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8. Impact of ingested liquids on 24-hour ambulatory pH tests.

Author

Shoenut, J., Duerksen, Donald, Yaffe, Clifford, Shoenut, J P, Duerksen, D, and Yaffe, C S

Abstract

A prospective investigation of the impact of ingested liquids on 24-hr pH test scores was conducted. Eighty-two patients contributed 142 samples. The liquids used were coffee/tea (N = 35), water (N = 32), fruit juice (N = 29), cola (N = 34), and beer (N = 12). The pH of cola, juice, and beer are approximately 3.0. The parameters studied included: total test time, total drink time, total minutes of pH < 4.0 during drink, minutes of < pH 4.0 10 min before drink, and minutes of pH < 4.0 10 min following drink. Analysis was performed using one-way ANOVA and repeated measures. Age of patients, total test time, and total time pH < 4.0 were not significantly different (P > 0.05). The total time to consume the drink was significantly greater (P < 0.05) for beer than all other liquids. The total time (7.7 +/- 6.0 min) pH < 4.0 for cola was significantly different (P < 0.023) than beer (3.3 +/- 3.7 min), tea/coffee (1.4 +/- 6.5 min), and water (1.1 +/- 2.5 min). The percentage of total time pH < 4.0 was not significantly different (P > 0.05) among any of the liquids. The percentage of time pH < 4.0 during the drink was the highest for cola (63 +/- 47%) and juice (51 +/- 57%); water, coffee/tea, and beer were not significantly different (P > 0.05). Although the impact of cola and juice were the greatest, none of these had an impact that exceeded 0.5%. The lack of impact of beer appears to be due to the increased period of time it takes to consume. We conclude that the impact of ingested fluids is minimal and can probably be disregarded in most patient groups. [ABSTRACT FROM AUTHOR]

Published
1998
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9. Solitary hepatic metastasis: comparison of dynamic contrast-enhanced CT and MR imaging with fat-suppressed T2-weighted, breath-hold T1-weighted FLASH, and dynamic gadolinium-enhanced FLASH sequences.

Author

Semelka, Richard C., Shoenut, J. Patrick, Ascher, Susan M., Kroeker, Mervyn A., Greenberg, Howard M., Yaffe, Clifford S., Micflikier, Allan B., Semelka, R C, Shoenut, J P, Ascher, S M, Kroeker, M A, Greenberg, H M, Yaffe, C S, and Micflikier, A B

Published
1994
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12. Canadian Surgery Forum.

