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On the respiratory quotient (RQ) of termites (Insecta: Isoptera).

The respiratory quotient (RQ) at 28 degrees C was determined by Warburg manometry in 23 species of termites from the Mbalmayo Forest Reserve (Cameroon) and three sub-tropical species cultured under laboratory conditions in the U.K. or freshly collected in Australia. The data are tabulated with other recently reported RQs (determined by manometry or GC) and with measured CH(4) emission rates to provide a survey of 29 species covering both lower and higher termites in all major trophic (functional) categories. In all species, except the wood-feeding Coptotermes acinaciformis and the soil-feeding Cubitermes fungifaber, the observed mean values (with manometry corrected for known fluxes of H(2) and CH(4)) were at or well above 1.00. Soil-feeding forms (except C. fungifaber) generally showed a high apparent RQ (not corrected for H(2)), with nine species (out of 13) above 1.20 and six species above 1.30. Well-replicated laboratory experiments with Reticulitermes lucifugus showed that there was a tendency for RQ to fall with time over a 4-h incubation, although remaining greater than 1.00.The observed RQs are consistent with carbohydrate being the principal substrate supporting respiration in all trophic and taxonomic categories, with little or no contribution from the degradation of lignin or other polyaromatic materials. However, in many species (especially soil-feeders), the observed RQ is greater than that expected from known fluxes of O(2), CO(2) and CH(4) on the assumption that carbohydrate is the respiratory substrate. This presupposes that there is a large hydrogen sink (additional to CH(4) production), possibly the emission of H(2) gas, and/or the existence of unresolved digestive mechanisms or electron routings. Uncertainties in the use of manometry with termites are discussed.

Journal Article↗

Intraocular pressure measurement in mice: a comparison between Goldmann and rebound tonometry.

PURPOSE: The development of mouse models of glaucoma requires methods to accurately measure the intraocular pressure (IOP) in this species. The aim of this study was to compare the accuracy of IOP measurements in mice between modified Goldmann and rebound tonometers. METHODS: IOP was measured either with a modified Goldmann or a rebound tonometer while simultaneously measuring the IOP using invasive manometry in enucleated eyes and in vivo. The level of IOP was controlled hydrostatically. The agreement and correlation between the IOP determined by invasive manometry and by either noninvasive method was evaluated. In addition, the IOP was determined by both noninvasive methods in a cohort of mice with laser-induced ocular hypertension (OHT), and the agreement and correlation between the two tonometry methods were evaluated. RESULTS: Measured IOP by either noninvasive tonometer correlated well with those recorded simultaneously by invasive manometry (r=0.98 for rebound and r=0.94 for Goldmann). In mice with OHT, the IOP correlation between rebound and modified Goldmann was moderate (r=0.71); the IOP measured by modified Goldmann tonometry was consistently higher than that by rebound by approximately 5 mmHg. However, the relative per cent increases in IOP were similar between the two methods. CONCLUSION: Both noninvasive methods of IOP measurements in mice are suitable to detect changes in IOP although rebound tonometry correlated better with the invasive manometry readings. The results suggest that the relative, rather than absolute, IOP offers a more reliable means of correlating findings from studies using different tonometers.

Anesthetics, Inhalation↗

[Persistent intestinal motility disorder after transient intestinal nematode infection in rats].

OBJECTIVE: To investigate the intestinal motor function (distal colonic manometry and gastrointestinal transit time) after T. spiralis infection in rats. METHODS: Sprague-Dawley rats were infected by administering T. spiralis larvae. Rats were studied on 14, 42, and 56 days post-infection (PI). Age matched non-infected animals served as controls. All rats underwent colonic manometry and gastrointestinal transit time test. RESULTS: (1) The small intestinal inflammation became the most severe on day 14 PI, and returned to normal on day 56. (2) The distal colonic manometry showed significantly active motility in acute infected rats either at rest or upon balloon stimulating. (3) Rat colonic motility parameters were not different from those of the control rats either at rest or upon small volume (1mL) balloon stimulating on day 42 and day 56 PI. But when the balloon was inflated with 2 mL of air, the colonic activity increased significantly compared with that of the control. (4) Gastrointestinal transit time was slower in acute and PI rats than that in the control group. CONCLUSION: Intestinal motility function was abnormal persistently after transient intestinal nematode infection in rats either in distal colonic manometry or in gastrointestinal transit time.

