Manometría de alta resolución en la acalasia de esófago / High-resolution manometry in achalasia of esophagus

Introducción: La manometría esofágica de alta resolución es la prueba ideal para el diagnóstico de la acalasia y muestra la presencia de ondas terciarias o aperistalsis y el aumento de presión, con ausencia de relajación, del esfínter esofágico inferior. Objetivo: Evaluar la utilidad de la manometría esofágica de alta resolución en el diagnóstico y clasificación de la acalasia esofágica. Métodos: Se realizó una investigación descriptiva, trasversal, en el Centro Nacional de Cirugía de Mínimo Acceso entre octubre del 2018 y diciembre del 2019, en 46 pacientes con diagnóstico de acalasia esofágica. Se excluyeron aquellos con cirugía previa del esófago. Las variables incluidas fueron: edad, sexo, tiempo de evolución, síntomas y hallazgos manométricos. Para el análisis de las variables cuantitativas se emplearon medidas de tendencia central, media y de dispersión, la desviación estándar. Las frecuencias y proporciones fueron utilizadas para describir las variables cualitativas. Resultados: Predominó la acalasia tipo II, en el sexo femenino (57 por ciento). La disfagia fue el síntoma más frecuente (84, 76 y 100 por ciento en los tipos I, II y III, respectivamente). El 70 por ciento de los casos presentó más de un año de evolución de los síntomas. La media de la presión de relajación integrada estuvo por encima de 21 mmHg independientemente del tipo. No se encontraron pacientes con subtipos de la acalasia tipo III. Conclusiones: La manometría esofágica de alta resolución es útil para el diagnóstico y clasificación de la acalasia esofágica(AU)

Introduction: High-resolution esophageal manometry is the ideal test for the diagnosis of achalasia and shows the presence of tertiary waves or aperistalsis and increased pressure, in the absence of relaxation, of the lower esophageal sphincter. Objective: To assess the usefulness of high-resolution esophageal manometry in the diagnosis and classification of esophageal achalasia. Methods: A descriptive, cross-sectional investigation was carried out at the National Center for Minimal Access Surgery, between October 2018 and December 2019, in 46 patients with a diagnosis of esophageal achalasia. Those with previous esophageal surgery were excluded. The variables included were: age, sex, time of evolution, symptoms and manometric findings. For the analysis of the results, the percentage and measures of central tendency (arithmetic mean and standard deviation) were used. Results: Type II achalasia predominated in females (57 percent). Dysphagia was the most frequent symptom (84, 76, and 100 percent in types I, II, and III, respectively). 70 percent of the cases presented more than one year of evolution of the symptoms. Regarding the high-resolution manometry parameters, it was observed that regardless of the type, the mean integrated relaxation pressure was above 21 mmHg. No patients with type III achalasia subtypes were found. Conclusions: High-resolution esophageal manometry is useful for the diagnosis and classification of esophageal acalasia(AU)

Manometría de alta resolución en pacientes con trastornos motores esofágicos / High resolution manometry in patients with esophageal motor disorders

Introducción: La manometría de alta resolución es la prueba de referencia para el estudio de los trastornos motores esofágicos. Objetivo: Determinar la factibilidad de la manometría de alta resolución para el estudio de las características de los trastornos motores esofágicos. Métodos: Se realizó una investigación descriptiva, transversal, en el Centro Nacional de Cirugía de Mínimo Acceso, entre septiembre de 2018 y diciembre de 2019, en 56 pacientes cubanos con diagnóstico de trastorno motor esofágico por manometría de alta resolución, con edades entre 18 y 80 años, que dieron su consentimiento para participar en el estudio. Se excluyeron pacientes con acalasia esofágica y los trastornos menores de la peristalsis. Las variables incluidas fueron: edad, sexo, diagnósticos manométricos y sus características, síntomas, tipos de unión esofagogástrica, diagnósticos imagenológicos o endoscópicos. Para el análisis de los resultados se empleó el porcentaje, medidas de tendencia central y ji cuadrado de Pearson de homogeneidad, con un nivel de significación p 8804; 0,05 y 95 por ciento de confiabilidad. Resultados: Predominó la contractilidad ausente (39,28 por ciento), el sexo femenino (58,9 por ciento) y la disfagia (66,07 por ciento). A la obstrucción al flujo de la unión esofagogástrica correspondió la media de presión de reposo del esfínter esofágico inferior más alta (43,28 mmHg) y la media de la presión de relación integrada por encima de 15 mmHg (38,88 mmHg). El esófago hipercontráctil presentó media de contractilidad distal integrada elevada (5564,25 mmHg/s/cm). Se comprobó la existencia de contracciones rápidas en el espasmo esofágico distal (media de 21,4 cm/ s). Conclusiones: La manometría de alta resolución es factible de ser empleada para el diagnóstico de los trastornos motores esofágicos(AU)

