Technical Difficulties in the Implementation of the Continuous Glucose Monitoring System / 中国医疗器械杂志

The continuous glucose monitoring system (CGMS) has been clinically applied to monitor the dynamic change of the subcutaneous interstitial glucose concentration which is a function of the blood glucose level by glucose sensors. It can track blood glucose levels all day along, and thus provide comprehensive and reliable information about blood glucose dynamics. The clinical application of CGMS enables monitoring of blood glucose fluctuations and the discovery of hidden hyperglycemia and hypoglycemia that are difficult to be detected by traditional methods. As a CGMS needs to work subcutaneously for a long time, a series of factors such as biocompatibility, enzyme inactivation, oxygen deficiency, foreign body reaction, implant size, electrode flexibility, error correction, comfort, device toxicity, electrical safety, et al. should be considered beforehand. The study focused on the difficulties in the technology, and compared the products of Abbott, Medtronic and DexCom, then summarized their cutting-edge. Finally, this study expounded some key technologies in dynamic blood glucose monitoring and therefore can be utilized as a reference for the development of CGMS.

Impact of prolonged 48-h wireless capsule esophageal pH monitoring on diagnosis of gastroesophageal reflux disease and evaluation of the relationship between symptoms and reflux episodes / Impacto da monitorização prolongada do refluxo por pHmetria sem cateter por 48 horas, no diagnóstico da doença do refluxo gastroesofágico e no estudo da relação entre os sintomas e o refluxo

CONTEXT: Gastroesophageal reflux disease is one of the most common digestive diseases and an important cause of distress to patients. Diagnosis of this condition can require ambulatory pH monitoring. OBJECTIVES: To determine the diagnostic yield of a wireless ambulatory pH monitoring system of 48-hours, recording to diagnose daily variability of abnormal esophageal acid exposure and its symptom association. METHODS: A total of 100 consecutive patients with persistent reflux symptoms underwent wireless pH capsule placement from 2004 to 2009. The wireless pH capsule was deployed 5 cm proximal to the squamocolumnar junction after lower esophageal sphincter was manometrically determined. The pH recordings over 48-h were obtained after uploading data to a computer from the receiver that recorded pH signals from the wireless pH capsule. The following parameters were analyzed: (1) percentual time of distal esophageal acid exposure; (2) symptom association probability related to acid reflux. The results between the first and the second day were compared, and the diagnostic yield reached when the second day monitoring was included. RESULTS: Successful pH data over 48-h was obtained in 95 percent of patients. Nearly one quarter of patients experienced symptoms ranging from a foreign body sensation to chest pain. Forty-eight hours pH data analysis was statistically significant when compared to isolated analysis of day 1 and day 2. Study on day 2 identified seven patients (30.4 percent) that would be missed if only day 1 was analyzed. Three patients (18.7 percent) out of 16 patients with normal esophageal acid exposure on both days, showed positive symptom association probability, which generated an increase in diagnostic yield of 43.4 percent. CONCLUSION: Esophageal pH monitoring with wireless capsule is safe, well tolerated, does not require sedation. The extended 48-h period of study poses an increased yield to diagnose gastroesophageal reflux disease patients.

