Technical aspects,indications and results of 24-hour esophageal pH-monitoring

Twenty four-hour esophageal pH-monitoring is considered as the gold standard for the diagnosis of gastroesophageal reflux disease. The aims of this review are to describe technical aspects, interprative modalities and normal values of esophageal pH data to determine the indications of esophageal pH-monitoring with special interest of the most established indications.     

Findings of 24-hour esophageal pH monitoring in patients with respiratory and otorhinolaryngologic manifestations of gastroesophageal reflux disease

We conducted a retrospective study on 24-hour esophageal pH monitoring performed to patients with non allergic asthma, chronic cough and chronic pharyngitis or laryngitis. We studied 168 patients. On 24-hour esophageal pH monitoring, gastroesophageal reflux was detected in 67 cases (40%), more frequently in patients with chronic cough and asthma than in patients with chronic pharyngitis or laryngitis. A statistically significant increase in all the pHmetric parameters, except for the number of reflux episodes, was found in asthmatic patients compared to patients with chronic pharyngitis or laryngitis. Comparison of the pHmetric parameters in patients with gastroesophageal reflux disease revealed that the number of reflux episodes of morethan five minutes and the duration of longest reflux episodes were higher in asthmatic patients than in patients with chronic cough. Gastroesophageal reflux disease is more frequent in asthma and chronic cough than in chronic pharyngitis or laryngitis. Reflux episodes in chronic cough are shorter than these in asthma. This difference should explain the different severity between the two situations.     

24-hour pH monitoring in the treatment of gastroesophageal reflux

The 24 hour pH monitoring is superior to other methods in assessing chemical activity and quantitative characteristics of gastroesophageal reflux (GER). This technique supported by the pull-through esophageal manometry, reveals and classifies the patients for either medical or surgical treatment. The comparison of the diagrams recorded before and after surgical repair, is a reliable guide in evaluating the efficacy of the anti-reflux procedure.     

Intestinal transplantation: indications, results and strategy

The term 'intestinal failure' is now often used to describe gastrointestinal function insufficient to satisfy body nutrient and fluid requirements. The first recognized condition of intestinal failure was short bowel syndrome. Severe motility disorders such as chronic intestinal pseudo-obstruction syndrome in children as well as congenital intractable intestinal mucosa disorders are also forms of intestinal failure, because no curative treatment for these diseases is yet available. Parenteral nutrition and home parenteral nutrition remain the mainstay of therapy for intestinal failure, whether it is partial or total, provisional or permanent. However, some patients develop complications while receiving standard therapy for intestinal failure and are considered for intestinal transplantation. Indeed, recent advances in immunosuppressive treatment and the better monitoring and control of acute rejection have brought intestinal transplantation into the realm of standard treatment for intestinal failure. Although it has been used in humans for the past two decades, this procedure has had a slow learning curve. According to the current results, this challenging procedure may be performed in children or adults, only under certain conditions.     

Percutaneous vertebroplasty: methods,indications, results

Percutaneous vertebroplasty (PVP) is a radiologically guided therapeutic procedure, which consists of percutaneous injection of a liquid polymer (bone cement) into a destroyed vertebral body. PVP was invented in 1984, in France, first for treating vertebral body haemangioma. Since its introduction the indications have been expanded progressively and today PVP is indicated mainly for treatment of vertebral haemangioma, malignant vertebral tumor and osteoporotic vertebral compression fracture. The unique advantage of this technique is that besides the stabilization of the vertebral body--and partly in connection with this--it affords prompt and lasting pain relief. Based on published data the success rate of the procedure is 80-100% with a complication rate of 1-10%. Thus, PVP is a valuable minimally invasive tool, providing immediate pain relief and early mobility in carefully selected patients. However, further work is needed to define the benefits of PVP compared to the standard treatment. The purpose of this paper is to demonstrate the technique by analyzing scientific reports published to date and summarizing the first author's own experience gained at the University Hospital of Geneva, Department of Neuroradiology, Switzerland.     

24小时食管pH监测电极的三种定位方法比较及其影响因素

目的 探讨食管测压法(M)、pH梯度定位法(P)及X线透视定位法(X)定位24 h食管pH监测电极的差别及其影响因素.方法 50例患者经M测定下食管括约肌距鼻外缘的长度,记录P定位的pH电极位置距鼻外缘的长度,在X线透视下观察电极位置与胃底贲门交界的距离.以差值绝对值≤2 cm为符合标准,分析三种定位方法的差异,并分析影响差别的相关因素.结果 经M、P、X定位的电极定位点距鼻外缘的长度分别为(37.9±2.9)、(40.8±4.4)和(40.7±5.3)cm,P与M以及X与M比较差异均有统计学意义(P＜0.01).P与M符合率62.0%(31/50);P与X符合率84.0%(42/50);X与M符合率58.0%(29/50).P较M偏向胃侧(2.9±3.9)cm.影响P与M差别的主要因素为年龄、身高和下食管括约肌的长度(P＜0.01或＜0.05).影响X和M的因素为身高和下食管括约肌长度(P＜0.05或＜0.01).结论 与M比较,P确定的位置倾向于偏向胃侧,在身材较高、下食管括约肌长度较长的受试者中易出现差异.X的变异不易确定,亦受身高的影响.     