Introduction: High-resolution manometry is the gold standard for the study of esophageal motor disorders. Objective: A descriptive, cross-sectional research was carried out in el Centro Nacional de Cirugía de Mínimo Acceso, between September 2018 and December 2019, in 56 patients, diagnosed with esophageal motor disorder by high-resolution manometry, aged between 18 and 20 years, who gave their consent to participate in the study. Esophageal achalasia and minor peristalsis disorders were excluded. The variables included were: age, sex, manometric diagnoses and their characteristics, symptoms, types of esophagogastric junction, imaging or endoscopic diagnoses. For the analysis of the results, the percentage, measures of central tendency and Pearson's chi square of homogeneity were used, with a level of statistical significance 8804; 0.05 and 95 percent reliability. Development: Absent contractility (39,28 percent), female sex (58,9 percent) and dysphagia (66,07 percent) predominated. The obstruction to the flow of the esophagogastric junction corresponded to the highest mean resting pressure of the lower esophageal sphincter (43,28 mmHg) and the mean integrated pressure ratio above 15 mmHg (38,88 mmHg). The hypercontractile esophagus presented mean high integrated distal contractility (5564,25 mmHg/s/cm). Rapid contractions were found in distal esophageal spasm (mean 21,4 cm/s). Conclusions: High resolution manometry was feasible to be used for the diagnosis of major esophageal motor disorders(AU)

Comparison of Two Specimen-Collection and Microscopy Methods for the Rapid Laboratory Diagnosis of Seborrheic Dermatitis- A Pilot Study

Malassezia spp. causes seborrheic dermatitis. For laboratory diagnosis, skin scrapings are collected and mounted in potassium hydroxide (KOH) for microscopy and processed for culture. Obtaining scrapings has disadvantages and KOH lacks colour contrast making interpretation difficult. This pilot study compared the results of specimen collection by cellophane tape method with scraping method. It also compared microscopy using Chicago Sky Blue 6B (CSB) stain plus KOH with the conventional method using KOH alone.METHODSSkin specimens were collected from the affected sites of 80 patients by scraping and cellophane tape. Specimens were subjected to KOH examination, KOH plus CSB stain, and culture for the presence of Malassezia spp.RESULTSA total of 160 specimens were collected from 80 patients for microscopy. Of 160 specimens, each was subjected to KOH and CSB plus KOH, 145 (91%) demonstrated Malassezia spp. by CSB plus KOH and 124 (77.5%) by KOH alone (p= 0.001). Cellophane tape method yielded 141 (88%) positive results compared to 128 (80%) by skin scraping (p=0.047). The odds of detecting Malassezia spp. was 4.4 times greater when the specimen was collected by cellophane tape and subjected to microscopy with CSB and KOH than when it was collected by scraping and examined microscopically with KOH alone (p= 0.002).CONCLUSIONSCellophane tape is a convenient method for specimen collection. CSB stain provides colour contrast and enables easy identification of fungal elements.