CONTEXTO: A doença do refluxo gastroesofágico é uma das doenças digestivas mais comuns e importante causa de desconforto para os pacientes. O diagnóstico desta condição clínica pode requerer monitoramento ambulatorial do pH esofágico. OBJETIVOS: Determinar o espectro diagnóstico do sistema de monitoramento ambulatorial do pH esofágico com cápsula telemétrica por um período de 48 horas no diagnóstico da variabilidade diária da exposição ácida anormal e sua associação com sintomas. MÉTODOS: Foram incluídos 100 pacientes adultos, consecutivos, com sintomas relacionados com a doença do refluxo gastroesofágico, que realizaram pHmetria com cápsula telemétrica por 48 horas entre 2004 e 2009. A cápsula foi posicionada e implantada a 5 cm da borda superior do esfíncter esofágico inferior, definida pela manometria esofágica. Foram analisados os seguintes parâmetros: (1) tempos percentuais de exposição ácida no esôfago distal; (2) probabilidade de associação dos sintomas com o refluxo ácido. Foram comparados os resultados entre o 1º e o 2º dia de monitoramento, assim como o eventual ganho diagnóstico obtido após a inclusão do 2º dia no monitoramento. RESULTADOS: Sucesso na obtenção dos dados do pH esofágico durante 48 horas foi obtido em 95 por cento dos pacientes. Aproximadamente 25 por cento dos pacientes apresentaram sintomas relacionados à implantação da cápsula, variando entre sensação de presença de corpo estranho à dor torácica. A análise dos resultados do estudo de 48 horas mostrou-se estatisticamente significante quando comparada com as análises isoladas do dia 1 e do dia 2. O estudo do dia 2 identificou sete pacientes (30.4 por cento) que teriam sido perdidos se somente o dia 1 fosse analisado. Três pacientes (18.7 por cento) dos 16 pacientes com exposição ácida normal no esôfago distal em ambos os dias, apresentaram probabilidade de associação com o sintoma positivo, que gerou incremento no ganho diagnóstico com este método diagnóstico de 43.4 por cento. CONCLUSÕES: O monitoramento do pH esofágico com a cápsula telemétrica é seguro, bem tolerado e não requer sedação. A extensão do período de estudo para 48 horas representa significativo aumento no ganho diagnóstico em pacientes com doença do refluxo gastroesofágico.

II norma venezolana para el monitoreo ambulatorio de presión arterialy automedición de presión arterial / II venezuelan norms for ambulatory monitoring of arterial pressure and self measurement

Durante los últimos 30 años el monitoreo ambulatorio de la presión arterial ha pasado de ser un método selectivo de investigación farmacológica a ser un método invaluable en el diagnóstico y valoración terapéutica del paciente hipertenso. Sin embargo, ha habido una variedad de criterios en la evaluación e interpretación de los resultados; de ahí la necesidad de presentar el estado del arte en cuanto al uso de esta metodología en la práctica clínica. Los valores de normalidad de la presión arterial medida a través del monitoreo ambulatorio de la presión arterial se diferencian de aquellos tomados en la consulta y en el hogar; así como, si se hacen durante el período de vigilia o sueño. La II Norma Venezolana para el Monitoreo Ambulatorio de la Presión Arterial y Monitoreo de Presión en el Hogar reportalos valores considerados normales; las indicaciones de su uso; la interpretación de los resultados; los equipos validados y recomendados en los ámbitos mundiales y nacionales; así los datos mínimos que debe poseer el reporte del monitoreo ambulatorio de la presión arterial.

During the past 30 years ambulatory blood pressure monitoring has gone from being a selective method of pharmacological research to a valuable method for the diagnosis and therapeutic assessment of patients with hypertension. However, there area variety of criteria for the evaluation and interpretation of results; hence the need for a state of the art approach to the use of this methodology in clinical practice. Normal blood pressure values measured by ambulatory blood pressure monitoring are different from those obtained in the clinic and in the home; as well as, during periods of wakefulness and sleep. The II Venezuelan Standards for Ambulatory Monitoringof Arterial Pressure and Monitoring of Pressure in the Home provide normal values; indications for use; interpretation of results; validated equipment as well as global and national recommendations; and the minimum data that a report should contain.

A simple method to assess freezing of gait in Parkinson's disease patients

Freezing of gait (FOG) can be assessed by clinical and instrumental methods. Clinical examination has the advantage of being available to most clinicians; however, it requires experience and may not reveal FOG even for cases confirmed by the medical history. Instrumental methods have an advantage in that they may be used for ambulatory monitoring. The aim of the present study was to describe and evaluate a new instrumental method based on a force sensitive resistor and Pearson's correlation coefficient (Pcc) for the assessment of FOG. Nine patients with Parkinson's disease in the "on" state walked through a corridor, passed through a doorway and made a U-turn. We analyzed 24 FOG episodes by computing the Pcc between one "regular/normal" step and the rest of the steps. The Pcc reached ±1 for "normal" locomotion, while correlation diminished due to the lack of periodicity during FOG episodes. Gait was assessed in parallel with video. FOG episodes determined from the video were all detected with the proposed method. The computed duration of the FOG episodes was compared with those estimated from the video. The method was sensitive to various types of freezing; although no differences due to different types of freezing were detected. The study showed that Pcc analysis permitted the computerized detection of FOG in a simple manner analogous to human visual judgment, and its automation may be useful in clinical practice to provide a record of the history of FOG.

