Technique Of Manometry Research Articles

Pathophysiological basis of hemorrhoidal treatment

ObjectiveTo study the underlying pathophysiology of hemorrhoidal disease and its application to the treatment modalities, particularly the operation of stapled anopexy with lateral internal sphincterotomy (LIS). Methods253 patients of piles, with or without fissure, were evaluated using the techniques of anal manometry. The establishment of control studies and the measurement of pressures in various grades of piles were the first phase and we continued the use of the measurements for all cases defining the changes, which occurred not only with the grade of piles but also in various stages of treatment and disease. ResultsThe anal pressures increase with the increase in the grade of piles and particularly high when associated with fissure. The primary treatment of piles by stapled anopexy gave a very satisfactory postoperative result. In the presence of high pressures, both resting and squeeze, particularly in presence of fissure, were indications for adding the operation of LIS. ConclusionThe technique of stapled anopexy with LIS when applicable is the methodology of choice for our patients of hemorrhoids of all grades. Use of the principle of stapled transanal rectal resection helps in the application of the technique to Grade IV piles also.

Dysphagia after antireflux fundoplication: endoscopic, radiological and manometric evaluation.

BackgroundThe transient dysphagia after fundoplication is common and most often disappears until six weeks postoperatively.AimAnalyze a group of patients who presented late and persistent dysphagia postoperatively.MethodsForty-one patients after Nissen fundoplication, 14 male and 27 female, mean age 48 year, were evaluated based on medical history, esophagogastroduodenoscopy, contrast radiographic examination and esophageal manometry. The results were compared with another 19 asymptomatic individuals.ResultsContrast radiographic examination of the esophagus revealed in six cases delayed emptying, characterizing that four patients had achalasia and two diffuse spasm of the esophagus. Esophageal manometry showed that maximal expiratory pressure of the lower sphincter ranged from 10 to 38 mmHg and mean respiratory pressure from 14 to 47 mmHg, values similar to controls. Residual pressure ranged from 5 to 31 mmHg, and 17 patients had the same values as the control group.ConclusionThe residual pressure of the lower sphincter was higher and statistically significant in patients with dysphagia compared with those operated without dysphagia. Future studies individualizing and categorizing each motility disorder, employing other techniques of manometry, and the analysis of the residual pressure may contribute to understand of persistent dysphagia in the postoperative fundoplication.

High-resolution manometry of the esophagus: more than a colorful view on esophageal motility?

Since the introduction of pressure measurement of the esophagus, there has been a stepwise improvement in manometric techniques and the recognition of esophageal manometry as a useful tool to evaluate esophageal function in clinical practice. The newest development in this field is high-resolution manometry of the esophagus. In this review, we will briefly discuss the indications for esophageal manometry and we will focus on the development of the technique of high-resolution manometry and the new insights that were obtained by using this emerging tool. We conclude that high-resolution esophageal manometry with spatiotemporal plotting of signals is a valuable research tool. Clinically, the solid-state high-resolution technique is attractive because it makes it easy to perform a high-quality manometric test. However, future studies will have to determine whether the yield of the technique is higher than that of conventional manometry.

Characteristics of oesophageal bolus transport in patients with mild oesophagitis

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. 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. 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. 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.

Photoinduced phase separation and miscibility in the condensed phase of a mixed Langmuir monolayer.

We report our studies on the mixed Langmuir monolayer of mesogenic molecules, p-(ethoxy)-p-phenylazo phenyl hexanoate (EPPH) and octyl cyano biphenyl (8CB), employing the techniques of surface manometry and Brewster angle microscopy. Our studies show that the mixed monolayer exhibits higher collapse pressures for certain mole fractions of EPPH in 8CB as compared to individual monolayers. Also, a considerable reduction in the area per molecule is seen in the mixed monolayer, indicating a condensed phase. We have also studied the photostability of the mixed monolayer at different initial surface pressures. The mixed monolayer, under alternate cycles of UV and visible illumination, exhibits changes in surface pressures. This is due to the photoinduced transformation of EPPH isomers in the mixed monolayer. Our in-situ Brewster angle microscope studies for 0.5 mole fraction of EPPH in 8CB show a phase separation in the UV and a miscible phase in the visible, at low surface pressures ( approximately 5 mN/m). At higher surface pressures ( approximately 10 mN/m), under UV illumination, we find a phase separation which does not revert to a miscible phase under visible illumination.

Impedance characteristics of normal oesophageal motor function.

To obtain detailed data about the correlation between oesophageal peristalsis and bolus transport for clinical oesophageal motility testing. 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. 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. 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.