To evaluate the motility of the esophageal phase of swallowing among brainstem stroke survivors / 中华物理医学与康复杂志

Objective@#To evaluate the motility of the esophagus while swallowing of brainstem stroke survivors.@*Methods@#Eighteen patients and 10 healthy subjects were included in the study. There was no significant difference in average age, gender, weight or body mass index between the two groups. All underwent high-resolution esophageal manometry to assess esophageal motility while swallowing, and they were rated using the version 3.0 of the Chicago classification.@*Results@#Fourteen of the 18 stroke survivors displayed abnormal esophageal dynamics (77.8%), compared with only 10.0% of the healthy control group, but that difference was not statistically significant. The typical abnormalities were a lack of contraction, high pressure contractile esophagus, gastroesophageal junction outflow obstruction and/or distal esophageal spasm. Compared with the control group, the average resting pressure of the patients′ upper esophageal sphincters (UESs) was significantly lower, while the UES residual pressure and integrated relaxation pressure of their lower esophageal sphincters (LESs) were higher and the average UES relaxation time was significantly shorter. No significant differences were found in the LES resting pressures, distal contractile integrals or the distal latency between the two groups.@*Conclusions@#Abnormal esophageal motility is highly prevalent in brainstem stroke survivors and due attention should be paid to it. High-resolution manometry can be used to assess this condition.

Elevated Intrabolus Pressure Predicts Abnormal Timed Barium Esophagram in Esophagogastric Junction Outflow Obstruction

BACKGROUND/AIMS: Timed barium esophagram (TBE) is used the classification of esophageal motility disorders and assessing esophageal function. Currently, there are no published studies examining the relationship between high-resolution manometry and TBE in patients with esophagogastric junction outflow obstruction (EGJOO). This study seeks to evaluate this relationship and identify manometric variables that may indicate further evaluation using TBE. METHODS: Retrospective review of medical records identified patients with a diagnosis of EGJOO per the Chicago classification version 3.0. TBE was performed using standard protocol. Patients were divided into 2 groups based on complete emptying or persistence of standing barium column at 5 minutes. RESULTS: Eleven patients were identified with EGJOO who underwent both high-resolution manometry and TBE within 3 months. Five patients had no standing barium column at 5 minutes, while 6 patients had a persistent barium column. Mean age of each group was 54.0 years and 57.8 years, respectively. Patients with abnormal TBE were found to have significantly elevated intrabolus pressure (IBP) compared with patients who had a normal TBE. CONCLUSIONS: In our study, we found significant differences in IBP between these patient groups. These findings suggest that patients with EGJOO and elevated IBP may prompt further clinical evaluation with TBE in order to clarify clinical diagnosis and guide therapeutic intervention.

Understanding the Chicago Classification: From Tracings to Patients

Current parameters of the Chicago classification include assessment of the esophageal body (contraction vigour and peristalsis), lower esophageal sphincter relaxation pressure, and intra-bolus pressure pattern. Esophageal disorders include achalasia, esophagogastric junction outflow obstruction, major disorders of peristalsis, and minor disorders of peristalsis. Sub-classification of achalasia in types I, II, and III seems to be useful to predict outcomes and choose the optimal treatment approach. The real clinical significance of other new parameters and disorders is still under investigation.

Cómo realizar e interpretar una manometría esofágica de alta resolución usando la clasificación de Chicago 3. 0 / How to perform and interpret a high resolution esophageal manometry using the Chicago 3.0 classification

Resumen Con la introducción de la manometría esofágica de alta resolución se revelaron patrones no identificados previamente de la función esofágica. De igual forma, este método diagnóstico adiciona patrones de presión topográfica de la presión esofágica, lo que lleva al desarrollo de nuevas herramientas para el análisis y clasificación de desórdenes motores esofágicos. En la actualidad, la clasificación de Chicago 3.0 es la herramienta de análisis de los diferentes trastornos motores esofágicos. En Colombia, cada día se ve el crecimiento en la realización de este estudio. El artículo propone hacer una revisión de cómo realizar e interpretar una manometría esofágica de alta resolución y clasificar los diferentes trastornos de la motilidad esofágica según la última actualización de la clasificación de Chicago 3.0.