Monitorização materno-fetal durante procedimento odontológico em portadora de cardiopatia valvar / Maternal-fetal monitoring during dental procedure in patients with heart valve disease / Monitoreo maternofetal durante procedimiento odontológico en portadora de cardiopatía valvular

FUNDAMENTO: Os efeitos da anestesia local em odontologia com lidocaína e epinefrina, sobre parâmetros cardiovasculares de gestantes portadoras de valvopatias e seus conceptos, não estão esclarecidos. OBJETIVO: Avaliar e analisar parâmetros da cardiotocografia, de pressão arterial e eletrocardiográficos da gestante portadora de doença valvar reumática, quando submetida à anestesia local com 1,8 ml de lidocaína 2 por cento sem vasoconstritor e com epinefrina 1:100.000, durante procedimento odontológico restaurador. MÉTODOS: Realizamos monitorização ambulatorial da pressão arterial, eletrocardiografia ambulatorial materna e cardiotocografia de 31 portadoras de cardiopatia reumática, entre a 28ª e 37ª semana de gestação, divididas em dois grupos conforme presença ou não do vasoconstritor RESULTADOS: Demonstrou-se redução significativa dos valores de frequência cardíaca materna nos dois grupos, durante o procedimento, quando comparado aos demais períodos (p < 0,001). Houve ocorrência de arritmia cardíaca em 9 (29,0 por cento) pacientes, das quais 7 (41,8 por cento) pertencentes ao grupo de 17 gestantes que recebeu anestesia com adrenalina. A pressão arterial materna não apresentou diferença quando comparamos períodos ou grupos (p > 0,05). O mesmo ocorreu (p > 0,05) com número de contrações uterinas, nível e variabilidade da linha de base e número de acelerações da frequência cardíaca fetal. CONCLUSÃO: O uso de 1,8 ml de lidocaína 2 por cento associado à adrenalina mostrou-se seguro e eficaz em procedimento odontológico restaurador durante a gestação de mulheres com cardiopatia valvar reumática.

BACKGROUND: The effects of local dental anesthesia with lidocaine and epinephrine on cardiovascular parameters of pregnant women with heart valve diseases and their fetuses are not fully understood. OBJECTIVES: To assess and analyze cardiotocographic, blood pressure and electrocardiographic parameters of pregnant women with rheumatic heart valve disease undergoing local anesthesia with 1.8mL of lidocaine 2 percent with or without epinephrine 1:100,000 during restorative dental treatment. METHODS: Maternal ambulatory blood pressure and electrocardiographic monitoring as well as cardiotocography of 31 patients with rheumatic heart disease were performed between the 28th and 37th week of gestation. The patients were divided into two groups, those with or without vasoconstrictor. RESULTS: A significant reduction in maternal heart rate was shown in both groups during the procedure in comparison with the other periods (p<0.001). Cardiac arrhythmia was observed in nine (29.0 percent) patients, of which seven (41.8 percent) were from the group of 17 pregnant women who received anesthesia plus epinephrine. No difference in maternal blood pressure was observed when periods or groups were compared (p>0.05). The same occurred (p>0.05) with the number of uterine contractions, baseline level and variability, and number of accelerations of fetal heart rate. CONCLUSION: The use of 1.8mL of lidocaine 2 percent in combination with epinephrine was safe and efficient in restorative dental procedures during pregnancy in women with rheumatic heart valve disease.

