three abnormal manometric patterns. Forty-six patients fulfilled Rome criteria and showed paradoxical anal contraction (type I) or impaired anal relaxation (type III) with adequate propulsion. However, 24 (34%) showed impaired propulsion (type II). Forty-five (64%) had slow transit, 42 (60%) impaired balloon expulsion and 26 (37%) abnormal defecography. Defecography provided no additional discriminant utility. Evidence of dyssynergia was reproducible in 51 of 53 patients. Symptoms alone could not differentiate dyssynergic subtypes or patients. Dyssynergic patients exhibited three patterns that were reproducible: paradoxical contraction, impaired propulsion and impaired relaxation. Although useful, Rome II criteria may be insufficient to identify or subclassify dyssynergic defecation. Symptoms together with abnormal manometry, abnormal balloon expulsion or colonic marker retention are necessary to optimally identify patients with difficult defecation.

Anal Canal↗
PubMed2004

Use of radioisotopic esophageal transit in the assessment of patients with symptoms of reflux and non-specific esophageal motor disorders.

The purposes of this study were to assess the esophageal clearance of a radioisotopic bolus in patients with symptoms of reflux and evaluate the impact of manometric abnormalities on scintigraphic esophageal transit. Esophageal clearance was assessed in a supine position and indicated by the retained radioactivity in the esophagus at 10, 20, 30 and 40 s after the ingestion of a liquid bolus labeled with 2 mCi 99 mTc-SC. The study included 214 consecutive patients with symptoms of reflux and 11 normal controls. The results were compared to the motility findings detected on manometry performed on a separate occasion. Esophageal manometry was normal in 93 patients. Nonspecific esophageal motor disorders were identified in 121 patients and were classified into: 'predominantly nonpropagated activity', 'predominantly low-amplitude peristaltic contractions' and 'miscellaneous disorders' diagnosed in 27, 47 and 47 patients, respectively. The radionuclide clearance was significantly delayed in the overall group of patients compared with that of normal controls (P < 0.001); in patients with reflux symptoms and nonspecific esophageal motor disorders compared with patients with reflux symptoms and 'normal manometry' (P < 0.01 at 20 s); and in patients with reflux symptoms and 'normal manometry' compared with the control group (P < 0.01 at 20 s). Abnormal radioisotope clearances were detected in 88% of patients with 'predominantly nonpropagated activity', in 70% of patients with 'predominantly low-amplitude peristaltic contractions' and in 57% of patients with 'miscellaneous disorders'. Radioisotopic esophageal clearance abnormalities are frequently observed in patients with reflux symptoms and are more likely to be associated to hypomotility disorders, i.e. nonpropagated motor activity or low-amplitude contractions.

Administration, Oral↗
PubMed2006

Management of achalasia with transabdominal esophagocardiomyotomy and partial posterior fundoplication.

In this article we present our experience in the management of achalasia. From May 1988 through August 2005, 71 patients with achalasia underwent transabdominal esophagocardiomyotomy and partial posterior fundoplication. Barium swallow, manometry, and 24-h pH studies were performed in all patients preoperatively. Manometry and 24-h pH monitoring were only carried out in 58 patients at the third post-operative week and in 43 patients during follow-up, even though 52 patients were included in the follow-up. There were no operative deaths or complications. All the 71 patients were able to eat semifluid or solid food without dysphagia and heartburn at discharge. Esophageal barium studies showed that the maximum esophageal diameter decreased 2.2 cm and the minimum gastroesophageal junction diameter increased 8.4 mm after operation. Manometry examination in 58 patients revealed that the lower esophageal sphincter resting pressure decreased 15.0 mmHg in the wake of the procedure. Twenty-four hour pH monitoring demonstrated that reflux events were within the normal post-operative range. Fifty-five of the 58 patients had normal DeMeester scores. Among the patients with a mean 90-month follow-up, 49 patients had normal intake of food without reflux, the remaining three had mild dysphagia without requiring treatment. All the patients resumed their preoperative work and social activities. The manometry and 24-h pH studies in the 43 patients showed there were no significant changes between the third post-operative week and during follow-up. Transabdominal esophagocardiomyotomy and posterior partial fundoplication are able to relieve the functional outflow obstruction of the lower esophageal sphincter, obviate the rehealing of the myotomy edge and prevent gastroesophageal reflux in patients who have undergone myotomy alone.

Adolescent↗
PubMed2006

Multichannel intraluminal impedance for the assessment of post-fundoplication dysphagia.