Animals↗

[Esophageal motor disorders in patients with dysphagia].

Endoscopy and radiology are usually suggested as the first line investigations in patients with dysphagia. Esophageal manometry is indicated if the above studies are unfruitful. Our aim was to evaluate the role of manometry in diagnosing motor disorders of the esophagus in patients with non-organic dysphagia. We retrospectively evaluated the results of seven years' experience with esophageal manometry performed in 114 patients with difficulty in swallowing not due to esophageal structural lesions or reflux esophagitis, both escluded by endoscopic and/or radiologic studies prior to manometric investigation. A variety of nonspecific esophageal motor disorders were the most common (32%) manometric abnormalities seen in patients with dysphagia. Achalasia was common (23%) too, whereas diffuse esophageal spasm (8%), nutcracker esophagus (6%) and hypertensive LES (1%) accounted for a few motility disorders associated with dysphagia. Low LES pressure was found in 3% of the patients, suggesting gastroesophageal reflux as the cause of their difficulty in swallowing. The study confirms the role of esophageal manometry in diagnosing the cause of a swallowing disorder, identified in 83 out of 114 patients (73%). Achalasia and nonspecific esophageal motor disorders accounted for more than 50% of the motility disorders in patients with dysphagia.

English Abstract↗

[Criteria of the evaluation of tubal function in patients with secretory otitis media].

Tubular function was assessed in patients with secretory otitis media before and after surgery (an original version of anterior tympanostomy). Preoperative tubular function was measured by impedance tympanometry. After tympanostoma was placed the acoustic tube was subjected to direct manometry. Perioperative measurements were made for tube patency for liquid (hydrocortisone). The tests of pressure adjustment implied routine spirit manometry and updated impedancemetry. Technical specifications of modern impedance meters met the criteria of clinical fitness for post-tympanostomy patients. The criteria of assessment and correlating quantitative values of the draining and ventilation capacities of the acoustic tube were determined. This was the basis for an original classification of tubular function grades. It was established that in secretory otitis media drainage dysfunction of the acoustic tube was registered in two thirds of the patients (66%), ventilatory dysfunction occurred in 100% of patients. There was a correlation between these functions. This fact was used for design of a simple screening variant of ear manometry i.e. registration of the threshold of acoustic tube passive opening. Screening manometry is convenient for following up postoperative changes in the tubular function and defining duration of carrying tympanostomy in secretory otitis.

Acoustic Impedance Tests↗

Assessment of clinical severity and investigation of uncomplicated gastroesophageal reflux disease and noncardiac angina-like chest pain.

Heartburn, suggesting gastroesophageal reflux, is common. Epidemiological studies have shown that 36% to 44% of adults experience heartburn at least once a month, 14% weekly and 7% once a day. Heartburn and regurgitations are the typical symptoms of gastroesophageal reflux disease (GERD). When present as predominant symptoms, they are quite specific but not very sensitive. Clinical severity of GERD does not predict the severity of the underlying condition. The diagnostic approach to patients with GERD depends on the clinical presentation and the question to be answered -Is abnormal reflux present? Is there mucosal injury? Are symptoms due to reflux? Several techniques such as barium swallow, endoscopy, ambulatory pH monitoring, esophageal manometry and 24 h pH/motility can be used to answer those questions. Barium swallow is not much help in diagnosing reflux esophagitis because reflux can occur in more than 25% of asymptomatic patients. It is most useful in demonstrating structural abnormalities such as strictures and hiatal hernia. The importance of hiatal hernia in the pathogenesis of GERD has been controversial. Recent studies suggest that GERD patients with hiatal hernia present with greater extent of reflux and more severe esophagitis. Endoscopy is the best diagnostic study for mucosal evaluation. Ambulatory 24 h pH monitoring is indicated for patients with atypical symptoms of reflux such as chest pain or pulmonary symptoms, or those who do no respond to therapy. The evaluation of duodenogastroesophageal reflux or alkaline reflux can be measured, but the clinical importance of this test remains controversial. Esophageal manometry allows measurement of the lower esophageal sphincter pressure (LES) and the evaluation of esophageal peristalsis. There is a lack of correlation between LES and reflux esophagitis. The role of peristaltic dysfunction in GERD is unclear, but the high percentage of abnormal contractions suggests a more severe form of GERD. Esophageal motility study can document the presence of effective esophageal peristalsis in patients before antireflux surgery. Twenty-four hour pH/motility is not yet available widely. It is useful in patients who have several daily attacks. There is a correlation with acid reflux in approximately 40% of events. Investigation of noncardiac angina-like chest pain is best achieved by standard esophageal manometry combined with provocative testing. Most laboratories performing these studies use acid perfusion and pharmacostimulation with either bethanechol or edrophonium to reproduce the patient's chest pain during esophageal manometry. Esophageal balloon distension is considered to give the highest yield as a provocative test in patients with angina-like chest pain. It is believed that abnormal esophageal nociception is not simply related to underlying motor dysfunction but also to the presence of a visceral sensory abnormality.