Measurement of gastric contraction activity in dogs by means of AC biosusceptometry

The mechanical nature of gastric contraction activity (GCA) plays an important role in gastrointestinal motility. The aim of this study was to detect GCA in anaesthetized dogs, using simultaneously the techniques of AC biosusceptometry (ACB) and manometry, analysing the characteristics of frequency and amplitude (motility index) of GCA, modified by drugs such as prostigmine and N-butyl-scopolamine. The ACB method is based on a differential transformer of magnetic flux and the magnetic tracer works as a changeable external nucleus. This magnetic tracer causes a modification in the magnetic flux, which is detected by the coils. The results obtained from the ACB showed a performance comparable to the manometry in measuring the modifications in the frequency and amplitude of the GCA. We concluded that this ACB technique, non-invasive and free of ionizing radiation, is an option for evaluating GCA and can be employed in future clinical studies.

Perendoscopic manometry of the distal ileum and ileocecal junction: Technique, normal patterns, and comparison with transileostomy manometry

The technique of perendoscopic manometry was used to study the motor patterns of the ileocecal junction and distal ileum. An expert endoscopist cannulated the distal ileum of 20 unsedated subjects in 260 ± 252 (mean ± SD) seconds, causing no discomfort beyond that of an ordinary colonoscopic examination. No sphincter-like motor activity was detected at the ileocecal junction, and four distinct motility patterns were identified in the distal ileum: (1) tone variations, (2) slow phasic contractions, (3) regular rapid phasic contractions, and (4) prolonged rapid phasic contractions. Previous appendectomy and insertion of the colonoscope into the distal ileum to position the manometric catheter did not affect the manometric recordings. Perendoscopic manometry of the distal ileum was compared with transileostomy manometry in 9 subjects. Perendoscopic and transileostomy manometric recordings showed the same motor patterns except for a longer occurrence of tone variations with perendoscopic manometry. In conclusion, this study shows that perendoscopic manometry of the distal ileum and ileocecal junction is feasible; recorded motor patterns are not affected. (Gastrointest Endosc 1994;40:685-91.)

The Role of the Endoscopist in Sphincter of Oddi Manometry

The endoscopist assumes an important role in manometric evaluation of the sphincter of Oddi. Besides being adept in the technique of manometry, the endoscopist should have a firm background on the clinical features, diagnostic tests, and various therapeutic options available for patients with sphincter of Oddi dysfunction. Although the technique still remains somewhat cumbersome, it seems that sphincter of Oddi manometry will remain one of the standard techniques to study the physiology and pathophysiology of sphincter of Oddi.

Standardization of procedure of esophageal manometry

Standardization of technique of esophageal manometry, method of analysis, and system of classification of data will improve consitency of diagnosis, promote computer analysis, and facilitate communication between clinians and scientists. Esophageal manometry should include a quantitative study of LES and distal (smooth muscle) esophagus and a qualitative study of the striated part of the gullet. Three recording ports 5 cm apart and radially oriented are minimum requirements. Resting LES pressure is expressed as mean of the peaks during pull-through. Number of LES relaxations and peristaltic performance of body contractions are reported as percentage of total number of swallows. Residual LES pressure after swallowing and amplitude, duration, and progression velocity of esophageal body contraction as well as their shape are to be determined. Classification of data should be primarily descriptive, and normal values should stay outside the classification to allow for continuous adaptation.

Functional disorders of Oddi's sphincter

The sphincter of Oddi (SO), located at a crucial anatomical site, continues to present diagnostic and therapeutic problems. A combination of the techniques of endoscopic retrograde cholangiopancreatography and manometry has permitted direct assessment of the SO function, and has opened up a new era in the study of this structure.

Biliary Manometry

The purpose of the paper is to introduce the reader to sphincter of Oddi dysfunction and the technique of biliary manometry. This paper will review sphincter of Oddi anatomy and physiology, abnormalities, patient selection, equipment and technique used in testing, interpretation and scoring.

The measurement of resting and stimulated lower esophageal sphincter pressure using the rapid pull-through technique of esophageal manometry.

The value of the rapid pull-through technique of esophageal manometry for the measurement of lower esophageal sphincter pressure (LESP), in the diagnosis of symptomatic gastroesophageal reflux, has been investigated. The technique provides reproducible measurements of LESP in individual subjects during the period of a single recording study. It does not discriminate between normal subjects and patients with symptomatic gastroesophageal reflux in measurements of basal LESP or in measurements of the LESP response to abdominal compression and the cholinergic drugs bethanechol and metoclopramide. The findings of the study suggest that the rapid pull-through technique will not prove helpful in the diagnosis of symptomatic reflux.