Abstract The introduction of high resolution esophageal manometry has led to the revelation of previously unidentified patterns of esophageal function. Similarly, this diagnostic method has revealed topographic patterns of esophageal pressure which has led to the development of new tools for analysis and classification of esophageal motility disorders. Currently, the Chicago 3.0 classification has become a tool for analysis of the various esophageal motility disorders. In Colombia, the use of this study is spreading and growing. This article reviews of how to perform and interpret high resolution esophageal manometry and shows how to classify esophageal motility disorders according to the latest update of Chicago 3.0.

Antinociceptive effects of chicago sky blue 6B: A vesicular glutamate transporters inhibitor / 国际药学研究杂志

Objective To investigate the effects of inhibiting vesicular glutamate transporters (VGLUT) on pain behaviors in animals. Methods The latency in hot plate test, number of writhes in acetic acid and licking time in formeldehyde solution (formalin) tests were recorded to determine the analgesic effect of Chicago sky blue 6B (CSB6B), a selective VGLUT inhibitor. Results Intraperitoneal administration of CSB6B did not affect the acute thermal pain responses in hot plate test. In acetic acid writhing, compared with control group (26.50±2.97), CSB6B (2.5 mg/kg, ip) significantly attenuated the acetic acid-induced writhing (8.22±1.90) 30 min after administration (P<0.01); CSB6B (2.5 mg/kg, ip) significantly reduced the acetic acid-induced writhing (9.60±1.84) 60 min after administration (P<0.01). In Formalin test, compared with control group(139.40±21.02), CSB6B 0.5 mg/kg, ip) significantly reduced the licking time 75.10±19.45) 30 min after administration P<0.05) during the second phase, but not during the first phases. CSB6B(p) did not affect the licking time 2 h after administration during the first and second phases. Conclusion Inhibition of VGLUTs activity is sufficient to attenuate the inflammatory pain and this finding suggests that VGLUT participate in regulation of inflammatory pain and be a novel therapeutic strategy for treatment of pain.

Antinociceptive effects of Chicago sky blue 6B:a vesicular glutamate transporters inhibitor / 国际药学研究杂志

Objective To investigate the effects of inhibiting vesicular glutamate transporters (VGLUT) on pain behaviors in animals. Methods The latency in hot plate test, number of writhes in acetic acid and licking time in formeldehyde solution (formalin) tests were recorded to determine the analgesic effect of Chicago sky blue 6B (CSB6B), a selective VGLUT inhibitor. Results Intraperitoneal administration of CSB6B did not affect the acute thermal pain responses in hot plate test. In acetic acid writhing, compared with control group (26.50 ±2.97), CSB6B (2.5 mg/kg, ip) significantly attenuated the acetic acid-induced writhing (8.22±1.90) 30 min after administration (P<0.01);CSB6B (2.5 mg/kg, ip) significantly reduced the acetic acid-induced writhing(9.60±1.84) 60 min after administration(P<0.01). In Formalin test, compared with control group(139.40±21.02), CSB6B (0.5 mg/kg, ip) significantly reduced the licking time(75.10±19.45) 30 min after administration(P<0.05) during the second phase, but not during the first phases. CSB6B(ip) did not affect the licking time 2 h after administration during the first and second phases. Conclusion Inhibition of VGLUTs activity is sufficient to attenuate the inflammatory pain and this finding suggests that VGLUT participate in regulation of inflammatory pain and be a novel therapeutic strategy for treatment of pain.

Clinical and Esophageal Dynamic Characteristics of Patients with Achalasia of Cardia Evaluated by Chicago Classification Criteria / 胃肠病学