Chest Pain↗

"Minified" Goldmann applanating prism for tonometry in monkeys and humans.

The tip diameter of the standard Goldmann applanating prism was reduced from 7.0 mm to 4.0 or 4.5 mm, but the endpoint of intraocular pressure measurement-applanation of a circle of cornea having a diameter of 3.06 mm-was not changed. The "minified" tonometers exhibited standard mechanical calibration characteristics in three standard configurations. The 4.5-mm tonometer was calibrated for cynomolgus monkey eyes in vivo by open and closed stopcock manometry. By open stopcock manometry, between pressures of 4 and 70 mm Hg, IOP(tonometer) = 1.01 IOP(manometer)-0.72, with very little scatter or curvature. During closed stopcock manometry, between pressures of 5 and 55 mm Hg, IOP(tonometer)=1.07 IOP(manometer)-1.32, again with very little scatter or curvature. The tonometer elevated manometric IOP by an average of about 7.5%; the percentage pressure elevation decreased slightly as pressure increased. The 4.0-mm tonometer was calibrated against a standard tonometer in living human eyes. Over the pressure range from 0 to 75 mm Hg, IOP(minitonometer)=0.98 IOP(standard tonometer)+ 0.82, with very little scatter or curvature. Similar comparison of two standard tonometers showed a virtually identical relationship and scatter. We conclude that minified Goldmann tonometers provide accurate and reprodible measurements of IOP in cynomolgus monkey and human eyes.

Animals↗

Heller myotomy via minimal-access surgery. An evaluation of antireflux procedures.

BACKGROUND: Myotomy offers the best known cure for achalasia and can now be performed via minimal-access surgery. OBJECTIVE: To examine the questions of surgical approach for Heller myotomy and choice of fundoplication in the setting of minimal-access surgery. DESIGN: Thirty-nine patients with achalasia underwent Heller myotomy via either thoracoscopy or laparoscopy, with either a Dor or a Toupet fundoplication (Heller-Dor and Heller-Toupet procedures, respectively). Manometry, pH analysis, and clinical course were evaluated 3 to 9 months after surgery. Clinical course was reviewed at 11 to 46 months after surgery. SETTING: University hospitals. PATIENTS: Diagnosis of achalasia was based on history and physical examination, contrast radiography, stationary manometry, and 24-hour pH analysis. All patients participated in the clinical evaluations. Twenty-two patients consented to postoperative manometry and 18 to postoperative pH analysis. INTERVENTIONS: Thoracoscopic Heller-Dor procedures (n = 4), laparoscopic Heller-Dor procedures (n = 6), and laparoscopic Heller-Toupet procedures (n = 29). MAIN OUTCOME MEASURES: Hospital stay and recovery time were compared between thoracoscopic and laparoscopic groups. Decrease in the lower esophageal sphincter pressure, 24-hour esophageal pH, postoperative symptoms, and overall satisfaction were compared between the Dor and Toupet groups. RESULTS: Only 1 patient was dissatisfied with the experience. Patients undergoing thoracoscopy had a longer convalescence. No postoperative reflux was identified, although some patients complained of heartburnlike symptoms. Dysphagia and heartburn were more prevalent among patients with Dor fundoplication than among patients with Toupet fundoplication. CONCLUSIONS: Minimal-access myotomy is an excellent intervention for achalasia. The preferred approach is via laparoscopy. Our experience has led us to favor the Toupet over the Dor fundoplication after myotomy.

