The effect of posture on esophageal ph in endoscopy normal reflux disease (ENRD) cases.

Purpose of the study Endoscopy Normal Reflux Disease (ENRD) is a common presentation of reflux disease. These patients are symptomatic but do not have abnormal endoscopy findings. They may have pathological intraesophageal reflux. Lifestyle modifications are the mainstay of management of these patients. Posture plays an important role in their management. It was felt that exact quantification of reflux pattern with different postures in ENRD cases should be studied to include it as a part of management of these cases. Basic Procedures Fifteen male patients were studied. 24 h ambulatory pH metry was done for all patients. Half an hour recording was studied for various postures: supine, supine with 30° head end elevated, upright, right and left lateral recumbent position. The data of pH metry for half an hour of each of these postures was studied. Results and Interpretation All fifteen patients were ENRD cases and were upright refluxers. None of them had an abnormal supine reflux pattern. The percentage time of reflux and the reflux episode duration was significantly low in supine (P<0.05) and supine with 30° head end elevated (P<0.005). Conclusion In our study of 15 upright refluxers, supine with 30° head end elevated and supine position were the postures associated with least reflux. Posture can help reduce the reflux significantly and can be used as an effective means in management.

Beta-adrenoreceptor blockade attenuates heat-induced tachycardia,but not the tolerance to the stress.

Ten healthy males (age 34 +/- 3 yr 9 SE) underwent 40 min of heat exposure (WD 39.7.C) after 2 hours of ingesting 120 mg of Propranolol (Inderal; ICI), or a placebo, in a random manner, the exposures being about a week apart. That there was no placebo effect was ensured by giving a control run (no medication). In the placebo trials, the end-experiment heart rate had increased by 52%, while after propranolol the increase was only 43%. Regression analysis showed that with the placebo, the HR increased by 22 beats/min/o rise in core (aural) temperature, while with propranolol, the rise (14 beats/min) was significantly lower (P < 0.02). The various heat strain indices viz the Craig's Index, the Body heat storage (Kilocals/m2/hr), and the effective heat storage were also similar for both the treatments. We conclude that beta-adrenoreceptor activity plays a significant role in producing tachycardia of heat exposure in humans, but blocking this activity with propranolol does not affect tolerance to heat stress.

Calcium channel blockers and the CVS reflex responses during lower body suction.

Nine normal men (mean age 27.6 yr) were exposed to continuous lower-body suction pressure (LBSP) of -20 to -50 mmHg (for 5 min at each level) on four different occasions after having consumed a single oral therapeutic dose of either diltiazem, nifedipine, verapamil, or a placebo, randomly, in a single blind manner. The suction was applied at 12.30 pm in all experiments, while the medications were administered in such a manner so that their expected peak plasma levels would have been achieved at the time of suction application. The cardiovascular reflex effects commenced at a pressure of -30 mmHg, and peaked at -50 mmHg. The increases in the heart rate for all treatments at -50 mmHg was statistically similar (about 16-20 beats/min). The systolic BP fell by about 9 mmHg for the placebo experiments, and this change was not different from the changes produced by the 3 Calcium channel blocker treatments. The diastolic BP increase was about 3 mmHg. The Cardiac index did not vary significantly. Our results suggest that the commonly used Ca++ channel blockers do not adversely affect orthostatic tolerance.

Peak expiratory flow rates in elderly Indians.

Peak expiratory flow rates were measured in 124 normal elderly men (55-85 yr) using the Wright's peak flow meter. In the less than 60 yrs age group (n = 32; mean age 57.7 yr) the PEFR was 431 +/- 13 lpm, while for the group greater than 60 yr (mean age 69.0 +/- 6.0; n = 92), the PEFR value was 373 +/- 11 1pm. These values are similar to those reported in other Indian studies, suggesting that the ethnic variations amongst Indian subjects do not affect the PEFR. However, the reported values are lower than those observed in Europeans, but greater than those of Chinese. The PEFR regressed at a rate of 4.47 1pm/year increase in age, but is positively correlated to the subjects' height (cm), and their FVC and FEVI. The smokers had a significantly higher PEFR as compared with the non-smokers. This finding was contrary to what was expected.