FUNDAMENTO: Los efectos de la anestesia local en odontología con lidocaína y epinefrina, sobre los parámetros cardiovasculares de gestantes portadoras de valvulopatías y sus conceptos, no son claros. OBJETIVO: Evaluar y analizar parámetros de la cardiotocografía, de la presión arterial y electrocardiográficos de la gestante portadora de enfermedad valvular reumática, al someterse a anestesia local con 1,8 ml de lidocaína 2 por ciento sin vasoconstrictor y con epinefrina 1:100.000, durante procedimiento odontológico restaurador. MÉTODOS: Realizamos monitoreo ambulatorio de la presión arterial, electrocardiografía ambulatoria materna y cardiotocografía de 31 portadoras de cardiopatía reumática, entre la 28ª y la 37ª semana de gestación, divididas en dos grupos según la presencia o no del vasoconstrictor. RESULTADOS: Se observó reducción significativa de los valores de frecuencia cardíaca materna en los dos grupos, durante el procedimiento, al compararlo con los demás períodos (p < 0,001). Se registró ocurrencia de arritmia cardíaca en 9 (29,0 por ciento) pacientes, de las cuales 7 (41,8 por ciento) pertenecían al grupo de 17 gestantes que recibió anestesia con adrenalina. La presión arterial materna no presentó diferencia al comparar períodos o grupos (p > 0,05). Lo mismo ocurrió (p > 0,05) con el número de contracciones uterinas, nivel de variabilidad de la línea de base y número de aceleraciones de la frecuencia cardíaca fetal. CONCLUSIÓN: El uso de 1,8 ml de lidocaína 2 por ciento asociado a la adrenalina se mostró seguro y eficaz en procedimiento odontológico restaurador durante la gestación de mujeres con cardiopatía valvular reumática.

Papel de la monitorización electroencefalográfica continua en el diagnóstico de la epilepsia pediátrica / Role of continuous EEG monitoring in the diagnosis of pediatric epilepsy

El diagnóstico de la epilepsia es fundamentalmente clínico, pero frecuentemente se plantea el diagnóstico diferencial con fenómenos no epilépticos. El desarrollo de la monitorización EEG continua (MEEGC) en las últimas dos décadas ha permitido mejorar el diagnóstico de pacientes epilépticos de todas las edades. En este trabajo se revisan los datos de la literatura sobre la eficacia de los distintos tipos de MEEGC en el diagnóstico de la epilepsia pediátrica, resaltando especialmente nuestra experiencia personal. En nuestros estudios, la MEEGC ambulatoria suplementada con video permitió contestar la pregunta que determinó su petición en el 80% de pacientes diagnosticados de epilepsia y en el 83% de aquéllos con sospecha diagnóstica de epilepsia. Con la MEEGC ambulatoria asistida por ordenador, dichas cifras fueron 88% y 89%, respectivamente y con la MEEGC intrahospitalaria con video fueron 82% y 51%, respectivamente. La MEEGC intrahospitalaria con video es crucial en la evaluación de pacientes con epilepsia, candidatos al tratamiento quirúrgico. La MEEGC es también importante en pacientes con encefalopatías agudas ingresados en las unidades de cuidados intensivos. La MEEGC, tanto ambulatoria como intrahospitalaria, es muy útil en el diagnóstico diferencial de fenómenos clínicos epilépticos y no epilépticos y en la confirmación del tipo de epilepsia o síndrome epiléptico. Los avances tecnológicos y el desarrollo de nuevas modalidades de EEG en el futuro, harán que la electroencefalografía siga siendo una técnica muy importante en el estudio de la función cerebral en pacientes con enfermedades neurológicas agudas o crónicas.