Dysphagia often occurs after fundoplication, although its pathophysiology is not clear. We sought to better understand postfundoplication dysphagia by measuring esophageal clearance with multichannel intraluminal impedance (MII) along with more traditional work-up (manometry, upper gastrointestinal imaging [UGI], endoscopy). We evaluated 80 consecutive patients after laparoscopic fundoplication between April 2002 and November 2004. Patients were evaluated clinically and underwent simultaneous manometry and MII, 24-hour pH monitoring, endoscopy, and UGI. For analysis, patients were divided into the following groups based on the presence of dysphagia and fundoplication anatomy (by UGI/endoscopy): (1) Dysphagia and normal anatomy; (2) Dysphagia and abnormal anatomy; (3) No dysphagia and abnormal anatomy; and (4) No dysphagia and normal anatomy. Patients with dysphagia (Groups 1 & 2) had similar peristalsis (manometry), but were more likely to have impaired clearance by MII (32 pts, 62%) than those without dysphagia (9 pts, 32%, P = 0.01). Patients with abnormal anatomy (Groups 2 & 3) were also more likely to have impaired esophageal clearance (66%vs. 38%, P = 0.01). Finally, of patients that had normal fundoplication anatomy, those with dysphagia were much more likely to have impaired clearance (12 pts, 52%) than those with dysphagia (4 pts, 21%, P = 0.03). MII after fundoplication provides objective evidence of esophageal clearance, and is commonly abnormal in patients with abnormal fundoplication anatomy and/or dysphagia. Esophageal clearance is impaired in the majority of patients with postoperative dysphagia, even with normal fundoplication anatomy and normal peristalsis. MII may detect disorders in esophageal motility not detected by manometry.

Adolescent↗
PubMed1989

Faecal incontinence: manometric and radiological changes following postanal repair.

Ten patients with idiopathic faecal incontinence underwent postanal repair based on clinical assessment of their symptoms. Their manometric and radiological values before surgery were compared with values from 10 normal volunteers and then the changes following surgery were examined and correlated with the clinical results. Anal manometry was performed using a multilumen, low compliance, perfused catheter system. Anorectal angles and perineal descent were established radiologically. Pre-operative manometry demonstrated significant reduction in maximum and squeeze pressure (median 77 mmHg versus 200 mmHg), the volume required to inhibit the rectoanal reflex (median 40 mL versus 70 mL), and the volume retained in the saline continence test (median 400 mL versus 1500 mL). The majority of patients had obtuse anorectal angles (six of 10 at rest), and abnormal perineal descent (eight of 10 on straining). Nine patients have been improved clinically following surgery. Postoperative manometry and radiology have been performed in seven patients and have shown no significant changes. Anal manometry and radiology are objective means of documenting faecal incontinence although their role in selecting patients for surgery is not yet determined. Postanal repair is effective in restoring continence, although the parameters measured have not explained the mechanism of this effect.

Aged↗
PubMed1997

Postanal repair for faecal incontinence: long-term follow-up.

BACKGROUND: To determine the long-term outcome of postanal repair, and to assess whether the preoperative and physiological tests had any bearing on this outcome. Review included an opportunity for assessment with anal manometry and anal ultrasound. METHOD: Review of all patients (n = 22) over a 10 year period from 1986 to 1996. Comparison was of pre-operative symptoms to symptoms at review. Correlation of outcome with pre-operative manometry and the results of manometry and ultrasound at review (n = 6) was determined. RESULTS: Assessment was possible in 19 of the 22 patients. Follow-up ranged from 2 to 10 years (median, 8 years). Two had stomas created at 6 and 9 months and are considered failures. Seven patients considered the operation a success, in four it improved their symptoms and in six it was considered a failure. Comparison of pre- and postoperative symptoms scores found a statistically significant improvement (P = 0.0093; two-tailed Wilcoxon signed rank sum test). The outcome was not influenced by the results of pre-operative anal manometry. Anal ultrasound found five sphincter defects in six patients. Such defects did not preclude improvement from postanal repair. CONCLUSIONS: Although the results showed improvement or success in only 11 (58%) of the patients this was felt to be important given that these patients may have few alternatives other than complicated procedures or a stoma. Postanal repair has a place in the management of faecal incontinence.

Adult↗
PubMed2000

Colonic motility after surgery for Hirschsprung's disease.