BacKground:AchaIasia of cardia is categorized into 3 subtypes by Chicago cIassification criteria defined by high-resoIution manometry( HRM). These different subtypes present different cIinicaI and esophageaI dynamic characteristics. Aims:To study the cIinicaI and esophageaI dynamic characteristics of patients with achaIasia of cardia categorized by Chicago cIassification criteria. Methods:Twenty-five untreated achaIasia of cardia patients from January 2012 to ApriI 2014 at Beijing Friendship HospitaI,CapitaI MedicaI University were enroIIed. CIinicaI data incIuding cIinicaI symptoms, manifestations of endoscopy and barium meaI radiography and data of HRM were anaIyzed retrospectiveIy. Results:Of the 25 patients,5 patients(20. 0%)were cIassified as type Ⅰ,15(60. 0%)as type Ⅱ and 5(20. 0%)as type Ⅲ. AII patients compIained as having dysphagia,and 26. 7%( 4/15 ) of type Ⅱ patients had chest pain. Incidences of regurgitation in typeⅠ,ⅡandⅢwere 60. 0%(3/5),53. 3%(8/15)and 20. 0%(1/5),respectiveIy,no significant difference was found among the three types(P>0. 05). Incidences of diIatation of esophagus in type Ⅰ,ⅡandⅢwere 60. 0%(3/5),73. 3%(11/15)and 20. 0%(1/5),respectiveIy,no significant difference was found among the three types (P=0. 11). No differences in Iength of Iower esophageaI sphincter(LES),abdominaI LES Iength,LES resting pressure, upper esophageaI sphincter( UES)resting pressure and integrated reIaxation pressure( IRP)among the three types were found(P>0. 05). Incidences of muItipIe swaIIowing and spontaneous UES reIaxation were 32. 0%(8/25)and 24. 0%(6/25),respectiveIy,no significant difference was found among the three types(P>0. 05). Conclusions:Of the patients with achaIasia of cardia ,typeⅡis more common. Large-sampIe muIticenter studies are needed for further research.

High-resolution Manometry: Esophageal Disorders Not Addressed by the "Chicago Classification"

The development of the high-resolution esophageal manometry (HRM) and the Chicago classification have improved the diagnosis and management of esophageal motility disorders. However, some conditions have yet to be addressed by this classification. This review describes findings in HRM which are not included in the current Chicago classification based on the experience in our center. This includes the analysis of the upper esophageal sphincter, proximal esophagus, longitudinal muscle contraction, disorders related to gastroesophageal reflux disease and respiratory symptoms. The utility of provocative tests and the use of HRM in the evaluation of rumination syndrome and post-surgical patients will also be discussed. We believe that characterization of the manometric findings in these areas will eventually lead to incorporation of new criteria into the existing classification.

Development of the department of medical education at the university of Illinois at Chicago and its inspiration / 中华医学教育探索杂志

Since 1959,the Department of Medical Education at the University of Illinois at Chicago(UIC DME)has experienced five stages,i.e.,formation,going to the world,turmoil,consolidation and prosperous prospects.UIC DME has been contributing a lot to its home institute,medical schools in the United States and also the world's health professions education.There are many aspect,;worth learning from it:such as variOtis institution-based services;multi-discipline faculty for the department;innovative multi-field researches;efficient and effective communication and stimulation for faculty and staff;fruitful collaboration with other organizations and winning active leadership supports.

Lesões coriorretinianas em mães de crianças com toxoplasmose congênita no national collaborative Chicago-based, toxoplasmosis study / Chorioretinal lesions in mothers of children with congenital toxoplasmosis in the national collaborative Chicago-based, congenital toxoplasmosis study

Aims: To determine whether mothers of children with congenital toxoplasmosis have chorioretinal lesions consistent with toxoplasmosis. Methods: Prospective cohort study. Ophthalmologists in our study have examined 173 children with congenital toxoplasmosis in a hospital outpatient setting. These children were referred to us by their primary care physicians. One hundred and thirty mothers of these children had retina examinations of both eyes at least once. Main outcome measure was lesion(s) consistent with ocular toxoplasmosis. Results: Of 130 mothers examined between 1991-2005, 10 (7.7%, 95% Confidence Interval 3.8%, 13.7%) had chorioretinal lesions which likely represent resolved toxoplasmic chorioretinitis. Most of these were small peripheral chorioretinal lesions. None reactivated between 1991-2005. Conclusions: Chorioretinal lesions consistent with quiescent ocular toxoplasmosis occur in mothers of children with congenital toxoplasmosis in the United States.