ABSTRACT
Esophageal manometry is an important investigation method but its direct impact on patients' well-being has not been studied. A structured questionnaire was given to all patients (n=92) after the manometry during one calendar year. The response rate was 91%. A total of seventy-one patients also reported their health status during the next 24 h. No serious side-effects were recorded. About half of the respondents regarded manometry as an easy or fairly easy investigation. The most common problems were irritation of nose and throat. In total, 48% of the respondents had mild to moderate late symptoms after manometry, usually soreness of the throat or nose lasting for some hours. The manometry was more troublesome to women than to men. It is concluded that esophageal manometry is generally a benign and fairly tolerated investigation, and the high level of anxiety that many patients show before the manometry is not well justified.
Subject(s)
Esophageal Diseases/diagnosis , Manometry/adverse effects , Manometry/methods , Adult , Age Factors , Aged , Female , Finland , Humans , Incidence , Male , Middle Aged , Pain/epidemiology , Pain/etiology , Pain Measurement , Patient Participation , Probability , Prospective Studies , Risk Assessment , Sampling Studies , Sex Factors , Statistics, Nonparametric , Surveys and QuestionnairesABSTRACT
Chronic cough is a stressful condition and can lead to extensive investigations. Bronchial asthma and postnasal drip syndrome are common causes, but sometimes the origin of cough is outside the respiratory tract (1,2). Such a relatively simple test as esophageal pH probing may suggest appropriate (antireflux) therapy.
Subject(s)
Cough/etiology , Gastroesophageal Reflux/diagnosis , Adolescent , Asthma/complications , Asthma/diagnosis , Chronic Disease , Diagnosis, Differential , Gastroesophageal Reflux/complications , Humans , Male , Rhinitis/complications , Rhinitis/diagnosis , Sinusitis/complications , Sinusitis/diagnosisABSTRACT
A slowly upsloping ST segment depression is an abnormal, and a rapidly upsloping ST segment depression is a normal exercise ECG response. We investigated the agreement of expert physicians on the visual classification of the ST segment depression, and compared the (majority) vote with the computer-generated ST slope. A total of 206 exercise ECG leads with an amplitude of the ST segment depression > or = 0.15 mV and a ST segment slope > or = 0.5 mVs(-1) were evaluated. All three interpreters agreed in 68 cases, two agreed in 123 cases, and all disagreed in 15 cases. Intraobserver agreement was 61%. The ST segment slope was significantly (p < 0.001) greater in leads generally interpreted as rapidly upsloping (n = 38; 2.1 +/- 0.8 mVs(-1)), than in those interpreted as slowly upsloping (n 121; 1.3 +/- 0.6 mVs(-1)) or horizontal (n = 32; 1.1 +/- 0.4 mVs(-1)), although there was some overlap. Thus, standardization of the computer-assisted exercise ECG interpretation should be continued.
Subject(s)
Coronary Disease/diagnosis , Electrocardiography , Exercise Test , Signal Processing, Computer-Assisted , Adult , Aged , Analysis of Variance , Chest Pain/diagnosis , Diagnosis, Computer-Assisted , Female , Humans , Male , Middle Aged , Observer Variation , Probability , Sensitivity and Specificity , Visual PerceptionABSTRACT
Gas compression profile may aid in the diagnosis of airway obstruction. However, the behavior of this parameter in repeated tests and the deviations in patients with bronchial asthma have not been thoroughly described. Thirty-six health subjects aged 6-16 years were studied in two test sessions with a pressure/flow plethysmograph, and 57 asthmatic patients of similar age were studied once. Three volumes of compressed thoracic gas (Vcomp) were obtained: with 25%, 50% and 75% of vital capacity (VC) expired. Relative Vcomp was calculated using the actual amount of gas remaining in the lungs. Regarding the best and second best manoeuvre, coefficient of variation (CoV) in Vcomp ranged from 47 to 79% (controls) and from 48 to 112% (patients). Regarding the best manoeuvre in the first and second test session (controls), CoV in Vcomp ranged from 73 to 159%. Bronchodilator response had an extreme individual variation, and the changes were insignificant in both groups. In the paediatric population, the poor repeatability of Vcomp invalidates its use in clinical assessment of pulmonary function.
Subject(s)
Asthma/physiopathology , Lung/physiopathology , Adolescent , Analysis of Variance , Case-Control Studies , Child , Female , Forced Expiratory Volume , Humans , Male , Plethysmography, Whole Body , Reproducibility of Results , Vital CapacityABSTRACT
In bronchial asthma, measurement of absolute lung volumes may reveal lung dysfunction more readily than forced expiratory spirometry. Sixty-one children (aged 4-16 years) with mild to moderate bronchial asthma and 35 children (aged 7-16 years) with other symptoms of the lower airways (OSLA) were studied, and the plethysmographic results were compared with data obtained from 36 healthy volunteers aged 6-16 years. In the first test session, repeatability of forced expiratory volume in one second (FEV1), forced vital capacity (FVC), residual volume (RV), functional residual capacity (FRC) and total lung capacity (TLC) were good. Control subjects were also tested the next day, and intra-subject variability of repeat pulmonary function testing was in the normal range. The FEV1/FVC ratio was significantly higher in control subjects than in patients with asthma or OSLA, but only the decrease in RV after bronchodilator challenge separated patients with asthma from patients with OSLA. Changes in FEV1 and RV after bronchodilator challenge had a significant, although low, inverse correlation. An increase of > or = 5% in FEV1 had a positive predictive value of 44% and a negative predictive value of 68% for the clinical diagnosis of bronchial asthma; for a decrease of > or = 24% in RV, the figures were 86% and 71% respectively. The support of baseline absolute lung volumes on clinical decision-making is not necessarily great. Bronchodilator response, particularly in RV, is more pertinent and may enhance the detection of reversible lung dysfunction.
Subject(s)
Residual Volume/physiology , Respiratory Tract Diseases/diagnosis , Adolescent , Asthma/physiopathology , Bronchodilator Agents , Child , Chronic Disease , Female , Forced Expiratory Volume/drug effects , Forced Expiratory Volume/physiology , Functional Residual Capacity/drug effects , Functional Residual Capacity/physiology , Humans , Male , Plethysmography , Reference Values , Residual Volume/drug effects , Respiratory Function Tests , Respiratory Tract Diseases/physiopathology , Spirometry , Total Lung Capacity/drug effects , Total Lung Capacity/physiology , Vital Capacity/drug effects , Vital Capacity/physiologyABSTRACT
Electrocardiographic estimation of myocardial injury has, in some studies, correlated poorly with the extent of nuclear perfusion defects at rest and with changes in the left ventricular ejection fraction after acute reperfusion therapy. The authors investigated 16 patients with fatty acid scintigraphy and with the Selvester-Wagner QRS score 2 weeks and 3 months after an anterior myocardial infarction. Segmental uptake on tomographic scans was semiquantitatively classified as low, moderate, or normal. The analysis included a total of 707 segments. QRS scores and the number of segments with low fatty acid uptake did not significantly change during the follow-up period, although the number of segments with moderate fatty acid uptake decreased from 15.9 +/- 5.1 to 12.4 +/- 5.7 (P < .05). The QRS score correlated significantly (rho = .56-.64) with low fatty acid uptake, but not with moderate fatty acid uptake. It is concluded that the QRS score is related to the degree of permanent myocardial injury, even after thrombolysis.