OBJECTIVE: Years after surgery for Hirschsprung's disease, many children continue to suffer from fecal incontinence or constipation. The purpose of the present investigation was to define the physiology underlying the persistent symptoms in children after surgery for Hirschsprung's disease, and to determine the outcome of interventions based on the results of the motility testing. METHODS: We studied 46 symptomatic patients (5.5+/-3.3 yr old, 35 male) >10 months after surgery for Hirschsprung's disease. We performed a colonic manometry with a catheter placed with the tip in the proximal colon. We used a structured questionnaire and phone interview to follow up the patients an average of 34 months after the manometry. RESULTS: We identified four motility patterns: 1) high-amplitude propagating contractions (HAPCs) migrating through the neorectum to the anal sphincter, associated with fecal soiling (n = 18); 2) normal colonic manometry associated with fear of defecation and retentive posturing (n = 9); 3) absence of HAPCs or persistent simultaneous contractions over two or more recording sites (n = 15), associated with constipation (n = 13); and 4) normal colonic motility and a hypertensive internal anal sphincter (>80 mm Hg) (n = 4). We based treatment on results of the motility studies. There was improvement in global health (mean score, 3.9+/-1.1 vs 2.8+/-1.3 at the time of initial evaluation, p < 0.001) and emotional health (3.8+/-1.1 vs 2.6+/-1.1, p < 0.0001). Improvement in the number of bowel movements occurred in 72% of children. Resolution or decreased abdominal pain was reported in 80%. CONCLUSIONS: Colonic manometry clarifies the pathophysiology and directs treatment in symptomatic children after surgery for Hirschsprung's disease.

Adolescent↗
PubMed2005

Multichannel intraluminal impedance monitoring in the evaluation of patients with non-obstructive Dysphagia.

BACKGROUND: Non-obstructive dysphagia (NOD) often poses diagnostic problems. The aim of this study was to evaluate the value of the addition of multichannel intraluminal impedance (MII) recording to esophageal manometry in the work-up of patients with NOD. METHODS: A total of 40 consecutive patients with NOD underwent combined esophageal MII recording and perfusion manometry. Ten liquid and 10 viscous boluses were tested in each patient. Values for bolus presence time (BPT) at each of the four recording sites and total bolus transit time (TBTT) were calculated. Bolus transit (BT) was considered to be normal when BPT at all sites and TBTT were within the normal limits defined in 42 healthy subjects. Patients were judged to have normal transit if >or=80% of liquid and >or=70% of viscous swallows showed normal transit. RESULTS: The following manometric diagnoses were made: normal motility (20), ineffective esophageal motility (IEM) (13), diffuse esophageal spasm (DES) (4), and achalasia (3). Abnormal transit for liquid and/or viscous boluses was found in 35.3% of patients with normal motility, in 66.7% of DES patients, and in 100% of achalasia patients. In patients with achalasia quantification of BT was often made impossible by low initial impedance baseline. Two IEM patients (15.4%) showed normal liquid and viscous transit. Swallows showing normal transit had significantly longer duration of LES relaxation in patients with normal manometry and IEM (p < 0.05). CONCLUSIONS: MII recording identifies esophageal function abnormalities in NOD patients with normal manometry, IEM, and DES. The MII technique seems to be less suitable for the most severe end of the dysphagia spectrum like achalasia.

Adult↗
PubMed1992

Alternative method of positioning the pH probe for oesophageal pH monitoring.

The most reliable method of positioning a pH probe for oesophageal pH monitoring is to use manometry to determine the upper margin of the lower oesophageal sphincter and to place the probe 5 cm above this point. Manometry is expensive, however, requires special equipment and training, and is not widely available. An alternative cheaper way of determining the site of the lower oesophageal sphincter has been evaluated. A fine bore nasogastric tube with a latex balloon at its tip was inserted transnasally into the stomach. The balloon was inflated with 10 ml of water and the tube withdrawn until resistance was met. The distance from the nose (in cm) was noted and compared with the upper margin of the lower oesophageal sphincter as determined by oesophageal manometry. The manometric distance agreed closely with the balloon distance minus 1 cm (bias 0.29 cm; 95% CI of bias, 0.03 to 0.55 cm; 2 SD, limits of agreement, 1.58 cm). We conclude that where oesophageal manometry is not available, balloon localisation is a suitably accurate way of identifying the lower oesophageal sphincter.

Adult↗
PubMed1996

Paroxysmal anal hyperkinesis: a characteristic feature of proctalgia fugax.

