ABSTRACT
BACKGROUND: There is no simple method to measure intravariceal pressure in patients with esophageal varices. OBJECTIVE: Our purpose was to develop a new noninvasive technique to measure resting intravariceal pressure and wall tension. DESIGN: A model was developed. A long balloon (varix) was fitted inside an airtight cylinder (esophagus). Fluid ran through the model varices to maintain 5 different constant pressures. An endoscope was placed in the model esophagus, and pressure was increased by air insufflation. The endoscopy and pressure readings from the esophagus and varix were recorded continuously until variceal collapse. SETTING: Patient studies were done in an endoscopy suite with the patient under fentanyl and midazolam sedation. PATIENTS: Esophageal pressure was measured during air insufflation in patients with varices until the varices collapsed. EUS was used to measure radius and wall thickness to calculate wall tension. RESULTS: In the varix model, the mean (SD) intraluminal esophageal pressures at variceal flattening for the model varices at 5, 10, 15, 20, and 25 mm Hg were 5.69 (0.34), 11 (0.32), 15.72 (0.51), 21.55 (0.63), and 25.8 (0.14) mm Hg. The correlation between actual and measured variceal pressure in the model at variceal flattening was r = 0.98. In the patients, a total of 10 varices in 3 patients were evaluated. The mean (SD) for the varices in each subject was 12.16 (2.4), 23.2 (1.3), and 6.5 (2.2) mm Hg for subjects 1, 2, and 3, respectively. CONCLUSION: Standard endoscopy with air insufflation and manometry can be used as an accurate, simple, and reproducible method to measure intravariceal pressure.
Subject(s)
Esophageal and Gastric Varices/diagnosis , Esophagoscopy/methods , Manometry/methods , Signal Processing, Computer-Assisted , Endosonography/methods , Esophageal and Gastric Varices/complications , Esophagus/blood supply , Gastrointestinal Hemorrhage/etiology , Gastrointestinal Hemorrhage/prevention & control , Humans , Insufflation , Male , Middle Aged , Models, Theoretical , Muscle, Smooth, Vascular/physiology , Pressure , Risk Assessment , Sensitivity and Specificity , Tensile Strength , Video RecordingABSTRACT
Parietal bone defects are rare and exhibit variable etiologies. We report on a 16-year-old girl with an isolated, giant parietal bone defect with encephalomalacia, and an asymptomatic Rathke's cleft cyst. The patient presented with epilepsy. We discuss the differential diagnosis and pertinent neurologic associations. Irrespective of cause, parietal bone defects remain a benign clinical entity. However, it is important to define the extent of the bone defect and associated intracranial abnormalities, and if needed, to take early preventive steps, medical as well as surgical, against potential brain damage.