Cardia↗

Examination of swallowing after total laryngectomy using manofluorography.

Investigation of postlaryngectomy dysphagia is usually limited to the standard barium swallow. Manofluorography (mano, manometry; fluoro, videofluoroscopy; graphy, picture) is a new technique that permits analysis of simultaneous manometry and videofluoroscopy of deglutition. Manofluorography provides more detailed analysis of the swallowing dynamics during the pharyngeal stage of deglutition than either barium studies or manometry used alone. This study uses manofluorography to examine swallowing in two patient groups, total laryngectomees and total laryngectomees with tongue impairment, to analyze the role of various anatomic components in the swallowing process. Pharyngeal transit times were prolonged in both patient groups studied, with the tongue impairment group exhibiting the longest times. The postlaryngectomy pharynx offered greater resistance to bolus flow. The laryngectomy patients compensated by using increased lingual propulsion, whereas the patients with tongue impairment and total laryngectomy could not. This emphasizes the importance of the tongue in bolus propulsion in the pharynx. Other postoperative changes in swallowing are discussed.

Deglutition Disorders↗

Laparoscopic esophagomyotomy for achalasia.

Results of an ongoing clinical study treating achalasia patients with a transabdominal laparoscopic Heller myotomy and Toupet partial fundoplication are presented. Twelve patients underwent surgery between January 1992 and October 1993. All patients had barium esophagograms, preoperative endoscopy, esophageal manometry, 24-h pH studies, and extensive GI history preoperatively. Surgical complications included two perforations of the mucosa at the gastroesophageal junction repaired laparoscopically. There were no surgical mortalities and the average hospital stay was 39 h. Postoperatively all patients at follow-up had a repeat GI history, esophagogastroscopy, 24-h pH testing, and esophageal manometry. This follow-up showed good-to-excellent relief of dysphagia in all 12 patients with one patient complaining of heartburn documented to be from reflux postoperatively. Manometry showed a mean decrease in the lower esophageal sphincter pressure from 33.4 mmHg preoperatively to 19.3 mmHg postoperatively; 24-hour pH testing showed no significant reflux in the nine patients who had Heller myotomy plus a Toupet fundoplication. However, two of three patients who had Heller myotomy alone demonstrated abnormal 24-h pH testing. One of these patients was symptomatic and was found to have mild esophagitis by biopsy on postoperative endoscopy. These good results have persisted for mean follow-up of 16 months.

Adult↗

Oesophageal motility disorders in patients with psychiatric disease.

Clinical and experimental observations indicate that the motility of the oesophagus may be affected by emotional stimuli. The aim of this study was to evaluate the incidence of oesophageal contractility impairment in patients suffering from a psychiatric disorder. Fifty-one patients admitted to the psychiatric department were submitted to an oesophageal transit study by means of krypton-81m. All patients with an abnormal oesophageal transit underwent manometry and endoscopy. The level of depression and anxiety was evaluated by the treating psychiatrist, using the Hamilton Depression and Anxiety Rating Scales. The oesophageal transit was abnormal in 13 patients. Two of these 13 patients refused manometric investigation. In ten of the 11 remaining patients, the manometry revealed functional motor abnormalities. Endoscopy, performed in all these ten patients, was normal. In conclusion, a high percentage of oesophageal contractility disturbances was found in psychiatric patients complaining of anxiety and/or depression. These abnormalities were detected by scintigraphy as well as by manometry. Owing to the normal endoscopic findings, these contraction abnormalities are likely to reflect a functional motor impairment.

Anxiety↗

Nonoperative measurement of pancreatic and common bile duct pressures with a microtransducer catheter and effects of duodenoscopic sphincterotomy.