BACKGROUND AND AIMS: Proctalgia fugax is a common problem, yet its pathophysiology is poorly understood. The objective was to characterise colorectal disturbances in a paraplegic patient with a 10 year history of proctalgia fugax that began two years after an attack of transverse myelitis. METHODS: Standard anorectal manometry and prolonged 33 hour ambulatory colonic manometry at six sites in the colon were performed together with myoelectrical recording of the anus. Provocative tests designed to simulate psychological and physical stress and two types of meals were included. RESULTS: Anorectal manometry showed normal internal sphincter tone and normal rectoanal inhibitory reflex but an inability to squeeze or to bear down or to expel a simulated stool. Rectal sensation (up to 360 ml inflation) was absent. Pudendal nerve latency was prolonged (4.5 ms (normal < 2.2 ms). During colonic manometry, the patient reported 27 episodes of pain, of which 23 (85%) were associated with bursts (1-60 min) of a high amplitude (0.5 to > 3.2 mv), high frequency (5-50/min) anal myoelectrical activity, particularly after stress tests, meals, and at night. The myoelectrical disturbance only occurred with proctalgia. Intermittently, 16 bursts of 3 cycles/ min phasic rectal contractions were seen, but only six were associated with proctalgia. Colonic motility was reduced compared with normal subjects. CONCLUSIONS: The temporal association between a high amplitude, high frequency myoelectrical activity of the anal sphincter, and the occurrence of proctalgia suggests that paroxysmal hyperkinesis of the anus may cause proctalgia fugax.

Anal Canal↗
PubMed2003

Abnormal oesophageal motility in patients with chronic cough.

BACKGROUND: Although gastro-oesophageal reflux is a recognised cause of chronic cough, the role of oesophageal dysmotility is unknown. The aim of this study was to determine the prevalence of abnormal oesophageal motility in a selected group of patients with chronic cough. METHODS: Oesophageal manometry and 24 hour pH monitoring were performed in 43 patients with chronic cough, 34 of whom had symptoms suggestive of gastro-oesophageal reflux. Comparative manometric measurements were made in 21 healthy subjects. RESULTS: Nine patients with chronic cough had normal manometry and 24 hour pH. Of the remaining 34 patients, 11 (32%) had abnormal manometry alone, five (15%) had abnormal 24 hour pH monitoring alone, and in 18 (53%) both tests were abnormal. Only one patient in the control group had manometric abnormalities. CONCLUSIONS: These results point to a previously unrecognised high prevalence of abnormal oesophageal manometry in patients presenting with chronic cough. Oesophageal dysmotility may therefore be important in the pathogenesis of cough in these patients.

Adult↗
PubMed2002

Multichannel intraluminal impedance accurately detects fasting, recumbent reflux events and their clearing.

Multichannel intraluminal impedance (MII) is a new diagnostic test for gastroesophageal reflux disease (GERD). The objective of this report is to determine the accuracy of MII in detecting individual reflux events (REs) identified by pH probe and manometry, as well as their clearing in patients with severe GERD compared with normal volunteers. Ten severe GERD patients and 10 normal volunteers underwent simultaneous manometry [7 sites: gastric, lower esophageal sphincter, esophagus (4), pharynx], pH, and MII (6 sites in esophagus) for 15 min in the left and right recumbent posture while fasting. We found that patients had 30-fold more REs than normal volunteers (41 +/- 11 vs. 1.3 +/- 0.4), and 95% of all REs were detected by MII. An average 15-fold fall in impedance with liquid and fivefold rise with gas made REs and their composition easy to detect with MII. In the right recumbent posture, nearly all REs detected by MII were liquid (98%, 98/100). In contrast, all 283 REs detected by MII in the left recumbent posture were gas. Nearly all REs detected by MII were cleared (98%, 368/374). Mean acid clearing time was threefold longer (47 s) than clearing time by either manometry (15 s) or MII (13 s), primarily due to acid rereflux, i.e., additional acid REs during acid clearing. We conclude that MII is accurate in detecting REs identified by manometry and/or pH probe, their composition, and their clearing.

Fasting↗
PubMed1990

The use of intraluminal strain gauges for recording ambulant small bowel motility.