Role of 24-hour monitoring in assessing blood pressure changes in polycystic ovary syndrome

INTRODUCTION: Polycystic ovary syndrome (PCOS) is associated with higher risk of developing cardiovascular diseases including higher incidence of hypertension later in life. Absence of circadian blood pressure fluctuations is considered as a marker of pre-hypertensive state and correlates highly with target organ damage in hypertension. AIM: Characterization of the circadian blood pressure rhythms as well as comparison of the results from the clinical measurements and Holter-monitored blood pressure data in women with PCOS. MATERIALS AND METHODS: The study comprised 35 women (mean age 22.6 +/- 5.9 years, mean BMI 31.4 +/- 7.1 kg/m2) with proven diagnosis. 24-hour ambulatory Holter-monitoring using Oscar device (Sun Tech Medical Instruments, USA) was performed in parallel with clinical measurements of blood pressure. RESULTS: There were 25.7% of the subjects diagnosed with hypertension according to the criteria of ambulatory monitoring observing discrepancy with the criteria for normal clinically measured blood pressure in 7 cases (20%). The "white coat" effect was observed in 11.4%. Physiological nocturnal drop in the systolic pressure was not observed in 51.4% of the patients and in the diastolic pressure - in 22.9% of the cases. CONCLUSIONS: The results confirm the advantages and the importance of the 24-hour monitoring as a diagnostic and predictive method for assessment of blood pressure alterations even in the absence of overt hypertension. PCOS is characterized by higher incidence of unstable blood pressure that is an additional risk factor for further development of cardiovascular diseases in this relatively young age group.     

动态血压监测预测妊娠期高血压疾病的价值

目的 了解动态血压监测对妊娠期高血压疾病的预测价值.方法 对350例孕妇在21～27孕周进行24小时动态血压监测,分析妊娠结局与动态血压监测指标的关系.结果 323例孕妇中有28例发生妊娠期高血压疾病,为妊娠期高血压疾病组,其余295例患者为对照组.妊娠期高血压疾病组患者与对照组比较,24小时血压平均值(收缩压t=13.69、舒张压t=13.58、平均动脉压t=13.80),日均血压值(收缩压t=13.12、舒张压t=9.32)及夜均血压值(收缩压t=10.27、舒张压t=13.56)均有极显著性差异(P＜0.01).以24小时平均舒张压等于8.9kPa为切点预测妊娠期高血压疾病敏感性为85.7%;特异性为94.6%;以24小时平均动脉压等于11.2kPa为切点预测妊娠期高血压疾病敏感性为89.3%;特异性为93.9%.结论 在孕中期,利用动态血压监测的24小时平均舒张压和24小时平均动脉压均可较好的预测妊娠期高血压疾病.     

Videotape dietary assessment: validity, reliability, and comparison of results with 24-hour dietary recalls from elderly women in a retirement home

The validity and reliability of a videotape method for quantifying food intake were tested, and results of the method were compared with results obtained from 24-hour dietary recalls. Participants were 37 elderly Catholic nuns (aged 81.8 +/- 4.1 years) who were ambulatory and living in a retirement home. The videotape method of dietary assessment consisted of videotaping food trays of each participant for three meals during 1 day and the subsequent identification of food types and amounts from the videotapes. Estimates of food amounts obtained were used in the calculation of energy and nutrient intake. Correlation coefficients between values for energy and 14 nutrients obtained by direct measurement of food and estimates from the videotape method were high (r = 0.86 to 1.0). Compared with measured food amounts, the videotape method underestimated food quantities by an average of 6%. The reliability test indicated that mean nutrient values obtained from the videotape method by two research assistants differed by an average of 3.7% and were highly correlated (r = 0.84 to 0.98). Comparison of the videotape method with 24-hour dietary recalls revealed differences between mean values that were greater than 10% for energy and 6 of the 14 nutrients and correlations that ranged from 0.09 to 0.82. These results suggest that use of 24-hour dietary recalls among the elderly may result in a high percentage of error.     