Effect of cigarette smoking on the lower oesophageal sphincter.

Observations on the effect of smoking on lower oesophageal sphincter pressure (LOSP) are based on station pull-through techniques of eosophageal manometry and recent studies have suggested that these techniques are inaccurate. Reproducible measurements of LOSP may be achieved with a rapid pull-through (RPT) method of manometry. This method was used to determine the effect of cigarette smoking on LOSP in 10 asymptomatic volunteers and in a group of 10 patients with symptoms of gastro-oesophageal reflux. Basal LOSP measurements in the two groups were not significantly different but LOSP was reduced by 19% in asymptomatic subjects (p less than 0-01) and by 21% in symptomatic patients (p less than 0-02) during cigarette smoking. The results suggest that smoking should be avoided in the clinical management of gastro-oesophageal reflux.

Esophageal determinants of alaryngeal speech.

Techniques of intraluminal manometry were applied to the study of the esophagus and its sphincters in 20 patients following laryngectomy and in 20 control subjects. Resting cricopharyngeal sphincter pressure was found to be significantly lower in laryngectomees with fluent esophageal speech (13 mm Hg) than in those unable to develop esophageal speech after laryngectomy (30 mm Hg) and controls (39 mm Hg). The function of the lower esophageal sphincter and the body of the esophagus was similar in all groups. Whereas the cricopharyngeal sphincter normally prevents entry of unwanted air into the digestive tract, following laryngectomy this function may be detrimental and hinder the development of useful esophageal speech.

NONOPERATIVE DIAGNOSIS OF HIRSCHSPRUNG'S DISEASE IN NEONATES

Twenty-eight neonates who presented with symptoms suggestive of Hirschsprung's disease have been studied by the technique of anorectal manometry using newly developed, miniaturized instrumentation. Eight infants have demonstrated the typical lack of relaxation of the smoothmuscle internal anorectal sphincter characteristic of Hirschsprung's disease. Aganglionosis has been demonstrated histologically in all eight, including two prematures; the remainder have not developed any sign of Hirschsprung's disease. This miniaturized technique of anorectal manometry may provide an accurate, simple, and atraumatic method for identifying Hirschsprung's disease in the newborn infant.

CO2 Fixation in Opuntia Roots

Nonautotrophic CO(2) metabolism in Opuntia echinocarpa roots was studied with techniques of manometry and radiometry. The roots were grown in a one-quarter strength nutrient solution for several days; the distal 2 cm was used for physiological studies. The roots assimilated significant quantities of (14)CO(2) and appeared to show a crassulacean-type acid metabolism with respect to quality and quantity. Most of the (14)C activity was associated with the distal portion of the elongating root indicating correlation with metabolic activity. The (14)CO(2) assimilation was comparable to a crassulacean leaf succulent, but 3 times greater than that found for stem tissue of the same Opuntia species.The rates of O(2) and CO(2) exchange and estimated CO(2) fixation were 180, 123, and 57 mul/g per hour. A respiratory quotient of 0.66 was found.The products of (14)CO(2) fixation were similar in most respects to reported experiments with leaf succulents. Equilibration of the predominant malic acid with isocitric, succinic, and fumaric acids was not evident. The latter observation was interpreted as metabolic isolation of the fixation products rather than poor citric acid cycle activity.A rapid turnover of the fixed (14)CO(2) was measured by following decarboxlyation kinetics and by product analysis after a postincubation period. The first order rate constant for the steady state release was 4.4 x 10(-3) min(-1) with a half-time of 157.5 minutes. Amino acids decayed at a more rapid rate than organic acids.

Studies on intraocular pressure. I. A technique for polyethylene tube implantation into the anterior chamber of the rabbit.

It is generally accepted that the intraocular pressure is determined directly by the rate of formation of aqueous humor, the resistance to outflow, and the recipient venous back pressure. The relationship during steady state conditions has been expressed in the following equation: Equation 1 ( F is the rate of flow of aqueous humor in the steady state, Po is the intraocular pressure, Pv is the recipient venous back pressure, and R is the resistance to outflow.) A sustained alteration of the intraocular pressure may result from a sustained change in the rate of formation of aqueous humor, in the resistance to outflow, or in the recipient venous back pressure. To study physiological and pharmacological effects upon the intraocular pressure ideally requires a technique of manometry which avoids irritation of the eye (and attendant breakdown of the blood aqueous barrier) and permits measurement of the intraocular pressure not only