Duodenoscopic manometry of the pancreatic duct (PD) and common bile duct (CBD) using a microtransducer catheter was distinct advantages over infusion manometry, giving absolute values of in situ intraluminal pressure. Microtransducer manometry was performed without medication in 49 patients with gallbladder stones (10), common bile duct stones (24), hepatic duct stones (6) and common bile duct dilatation (9), and was successful in 42 (86%) for PD and 36 (73%) for CBD. Ductal pressures showed respiration-synchronized biphasic variations superimposed by the arterial pulsation effect. Considerable postural change of the pressure values suggested that the recording posture should be predetermined. The PD-to-duodenum pressure gradient was higher than the CBD-to-duodenum gradient in most cases. Both were lower than those obtained previously by infusion methods. No significant differences were found in pressure profiles of the four disease groups. Endoscopic sphincterotomy significantly reduced not only CBD pressure but also PD pressure.

Adult↗

Esophageal motility in progressive systemic sclerosis (PSS). Comparison of cine-radiographic and manometric evaluation.

The evaluation of structural and functional abnormalities of the esophagus by manometry (using perfused tubes) and cine-radiography were compared in 25 subjects with progressive systemic sclerosis (PSS). Motility by both procedures was definitely abnormal in 19 subjects and normal in 3. The remaining 3 subjects had abnormal motility on manometry, coupled with cine-esophagrams interpreted as normal. Many structural abnormalities not demonstrated by manometry were identified by cine-radiography. Therefore, the initial diagnostic examination of motility in PSS should be the cine-esophagram.

Cineradiography↗

Effects of upper dorsal sympathectomy on esophageal motility in humans.

To evaluate the role of the sympathetic nervous system in modulating esophageal motility, esophageal manometry was performed on two groups of patients who underwent upper dorsal sympathectomy for relief of palmar hyperhydrosis. In six patients sympathectomy was done by the supraclavicular approach, with removal of T2 and T3 ganglia. Manometry was performed before the operation and three weeks after it. In seven other patients sympathectomy was done by the axillary approach, with removal of T2-T4 ganglia. Manometry in this group was performed 28.4 +/- 22.4 months after the operation. Fifteen individuals with an intact sympathetic system served as controls. Manometric parameters evaluated were esophageal contraction amplitude and duration and lower esophageal sphincter pressure. The difference between the results obtained in the pre- and postoperative periods in the first group was not statistically significant. The differences between the two patient groups and between the patient groups and the control group were not statistically significant either. We conclude that upper dorsal sympathectomy does not affect esophageal motility in man.

Adolescent↗

Effect of catheter diameter on resting pressures in anal fissure patients.

PURPOSE: Controversy exists as to whether fissure patients have elevated resting pressures when compared with control patients. The diameter of manometry catheters used in past studies varies widely (1.5-25 mm) and may have contributed to differences observed in resting pressures. A prospective study was undertaken to determine the influence of manometry catheter diameter on maximum resting pressure in patients with idiopathic chronic anal fissures. METHODS: A total of 28 fissure patients and 28 control patients had manometry performed with both a 1.8-mm and a 4.8-mm (external diameter) water-perfused catheter. RESULTS: Mean maximum resting pressure (RP) for fissure patients as measured with the 1.8-mm catheter was 86 (range, 65-115) mmHg and 83 (range, 47-117) mmHg with the 4.8-mm catheter (P = 0.65). Mean maximum RP for control patients with the 1.8-mm catheter was 70 (range, 30-108) mmHg and 72 (range, 35-109) mmHg with the 4.8-mm catheter (P = 0.07). When fissure and control patients were compared, a significantly higher mean RP was observed in the fissure group for both the 1.8-mm catheter (86 vs. 70 mmHg, respectively; P = 0.01) and the 4.8-mm catheter (83 vs. 72 mmHg, respectively; P = 0.03). There was no significant difference in length of the high-pressure zone within each group or when the fissure group and controls were compared, regardless of catheter used. For both groups of patients, there was a significantly higher incidence of ultraslow waves (USWs) observed with the 4.8-mm catheter when compared with the 1.8-mm catheter. The USW frequency was not significantly different when fissure and control groups were compared with either catheter type. CONCLUSIONS: Catheter size did not influence measured maximum RP in fissure patients. The maximum RP was significantly greater for fissure patients overall when compared with the control group, regardless of catheter used. There was an increased frequency of USWs noted with the larger catheter size in all patients; however, these USWs only became apparent when catheter was left at each station until a true baseline RP was obtained.