The diagnosis of epilepsy is basically clinical, but it frequently raises the differential diagnosis with non-epileptic events. The development of continuous EEG monitoring (CEEGM) in the past decades has allowed a better diagnosis of epileptic patients of all ages. In this paper we review the data available in the literature about the efficacy of the different modalities of CEEGM in the diagnosis of pediatric epilepsy, emphasizing our personal experience. In our studies the ambulatory CEEGM supplemented with video allowed to answer the question that prompted its request in 80% of patients diagnosed with epilepsy and in 83% of those with the suspected diagnosis of epilepsy. With ambulatory computer-assisted CEEGM those figures were 88% and 89%, respectively, and with inpatient video-CEEGM they were 82% and 51%, respectively. The latter is crucial in the evaluation of epilepsy patients who are candidates for surgical treatment. Inpatient video-CEEGM is also very important in the management of patients with acute encephalopathies admitted to the Intensive Care Units. Both, ambulatory or inpatient CEEGM, are very useful in the differential diagnosis of clinical epileptic versus non-epileptic events, as well as in the confirmation of the type of epilepsy or epileptic syndrome. The development of technological advances and new EEG modalities in the future will help to continue to consider electroencephalography as a very important technique in the study of brain function in patients with acute or chronic encephalopathies.

Acelerometría: una nueva herramienta para incluir en la práctica clínica / Accelerometry: a new techinique in a clinical practice

El propósito del presente trabajo es mostrar un primer acercamiento al estudio del movimiento humano a través de acelerometria. Se describe el funcionamiento de los sensores involucrados y se revisan algunas investigaciones que han aplicado esta tecnología bajo distintas configuraciones. Mediante el análisis del comportamiento de las señales obtenidas a través de registros acelerométricos se analizó la marcha automática sobre una cinta caminadora a velocidad constante durante treinta segundos en un sujeto sin disfunción del movimiento. Se analizó la respuesta para las direcciones vertical, medio-lateral y antero-posterior observándose un patrón característico, tanto en el dominio del tiempo como de la frecuencia. Los resultados presentados en este reporte muestran concordancia con Los hallazgos obtenidos por otros autores, lo que evidencia un aporte significativo desde el punto de vista de la tecnología empleada en Los registros, tanto por las proyecciones que esta herramienta ofrece, como por los reducidos costos involucrados. En Chile, este tipo de herramientas es poco conocida, sin embargo esta línea de investigación y desarrollo puede constituir una real alternativa a los sistemas de análisis de movimiento convencionales. En el Laboratorio de Análisis de Movimiento Humano de la Universidad Metropolitana de Ciencias de la Educación, se está abriendo esta línea de investigación, que puede significar una alternativa a los sistemas convencionales de análisis de movimiento y un aumento del trabajo investigativo en Kinesiología, al situarse como una técnica barata, con el potencial de ser aplicada en cualquier lugar, sin necesidad de un Laboratorio, lo que además abre la posibilidad de realizar mediciones de forma ambulatoria, por ejemplo en un consultorio o en la casa de un paciente.

The purpose of this work is to show a first approach to the study of the human motion through accelerometry. The functioning of the involucrate sensors is described and some investigations that applied this technology under different configurations were checked. By means of the analysis of the signal behaviour obtained through accelerometric records examined the automatic walk on a treadmill at constant velocity during thirty seconds in a patient without dysfunction of movement. The answer was examined for vertical, half lateral and antero posterior directions observing a similar pattern, as much as in the domain of the time as in frequency. The results given in this report show concordance with obtained findings by other authors, what evidences a significant contribution from a technology point of view used in the records, as much as projections this tool offers, as implicated costs reduced. In Chile, this kind of tool is not well known, however this line of research and development can constitute a real alternative to conventional systems of analysis of movement. In the Laboratory of Human Movement Analysis of The Universidad Metropolitana de Ciencias de la Educación university, this line of investigation is starting to open, this can mean an alternative to the conventional systems of analysis of movement and an increase of the investigating work in Kinesiology, been placed like a cheap technique, with the potential to be used everywhere, without the need of a Laboratory, giving also the possibility to take records in a outpatient clinic, at a primary healthcare or at patient’s house, for instance. Therefore, the challenge is to include this tool within the routine of the national healthcare, either to describe a patient’s movement quantitatively, compare the results of a therapy or training objectively, determine principles of a treatment or evaluate data with other records to understand the causes that determine the condition to study.