Author

Fayez R, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, AlMuntashery A, Fayez R, Demyttenaere S, Christou N, Court O, Bodie G, Bonrath E, Hagen J, Okrainec A, Sullivan P, Grantcharov T, Almamar A, Sharma A, Karmali S, Birch DW, Gill RS, Majumdar SR, Wang X, Tuepah R, Klarenbach SW, Birch DW, Karmali S, Sharma AM, Padwal RJ, Raîche I, Smith C, Haggar F, Moloo H, Poulin EC, Martel G, Yelle JD, Mamazza J, Mueller CL, Jackson TD, Penner T, Pitzul K, Urbach DR, Okrainec A, AlMuntashery A, Villeneuve S, Roy M, Fayez R, Demyttenaere S, Christou N, Court O, Fayez R, Roy M, Villeneuve S, AlMuntashery A, Demyttenaere S, Christou N, Court O, AlMuntashery A, Fayez R, Demyttenaere S, Court O, Christou N, Moustarah F, Biertho L, Hould FS, Lebel S, Lescelleur O, Marceau S, Marceau P, Biron S, Khokhotva M, Grantcharov T, Anvari M, Sharma A, Yusuf S, Kwong J, Okrainec A, Pitzul KB, Urbach DR, Jackson T, Elkassem S, Lindsay D, Sullivan P, Smith L, Bonrath E, Zevin B, Dedy N, Grantcharov TP, Zevin B, Bonrath EM, Aggarwal R, Grantcharov T, Sockalingam S, Cassin S, Crawford S, Pitzul K, Khan A, Hawa R, Jackson T, Okrainec A, Smith C, Brar B, Mamazza J, Raîche I, Yelle JD, Haggar F, Moloo H, Smith C, Brar B, Haggar F, Dent R, Mamazza J, Raîche I, Moloo H, Whitlock KA, Gill RS, Ali T, Shi X, Birch DW, Karmali S, Gill RS, Whitlock KA, Shi X, Sarkhosh K, Birch DW, Karmali S, Suri M, Turner JM, Nation PN, Wizzard P, Brubaker PL, Gisalet DL, Wales PW, Palter VN, Grantcharov TP, Wakeam E, Tien H, Spencer F, Brenneman F, Khan RSA, Kowal J, Wiseman SM, Martelli V, Fraser SA, Vedel I, Deban M, Holcroft C, Monette M, Monette J, Bergman S, Malik A, Bell C, Stukel T, Urbach DR, Young PY, Mueller TF, Lucykx VA, Lukowski CM, Compston CA, Churchill TA, Khadaroo RG, Daigle C, Grantcharov T, McCreery G, Vogt K, Dubois L, Gray D, Seth R, Ananth A, Tai LH, Lam T, Falls T, Souza C, Bell J, Auer R, Paskar D, Crawford S, Parry N, Leslie K, Sudarshan M, Alhabboubi M, St-Louis E, Deckelbaum D, Razek T, Feldman LS, Khwaja K, Richardson D, Porter G, Johnson P, Haggar F, Boushey R, Moloo H, Raiche I, Mamazza J, Davis VW, Schiller DE, Eurich D, Sawyer MB, Rivard J, Vergis A, Unger B, Hardy K, Andrew C, Gillman L, Park J, Agzarian J, Prodger J, Kelly W, Kelly S, Prodger D, Racz J, Ewara E, Martin J, Sarma S, Chu M, Schlachta C, Zaric G, Winocour J, Al-Ali K, Briggs K, George R, Zilbert NR, Murnaghan ML, Leung A, Regehr G, Moulton CA, Decker C, Neumann K, Mahmud S, Metcalfe J, McKay A, Park J, Hochman D, Gosney JE Jr, Burkle FM Jr, Redmond AD, McQueen K, Wissanji H, Desrosiers E, Gilbert A, Chadi SA, Leslie K, Ott MC, Alhabboubi M, Sudarshan M, Jessula S, Alburakan A, Deckelbaum D, Razek T, Iqbal S, Khwaja K, Partridge E, Aikins C, Alhabboubi M, Sudarshan M, Deckelbaum D, Iqbal S, Khwaja K, Razek T, Olszewski M, Roberts N, Moulton CA, Murnaghan ML, Cil T, Chan R, Marshall J, Pederson K, Erichsen S, White J, Nadler A, Aarts MA, Okrainec A, Victor JC, Pearsall E, McLeod RS, Hameed U, Jackson TD, Okrainec A, Penner TP, Urbach DR, Brotherhood H, Karimuddin A, Hall C, Bawan S, Malik S, Hayashi A, Menezes AS, Gill RS, McAlister C, Zhang N, DesRosiers E, Mills A, Crozier M, Lee L, Maxwell J, Partridge E, Chad S, Steigerwald S, Mapiour D, Roberts D, MacPherson C, Donahoe L, MacDonald B, Mercer D, Hopman W, Rakovich G, Latulippe JF, Hilsden R, Knowles S, Moffat B, Parry N, Leslie K, Merani S, Switzer N, Khadaroo RG, Tul Y, Widder S, Davis P, Molinari M, Levy A, Johnson P, Davis PJB, Bailey J, Molinari M, Hayden J, Johnson P, Cools-Lartigue J, Benlolo S, Marcus V, Ferri L, Ojah J, Finley R, Anderson D, Julien F, Gagné JP, Carter D, Chan S, Wong S, Li J, Michael A, Choi D, Liu E, Hoogenes J, Dath D, Pitt D, Aubin JM, Banks BA, Mew