Percutaneous nucleotomy: indications and preliminary results

Percutaneous nucleotomy was developed in the late seventies. In the beginning special forceps were used to remove the nuclear tissue. However, because of the large diameter of the cannulas used there was a risk of nerve damage. In 1985 Onik et al. presented the 'automated percutaneous lumbar diskectomy'. The risk of damage to the surrounding tissues of the disc was low. The method proved to be successful. In this article we describe the method and analyse our first 40 patients treated for a disc protrusion between February and June, 1988. This pilot study also shows that CT discography is important for the selection of patients for treatment with this method.     

Statistical issues in analyzing 24-hour dietary recall and 24-hour urine collection data for sodium and potassium intakes

Dietary recalls and urine assays provide different metrics for assessing sodium and potassium intakes. Means, variances, and correlations of data obtained from these two modes of measurement differ. Pooling of these data is not straightforward, and results from studies employing the different modes may not be comparable. To explore differences between these metrics, the authors used data from the Trial of Nonpharmacologic Intervention in the Elderly (TONE), which included repeated standardized 24-hour dietary recalls and 24-hour urine collections administered over 3 years of follow-up, to estimate sodium and potassium intakes. The authors examined data from 341 control participants assigned to usual care that were collected between August 1992 and December 1995. Dietary recalls yielded estimates of sodium intake that averaged 22% less than those from urine assays and estimates of potassium intake that averaged 16% greater than those from urine assays. Sodium intake estimates were less repeatable (r = 0.22 for diet; r = 0.30 for urine) than potassium intake estimates (r = 0.49 for diet; r = 0.50 for urine), making relations with outcomes more difficult to characterize. Overall, the performance of the two measurement modes was fairly similar across demographic subgroups. Errors in separate estimations of long term sodium and potassium intakes using short term data were strongly correlated, more strongly than the underlying long term intakes of these electrolytes. Because of the correlated measurement error, estimated regression coefficients for linear models including both electrolytes as predictors may be confounded such that the separate relations between these nutrients and outcomes such as blood pressure cannot be reliably estimated by common analytical strategies.     

Cardiac event recording yields more diagnoses than 24-hour Holter monitoring in patients with palpitations

Palpitation is a common symptom that sometimes results from a substantial cardiac arrhythmia. We compared the diagnostic yield of trans-telephonic event monitors with those of Holter monitoring in patients with intermittent palpitations. In all, 310 patients were randomly assigned to receive an event recorder or 24-hour Holter monitoring. Event recorders were used for seven days or until two recordings were obtained while symptoms occurred. The main end-point was an electrocardiogram (ECG) recorded during symptoms. The patients with palpitation recorded the one-lead ECG trace and sent it to a telemedicine call centre, where a nurse responded. There were 119 symptomatic patients in the event recorder group and 74 in the Holter group. The total costs were 6019 for event recording and 9605 for Holter monitoring. The average costs were 51 per symptomatic patient detected by event recorder monitoring and 130 per symptomatic patient detected by Holter monitoring. More patients therefore received a clear diagnosis, and more quickly, when using event recording than with Holter monitoring. For this reason, event recorders are preferable to Holter monitors for patients with palpitations.     

The value of ambulatory 24-hour esophageal manometry in the diagnosis of retrosternal pain of non-cardiac origin

The clinical relevance of a system of ambulatory 24-hour oesophageal pressure and pH recording with automated data analysis was investigated in 33 unselected patients with non-cardiac chest pain. After conventional manometry with edrophonium (Tensilon) provocation, 24-hour oesophageal pH and pressure monitoring was performed. In 17 patients conventional manometry, edrophonium provocation and 24-hour pH recording revealed an oesophageal origin of the symptoms: 6 patients had oesophageal motility disorders, 3 were positive responders to edrophonium and 8 had chest pain associated with gastro-oesophageal reflux. In none of the patients who had a pain attack during prolonged oesophageal pressure recording, was a new motility disorder detected.     

24-hour energy expenditure and the menstrual cycle

To determine whether 24-h energy expenditure changes during the menstrual cycle, 10 normally menstruating women in their 20s and 40s were measured repeatedly for periods of 36 and 46 h by simultaneous direct and indirect calorimetry. A standardized sedentary daily schedule included three meals to provide food intake equal to expenditure. Eight of the 10 women showed increases of 8-16% during the 14-day luteal phase following ovulation, a significant increase (p less than 0.00002 by direct calorimetry, p less than 0.001 by indirect calorimetry). One subjects, whose increase was 14% following ovulation, showed no significant change during a month when she took an oral contraceptive. Progesterone from the corpus luteum is the likely cause of a 9% increase in 24-h energy expenditure in normally menstruating women.