Evaluación hemodinámica ambulatoria mediante un nuevo sensor implantable inalámbrico en el seguimiento de pacientes con insuficiencia cardíaca: experiencia clínica inicial / Ambulatory hemodynamic evaluation of a new wireless implantable sensor in the follow up of patients with congestive heart failure: a preliminary experience

Antecedentes: El monitoreo hemodinámico puede contribuir al ajuste oportuno de terapia en insuficiencia cardíaca (IC). Existe un creciente interés en el desarrollo de sistemas que permitan el monitoreo en el ámbito extra hospitalario. Objetivo: Evaluar la exactitud de la determinación de presión de arteria pulmonar (PAP) del sensor CardioMEMS HeartSure (HS) comparado con catéter de Swan Ganz (SG) y Ecocardiografía (Eco) en el seguimiento de pacientes con IC. Método: 12 pacientes con IC NYHA clase II-IV fueron incluidos. El dispositivo HS fue implantado en la arteria pulmonar mediante técnica percutánea bajo visión angiográfica. La determinación de PAP se realizó mediante un sistema inalámbrico que otorga una curva de presión en tiempo real. Dos operadores independientes realizaron tres mediciones consecutivas por HS en cada visita. Se llevó a cabo una evaluación ecocardiográfica los días 2, 14, 30,60 y 90 post- implante. Mediciones simultáneas mediante SG se realizaron el día del implante y a los 60 días. Se empleó análisis de regresión lineal como una medida de la correlación entre métodos. La variabilidad entre métodos e interobservador se evaluó mediante análisis de Bland-Altman. Resultados: Todos los pacientes completaron el seguimiento a 30 días; cinco completaron el periodo de 90 días. La edad promedio fue de 63 +/- 14.6 años. La etiología de la IC era isquémica en 3 pacientes, valvular en 4 e idiopática en los 5 restantes. PAP sistólica (SPAP) fue de 64 +/- 22 y 58 +/- 22 mmHg medida por HS y SG, respectivamente. Ambos métodos mostraron una correlación significativa (r2 = 0.96, p<0.01), con una diferencia media de 6.2 +/- 4.5 mmHg. PAP diastólica (DPAP) fue de 23 +/- 14 y 28 +/- 16 mmHg para HS y SG, respectivamente, con una buena correlación entre las medidas (r 2 = 0.84) y una diferencia media de -1,6 +/- 6.8 mmHg. SPAP fue de 60 +/- 20 y 62 +/- 12 mmHg paraHS y Eco, respectivamente, con...

Background: hemodynamic monitoring may contribute to prompt adjustment of medical therapy in patients with congestive heart failure (CHF). There is a great interest in the development of system to perform this monitoring in ambulatory patients. Aim. To evaluate the accuracy of pulmonary artery pressure (PAP) determination using the CardioMEMS HeartSure (HS) sensor using Swan Ganz (SG) and echocardiography (Echo) measurements as gold standards in the followup of patients with CHF Methods: 12 patients with NYHA class II to IV CHF were included. The HS device was implanted in the pulmonary artery under angiographic vision. The determination of PAP was obtained from an online measurement using a wireless system allowing real time monitoring. In each visit two independent observers performed 3 consecutive measurements of PAP. An echocardiogram was performed at HS implantation and 14, 30, 60 and 90 days post implant. Simultaneous PAP by SG and HS were obtained at implantation time and 60 days later. Linear regression analysis was used to correlated measurements. Bland-Altman analysis was used to evaluate variability between methods and between observers. Results: All patients completed 30 days of follow up and 5 completed 90 days. Mean patient age was 63 years (SD 14.6). The cause of HF was ischemic in 3, valvular in 4 and idiopathic in the remaining 5 patients. Systolic PAP (SPAP) was 64 +/- 22 and 58 +/- 22 mmHg for HS and SG measurements respectively. r2 between methods was 0.96 (p<0.01) and mean difference was 6.2 +/- 4.5 mmHg. Diastolic PAP (DPAP) was 23 +/- 14 and 28 +/- 16 mmHg for HS andSG, respectively; r2 = 0.84, mean difference = -1,6 +/- 6.8 mmHg. SPAP was 60 +/- 20 and 62 +/-12 mmHg for HS and Echo, respectively; r2 =0.75 (p<0.01), mean difference -2.6 +/- 11 mmHg. No significant difference was observed between operator for HS measurement: mean difference -0.8 +/-6.5 and -2.5 +/- 5.7 mmHg for SPAP y DPAP, respectively.