Adult↗

Selection criteria for anterior rectal wall repair in symptomatic rectocele and anterior rectal wall prolapse.

PURPOSE: This study was undertaken to determine the outcome and changes produced by an endorectal anterior wall repair in objective functional parameters using anorectal manometry and defecography and to asses their usefulness in the selection of patients for the operation. METHODS: Between 1986 and 1990, we performed a prospective study of 76 consecutive patients with symptomatic rectocele and/or an anterior rectal wall prolapse. All patients were studied prospectively according to a fixed protocol. Standard questionnaire, defecation diary, clinical examination, defecography, and anal manometry were performed preoperatively and three to four months postoperatively. RESULTS: Three months postoperatively, 38 patients (50 percent) had no complaints at all (excellent result), 32 (42 percent) had only a minor complaint (good result), and in 6 patients (8 percent) the complaints were essentially unchanged (unsatisfactory result). After one year, similar figures were obtained. The postoperative mean stool frequency in all patients after three months was significantly increased (P < 0.05) but not after one year. Postoperative defecographies showed a complete absence or significant diminution of the rectocele at three months and were significantly correlated with relief of symptoms. An inverse correlation was found between improvement in incontinence grade after operation and (larger) preoperative volume at which urge to defecate was elicited, making it a good predictor of improvement in incontinence by the operation. CONCLUSIONS: The anterior rectal wall repair positively influences rectal sensation in patients with incontinence and/or obstructed defecation caused by a rectocele and/or an anterior rectal wall prolapse. Anorectal manometry was useful in studying the beneficial physiologic effects of the endorectal repair. In patients with no previous pelvic surgery, a large urge to defecate volume is a good predictor of a good clinical outcome.

Adult↗

Anal sphincter repair for obstetric injury: manometric evaluation of functional results.

Anal manometry before and after surgical repair on a homogeneous group of patients with anterior sphincter defect caused by obstetric injury defined the parameters affected by the repair to achieve anal continence. Between November 1985 and April 1989, 28 patients who underwent anterior anal sphincter reconstruction were studied using anal manometry and were graded for continence. Anal function was improved for 27 of 28 patients (96 percent) relative to their preoperative symptoms, and total control of solid and liquid stools was restored in 21 patients (75 percent). Anal manometry demonstrated that complete control of continence could be achieved if anal sphincter length, resting pressure, and squeeze pressure were restored to normal. Our results showed that sphincter length was improved in 20 patients (71 percent), resting pressure in 16 patients (57 percent), and squeeze pressure in 22 patients (79 percent). The most important factor in achieving normal function of the anal sphincter is restoration of a normal squeeze pressure.

Adult↗

Manometric assessment of patients with obstetric injuries and fecal incontinence.

Anorectal manometry was performed with a multilumen continuously perfused catheter in nine women with fecal incontinence after vaginal delivery. All patients had a third-degree or fourth-degree perineal laceration. The median age was 30 (range, 24 to 38) years. Anal manometry revealed low resting and squeeze pressures with a mean pressure of 28.7 +/- 5.3 mm Hg (normal, 60 to 80 mm Hg) and 42.5 +/- 5.9 mm Hg (normal, 100 to 150 mm Hg), respectively. Seven of nine patients had specific anterior quadrant defects demonstrated by cross-sectional analysis of the sphincter. In addition, five patients had evidence of global defects of the sphincter or relatively low pressures in other portions of the sphincter. Follow-up manometric data were obtained in four patients after reconstruction of the sphincter and demonstrated a mean improvement of resting and squeeze pressures of 5.1 mm Hg and 16.0 mm Hg, respectively. Although specific anterior defects may be expected with the history of obstetric trauma, the presence of global defects of the sphincter was unexpected and may support the role of injury to the innervation of the musculature of the pelvic floor as a contributing cause of fecal incontinence after childbirth. Anal manometry provides a quantitative assessment of sphincter function and dysfunction and is an important part of the preoperative assessment of patients with fecal incontinence from obstetric injuries.

Adult↗