Perfused-tube manometry has hitherto been the standard technique for recording intraluminal intestinal pressure in humans, but it is unsuitable for ambulant use. The aim of our study was to evaluate the ability of resistive strain gauge transducers attached to a fine catheter to detect pressure change. Simultaneous strain gauge and perfused-tube manometry was performed on six fasting subjects; in four, strain gauge activation was continuous and in two, the transducers were activated in a pulsed mode with data encoded as a pulse train with an approximate frequency of 20 Hz. Eight thousand eight hundred eighty-eight pressure waves were recorded by strain gauge, of which 96% were detected by perfused-tube manometry. There was good agreement in both phases II and III of the migrating motor complex. The amplitude of pressure waves recorded by strain gauge was slightly but significantly greater. A proportion (14-17%) of pressure waves recorded by strain gauge were bifid; this was not seen with the perfused tube. These differences are best explained by the greater sensitivity and more rapid rise time of the strain gauges. There was no loss of fidelity in the pulse-interval recording mode. A seventh subject underwent a continuous 72-h recording with the strain gauge catheter attached to a battery-operated encoder and magnetic tape cassette recorder and was freely ambulant during this period. The procedure was well tolerated and motility patterns could be clearly identified. We conclude that intraluminal strain gauge catheters are suitable for prolonged use in ambulant subjects and produce data that are closely comparable to the data acquired from perfused-tube manometry under laboratory conditions.

Adult↗
PubMed2006

Relationship between fluoroscopic and manometric measures of pharyngeal constriction: the pharyngeal constriction ratio.

OBJECTIVES: The gold standard objective measure of pharyngeal strength is pharyngeal manometry. We have developed an objective fluoroscopic measure of pharyngeal strength, the pharyngeal constriction ratio (PCR). A high PCR indicates poor pharyngeal constriction. The objective of the current study was to evaluate the correlation between the PCR and peak pressures on pharyngeal manometry. METHODS: The charts of 20 consecutive individuals who underwent a dynamic fluoroscopic swallow evaluation and pharyngeal manometry at the Center for Voice and Swallowing of the University of California, Davis, were retrospectively reviewed. Information regarding patient demographics, diagnoses, PCR, and manometric pharyngeal peak pressures was abstracted. The correlation between the PCR and pharyngeal pressure was determined with the Pearson correlation coefficient. RESULTS: The mean (+/-SD) age of the cohort was 63 +/- 11 years. Fourteen of the 20 patients (70%) were male. The most common diagnoses were reflux (7 of 20) and cerebrovascular accident (4 of 20). The mean PCR was 0.26 +/- 0.31. The mean pharyngeal pressure was 83 +/- 43 mm Hg. The correlation between the PCR and pharyngeal pressure was -0.70 (p < .01). CONCLUSIONS: There was a high inverse correlation between the PCR and the peak pharyngeal pressure on manometry (-0.70). The PCR appears to be a valid objective surrogate measure of pharyngeal strength.

Aged↗
PubMed2006

Pathophysiology of pneumothorax following ultrasound-guided thoracentesis.

STUDY OBJECTIVES: Pneumothorax following ultrasound-guided thoracentesis is rare. Our goal was to explain the mechanisms of pneumothorax following ultrasound-guided thoracentesis in a setting where pleural manometry is routinely used. METHODS: We reviewed the patient records and procedure reports of 401 patients who underwent ultrasound-guided thoracentesis. When manometry was performed, pleural space elastance was determined. A model assuming dependence of the pleural space elastic properties on respiratory system elastic properties was used to isolate cases with presumed normal pleural space elastance. Elastance outside mean +/- SD x 2 of the isolated sample was considered abnormal. Four radiographic criteria of unexpandable lung were used: visceral pleural peel, lobar atelectasis, basilar pneumothorax, and pneumothorax with ipsilateral shift. RESULTS: There were 102 diagnostic thoracenteses, 192 therapeutic thoracenteses with pleural manometry, and 73 therapeutic thoracenteses without manometry. There was one pneumothorax that occurred from lung puncture and eight unintentional pneumothoraces, all of which showed radiographic evidence of unexpandable lung. Four of eight unintentional pneumothoraces had abnormal elastance; none had excessively negative pleural pressure (< -25 cm H(2)O). CONCLUSIONS: Unintentional pneumothoraces cannot be prevented by monitoring for symptoms or excessively negative pressure. These pneumothoraces were drainage related rather than due to penetrating lung trauma or external air introduction. We speculate that unintentional pneumothoraces are caused by transient, parenchymal-pleural fistulae caused by nonuniform stress distribution over the visceral pleura that develop during large-volume drainage if the lung cannot conform to the shape of the thoracic cavity in some patients with unexpandable lung. These fistulae appear to be pressure dependent, and the resulting pneumothoraces rarely require treatment. Drainage-related pneumothorax is an unavoidable complication of ultrasound-guided thoracentesis and appears to account for the vast majority of pneumothoraces occurring in a procedure service.

Biomechanical Phenomena↗