A Comparative Study of Patient Experiences of Conventional Fluoroscopic and Four-Hour Ambulatory Urodynamic Studies

We assessed several emotional variables in patients experiencing conventional urodynamic and ambulatory urodynamic monitoring (AUM) to verify the hypothesis that AUM is tolerated as well as conventional urodynamics. A total of 33 women and 7 men from 23 to 72 years of age who were undergoing both procedures were prospectively included in this study. Prior to and immediately after the procedures, each patient completed a self-administered questionnaire. Answers were given on a visual analogue scale. The degree of anxiety was higher for conventional urodynamics than for AUM (p = 0.045), while the degree of boredom experienced during AUM was higher than that during conventional urodynamics (p= 0.013). There was no significant difference in the degree of shame or bother experienced by the patients during the two procedures. In general, patients tolerated both examinations extremely well. The examiner-rated degree of intolerance during conventional urodynamics was influenced by the subjective pain score (p=0.001), while all other emotional variables except bother were not significantly related with the degree of intolerance during AUM (p=0.007). A total of 74.4% and 84.6% responded that they were willing to repeat conventional urodynamics and AUM, respectively, which were not significantly different. Although AUM produced a significantly higher level of boredom than conventional urodynamics, our data demonstrates that patients are as tolerant of AUM as they are of conventional urodynamic procedures.

Monitoreo ambulatorio de presión arterial en adultos / Arterial pressure in adults ambulatory monitoring

El monitoreo ambulatorio de presión arterial consiste en el registro automatizado de la presión arterial braquial, en intervalos cortos, durante un período de 24 horas. Esta técnica es relevante para el diagnóstico de la hipertensión ocasional del "delantal blanco", la evaluación del ciclo circadiano de presión arterial, el diagnóstico de la hipertensión resistente y para la determinación de la eficiencia y de algunas complicaciones del tratamiento antihipertensivo. Este artículo resume las indicaciones y características generales del MAPA.

Monitoreo ambulatorio de presión arterial en niños / Arterial pressure in children ambulatory monitoring

La hipertensión arterial en niños es un problema desde la toma de la presión arterial, existiendo antecedentes de 22 a 44 por ciento de falsos diagnósticos por errores en la técnica o por hipertensión del delantal, por lo que se ha hecho cada vez más frecuente el uso del monitoreo de presión en 24 horas. Presentamos los antecedentes acerca del equipo, técnica de toma del examen y cómo analizar los resultados, haciendo mención a experiencias multicéntricas del extranjero y mostrando algunas cifras publicadas en nuestro medio, las que son semejantes a lo publicado por autores europeos o de Norteamérica. También se presentan tablas que muestran los valores en ambos sexos.

Caracterização dos perfis glicêmicos domiciliares como estratégia para os ajustes insulinoterápicos em pacientes com diabetes mellitus do tipo 1 / Caracterización de los perfiles glicémicos domiciliares como estrategia para los ajustes insulino-terápicos en pacientes con diabetes mellitus tipo 1 / Glycemic profiles in insulin adjustments in patients with type 1 diabetes mellitus

O artigo tem como objetivo principal caracterizar os perfis glicêmicos domiciliares de pacientes com diabetes mellitus tipo1, a partir de um esquema de monitorização proposto, e adotá-los como estratégia de ajuste nas doses de insulina. Foram realizados 3259 testes, 781 antes do café, 752 antes do almoço, 765 antes do jantar, 740 antes de deitar e 221 pela madrugada. A média das glicemias nestes períodos ultrapassaram os limites superiores satisfatórios em 6,87%, 3,83%, 11,37%, 30,50% e 19,28% respectivamente. Estes dados forneceram subsídios para ajustes nos esquemas insulinoterápicos. Os níveis HbA1c não mudaram de forma significante com os ajustes realizados porém, foram mantidos em 10%.