D, McConnell Y, Rudovics A, Classen D, Kanthan S, Ravichandran P, Croome KP, Kovacs MJ, Lazo-Langner A, Hernandez-Alejandro R, Anantha R, Vogt K, Crawford S, Parry N, Leslie K, Aad I, Kholdebarin R, Khoshgoo N, Iwasiow BM, Keijzer R, Aird LNF, Brown CJ, Wong SL, Isa D, Pace D, Payne JRM, Widder S, Tul Y, Primrose M, Hudson D, Khadaroo RG, Hallet J, Lauzier F, Mailloux O, Trottier V, ARchambault P, Zarychanski R, Turgeon AF, Mailloux O, Farries L, Hardy P, Muirhead RM, Raiche I, Masters J, Haggar F, Poulin HMEC, Martel G, Mamazza J, Botkin C, Milbrandt C, Keijzer R, Morency D, Sideris L, Grenier-Vallée P, Latulippe JF, Dubé P, Berger-Richardson D, Kurashima Y, Kaneva P, Feldman LS, Fried GM, Vassiliou MC, Isa AD, Kwan AH, Dupuis I, Fraser SA, Schweigert M, Solymosi N, Rauh N, Dubecz A, Renz M, Ofner D, Stein HJ, Koubi S, Borgaonkar M, Ernjakovic M, Crystal P, Easson A, Escallon J, Reedijk M, Cil T, Leong WL, McCready DR, Grant K, Clifton J, Mayo J, Finley R, Cools-Lartigue J, Noreau-Nguyen M, Mulder DS, Ferri LE, Carrott P, Markar S, Hong J, Low DE, Stafford T, Maslow A, Davignon K, Ng T, Malthaner R, Tan L, Aruranian J, Kosa S, Sudarshan M, Ferri LE, Hanna WC, Murphy G, Allison F, Moshonov H, Darling GE, Waddell TK, De Perrot M, Cypel M, Yasufuku K, Keshavjee S, Paul NS, Pierre AF, Lee L, Darling G, Pedneault C, Marcus V, Mulder DS, Ferri LE, Markar S, Low D, Razzak R, Roa W, Löbenberg R, McEwan S, Bédard EL, Bharadwaj SC, Louie BE, Farivar AS, McHugh SP, Aye RW, Ashrafi AS, Tan-Tam C, De Vera M, Bond RJ, Ong SR, Johal B, Schellenberg D, Po M, Nissar S, Lund C, Ahmadi SY, Ouellette D, Wakil N, Rakovich G, Beauchamps G, Markar S, Preston S, Baker C, Low D, Bottoni DA, Campbell G, Malthaner RA, Knickle C, Bethune D, Henteleff H, Johnston M, Buduhan G, Coughlin S, Coughlin HE, Roth L, Bhandari M, Malthaner R, Gazala S, Johnson J, Kutsogiannis J, Bédard E, Gazala S, Rammohan K, Stewart K, Bédard E, Donahoe L, Buduhan G, Walker K, Gruchy J, Xu Z, Buduhan G, Li C, Ferri LE, Mulder DS, Ncuti A, Neville A, Kaneva P, Watson D, Vassiliou M, Carli F, Feldman LS, Alnasser S, Av R, Mayrand S, Franco E, Ferri LE, Schweigert M, Dubecz A, Renz M, Stadlhuber RJ, Ofner D, Stein HJ, Schweigert M, Renz M, Dubecz A, Solymosi N, Thumfart L, Ofner D, Stein HJ, Zhuruk A, Croome K, Leeper R, Hernandez R, Hanouf A, Livingstone S, Sapp J, Woodhall D, Alwayn I, Vanounou T, Bergman S, Karanicolas P, Lam-McCulloch J, Balaa F, Jayaraman S, Quan D, Wei A, Guyatt G, Aubin JM, Rekman JF, Fairfull-Smith RJ, Mimeault R, Balaa FK, Martel G, Yeung JC, Boehnert MS, Bazerbachi F, Knaak JM, Selzner N, McGilvray ID, Rotstein OD, Adeyi OA, Levy GA, Keshavjee S, Grant DR, Selzner M, Dumitra S, Khalil JA, Jamal M, Chaudhury P, Zogopoulos G, Petrakos P, Tchervenkov J, Barkun J, Simoneau E, Jamal MH, Hassanain M, Chaudhury P, Wong S, Salman A, Tran T, Metrakos P, Vanounou TT, Groeschl RT, Geller DA, Marsh JW, Gamblin TC, Howe B, Croome K, Hawel J, Croome K, Quan D, Hernandez R, Jang JH, Kim PTW, Greig PD, Gallinger S, Moulton CA, Wei AC, Fischer SE, Cleary SP, Bertens K, Vogt KN, Hernandez-Alejandro R, Gray DK, Rekman JF, Aubin JM, Fairfull-Smith JJ, Mimeault R, Balaa FK, Martel G, Wei AC, Devitt KS, Ramjaun A, Gallingher S, Dumitra S, Alabbad S, Constantinos D, Hassanein M, Barkun J, Metrakos P, Paraskevas S, Chaudhury P, Tchervenkov J, Koubi S, Borgaonkar M, Ouellet JF, Tanyingoh D, Dixon E, Kaplan GG, Myers RP, Howard TJ, Sutherland FR, Zyromski NJ, Ball CG, Wei AC, Coburn N, Moulton CA, Cleary SP, Law CH, Greig P, Steven G, Covelli A, Baxter N, Fitch M, Wright F, Maniar R, Hochman DJ, Wirtzfeld DA, McKay A, Yaffe CS, Yip B, Silverman R, Park J, Sun S, McConnell YJ, Temple WJ, Mack LA, Davis VW, Schiller DE, Bathe OF, Sawyer