The goal of this paper is to characterize the glycemic profiles of patients with type 1 diabetes mellitus like a strategy in insulin adjustments. A total of 3259 tests were realized being 781 before breakfast, 752 before lunch, 765 before dinner and 740 before bed and 221 in the dawn. The average of the blood glucose tests in these periods oversteped the superior limits in 6,87%, 3,83%, 11,37%, 30,50% e 19,28% respectively. These data gave the conditons to make the insulin adjustments. The HbA1c levels evidenced that there was no significant statistical difference in the metabolic control, but they remained in 10%.

El objetivo principal de este artículo consiste en caracterizar los perfiles glicémicos domiciliares de los pacientes con diabetes mellitus tipo 1, a partir de un esquema propuesto de monitorización, para aplicarlo como estrategia, en los ajustes de las dosis de insulina. Fueron realizados 3.259 tests, de los cuales 781se hicieron antes del desayuno, 752 se realizaron antes del almuerzo, 765 antes de la merienda, 740 se hicieron antes de dormir y los 221 se hicieron en la madarugada. La media de las glicemias en estos períodos ultrapasaron los límites superiores satisfactorios em 6,8%, 3,83%, 11,37%, 30,50% y 19,28% respectivamente. Estos datos ofrecieron subsidios para poder ajustar los esquemas insulinoterápicos. Los niveles de HbA1c no variaron de forma significativa com los ajustes realizados y se mantuvieron em 10%.

Novo sistema de monitorizaçäo de EEG ambulatorial: metodologia de análise do registro e classificaçäo das descargas epilépticas em 100 pacientes / New system for ambularoty EEG monitoring: analysis and classification of epileptic discharge en 100 patients

Desde 1994 vem sendo utilizado no Brasil um equipamento de monitorização eletrencefalográfica ambulatorial (Holter Cerebral) que foi desenvolvido com união da iniciativa privada e a Universidade Federal de São Paulo - UNIFESP. O objetivo deste estudo foi estabelecer um método de análise, uma classificação das descargas epilépticas encontradas e analisar os resultados da monitorização ambulatorial dos primeiros 100 exames consecutivos de pacientes epilépticos e não-epilépticos, adultos ou crianças, realizados no Setor de Investigação e Tratamento das Epilepsias da UNIFESP. Neste estudo foi possível a identificação de descargas paroxísticas epilépticas e de anormalidades da atividade elétrica cardíaca durante atividades da vida diária dos pacientes.

Sistema computadorizado para monitorizaçäo cardio-respiratória / Computerized system for cardiorespiratory monitoring

Um sistema baseado em computador pessoal é usado para a monitorização cardio-respiratória de pacientes, em tempo-real, integrando sinais obtidos de diferentes equipamentos: monitor fisiológico (ECG), espectrômetro de massa respiratória (EMR: frações gasosas) e pneumotacógrafo (fluxo ventilatório). O sistema detecta complexos QRS e ciclos respiratórios, e calcula freqüência cardíaca e vários parâmetros respiratórios. O desempenho dos algoritmos é avaliado com sinais simulados, o MIT-BIH Arrhytmia Database e experimentos in-vivo. O sistema é empregado em pesquisa da fisiologia do exercício

Abstract- A modular system based on a personal computer is used to perform real-time cardio-respiratory monitoring of patients. integrating data from different equipments: a bed side monitor (ECG ), a respiratory mass spectrometer (RMS: gas fractions) and a pneumothacograph (respiratory tlow). The system includes an automatic detection of the QRS complexes and the respiratory cycles and it calculates heart rate and severa! respiratory parameters. The performance of the algorithms is estimated with simulated data. the MIT-BIH Arrhythrnia Database and in rivo experirnents. This system is being used for research in exercise physiology