MB, Brackstone M, Scott L, Vandenberg T, Perera F, Potvin K, Chambers A, Boissonneault R, Loungnarath R, DeBroux É, Lavertu S, Donath D, Ayoub JP, Tehfé M, Richard C, Kim SHH, Cornacchi SD, Heller B, Farrokhyar F, Babra M, Lovrics PJ, Baliski C, Liberto C, Gazala S, Ghosh S, McLean R, Schiller D, Hameed U, Jackson TD, Okrainec A, Penner TP, Urbach DR, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Arnaout A, Seely J, Smylie J, Knight K, Robertson S, Watters J, Wedman D, Zhang T, Arneout A, Nostedt M, Hochman D, Wirtzfeld D, McKay A, Yip B, Yaffe CS, Silverman R, Park J, Hebbard P, Baxter N, Yun L, Rakovitch E, Wright F, Warner E, McCready D, Hodgson N, Quan ML, Shetty SJ, Natarajan B, Govindarajan V, Thomas P, Loggie BW, Dixon M, Brar S, Mahar A, Law C, Coburn N, Wei AC, Devitt KS, Wiebe M, Bathe OF, McLeod RS, Baxter NN, Gagliardi AR, Kennedy ED, Urbach DR, Dixon M, Brar S, Mahar A, Law C, Coburn N, Kazazian K, Zih F, Rosario C, Dennis J, Gingras AC, Swallow C, Lemke M, Ko YJ, Rowsell C, Law CHL, Wells B, Saskin R, Quan ML, Musselman RP, Xie M, McLaughlin K, Marginean C, Moyana TN, Moloo H, Boushey RP, Auer RC, Zih FSW, Razik R, Haase E, Mathieson A, Smith AJ, Swallow CJ, Menezes AS, Barnes A, Scheer AS, Moloo H, Boushey RP, Sabri E, Auer RAC, Nassif M, Reidel K, Trabulsi N, Meterissian S, Tamblyn R, Mayo N, Meguerditchian AN, Leon-Carlyle M, Brown JA, Hamm J, Phang PT, Raval MJ, Brown CJ, Wei AC, Devitt KS, Wiebe M, Bathe OF, McLeod RS, Taylor B, Urbach DR, Krotneva S, Reidel K, Mayo N, Tamblyn R, Meguerditchian A, Bradley NL, Hamm JD, Wiseman SM, Trabulsi N, Patakfalvi L, Nassif M, Turcotte R, Nichols A, Meguerditchian A, Trabulsi N, Riedel KE, Winslade NE, Grégoire JP, Meterissian S, Abrahamovicz M, Megueerditchian A, Chin-Lenn L, Pasieka J, Cheng H, McMillan C, Lipa J, Snell L, Petrucci AM, Sudarshan M, Dumitra S, Duplisea J, Wexler S, Meterissian S, Sandhu L, Tomlinson G, Kennedy ED, Wei A, Baxter NN, Urbach DR, Neville A, Liberman AS, Charlebois P, Stein B, Ncuti A, Vassiliou MC, Fried GM, Feldman LS, Lee L, Capretti G, Power A, Liberman AS, Charlebois P, Stein B, Kaneva P, Carli F, Fried GM, Feldman LS, Li C, Carli F, Charlebois P, Stein B, Liberman AS, Kaneva P, Augustin B, Gamsa A, Kim DJ, Vassiliou M, Feldman L, Yang I, Boushey R, Moloo H, Prabhu KL, Vu L, Chan S, Phang PT, Gown A, Jones S, Wiseman S, Melich G, Jeong DH, Hur H, Baik SH, Kim NK, Faria J, Min BS, Knowles S, Lumb K, Colquhoun P, Richardson D, Porter G, Johnson P, Borowiec AM, Baxter NN, Schmocker S, Huang H, Victor JC, Krzyzanowska MK, Brierley J, McLeod RS, Kennedy ED, Hallet J, Milot H, Desrosiers E, Lebrun A, Drolet S, Bouchard A, Grégoire RC, Boissonneault R, Vuong T, Loungnarath R, DeBroux E, Liberman AS, Charlebois P, Stein B, Richard C, Kolozsvari NO, Capretti G, Kaneva P, Neville A, Carli F, Liberman S, Charlebois P, Stein B, Vassiliou MC, Fried GM, Feldman LS, Hallet J, Milot H, Drolet S, Bouchard A, Grégoire RC, Tuttle P, Powell R, Fowler A, Mathieson A, VanHouwelingen L, Martin K, Vogt K, Ott MC, Haggar F, Pereira G, Einarsdottir K, Moloo H, Boushey R, Mamazza J, Boulanger-Gobeil C, Bouchard A, Gagné JP, Grégoire RC, Thibault C, Bouchard P, Chan BP, Gomes T, Musselman RP, Auer RC, Moloo H, Mamdani M, Al-Omran M, Boushey RP, AlObeed O, Chan BP, Armstrong JBP, Fergusson DA, Forster AJ, Boushey RP, Richardson D, Porter G, Johnson P, Musselman RP, Gomes T, Chan BP, Auer RC, Moloo H, Mamdani M, Al-Omran M, Al-Obaid O, Boushey RP, Melich G, Lim DR, Min BS, Baik SH, Gordon PH, Kim NK, Phang PT, Lo A, Pinsk I, Brown C, Raval M, Goldstein LJ, Cheng H, Wen C, Wong C, Johnston N, Farrokhyar F, Stephen W, Kelly S, Lindsay L, Forbes S, Lebrun A, Bouchard A, Chadi SA, Parry NG, Leslie K, and Ott MC

Published
2012
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13. Effect of nasal continuous positive airway pressure on esophageal function.

Author

Fournier MR, Kerr PD, Shoenut JP, and Yaffe CS

Subjects
Analysis of Variance, Humans, Prospective Studies, Esophagogastric Junction physiology, Gastroesophageal Reflux therapy, Positive-Pressure Respiration methods
Abstract

Objective: The purpose of this study was to conduct a prospective investigation of the mechanism(s) of nasal continuous positive airway pressure (CPAP) upon the reduction of recumbent gastroesophageal reflux., Design: Prospective assessment., Setting: Health Sciences Center and St. Boniface General Hospital, Winnipeg, Manitoba., Methods: An esophageal motility examination was conducted on 16 patients during the application of nasal CPAP set at 0 cm, 4 cm, and 8 cm water pressure. Esophageal parameters studied were wave amplitude and velocity, midesophageal resting pressure, and upper and lower esophageal sphincter resting pressure., Results: The midesophageal resting pressure increased significantly from a baseline of -3.5 +/- 1.4 mm Hg to -1.6 +/- 1.8 mm Hg at 4 cm CPAP (p < .01) and -0.9 +/- 1.2 mm Hg at 8 cm CPAP (p < .01)., Conclusions: The known reduction of nocturnal reflux that occurs when patients use an application of nasal CPAP appears to be related to direct mechanical compression of the esophagus. Results of an earlier report suggesting a reflex response by the lower sphincter were not reproduced.

Published
1999

14. A prospective assessment of gastroesophageal reflux before and after treatment of achalasia patients: pneumatic dilation versus transthoracic limited myotomy.

Author

Shoenut JP, Duerksen D, and Yaffe CS

Subjects
Adult, Aged, Aged, 80 and over, Esophageal Achalasia surgery, Esophagus physiopathology, Esophagus surgery, Female, Humans, Hydrogen-Ion Concentration, Male, Middle Aged, Prospective Studies, Thoracoscopy, Time Factors, Catheterization, Esophageal Achalasia physiopathology, Esophageal Achalasia therapy, Gastroesophageal Reflux physiopathology
Abstract

Objectives: We conducted this study to determine whether reflux should be a major consideration in the choice of treatment for achalasia patients. Achalasia patients undergoing either pneumatic dilation or transthoracic limited esophagomyotomy were monitored for reflux before and after treatment, for comparison., Methods: Twenty-four hour ambulatory esophageal pH tests and esophageal manometry were performed on 32 consecutive, untreated achalasia patients. Studied (before and after treatment) were 17 patients who underwent pneumatic dilation and 15 patients who received transthoracic limited myotomy without fundoplication. All follow-up studies were completed within 12 months of treatment., Results: The ages of the two groups were not significantly different (p > 0.05, 45 +/- 9 yr myotomy vs. 44 +/- 13 yr dilation). The resting lower esophageal sphincter pressure was not significantly different (p > 0.05 before treatment) between groups but was reduced significantly (p < 0.05 after treatment) in both groups (30 +/- 9 mm Hg before vs. 9 +/- 4 mm Hg after myotomy, and 27 +/- 10 mm Hg before vs. 11 +/- 4 mm Hg after pneumatic dilation. The total time the pH was < 4.0 was not significantly different, p > 0.05, in either group before treatment (myotomy, 3.7 +/- 4.4%; dilation, 2.9 +/- 4.9%) or after treatment (myotomy, 8.6 +/- 9.2%; dilation, 10.2 +/- 15.9%). Twelve of 32 patients (38%), had a percent total time < 4.0 that exceeded 6% after treatment, eight of whom were asymptomatic., Conclusions: These results indicate that the amount of reflux after treatment by both pneumatic dilation and transthoracic esophagomyotomy is similar. The absence of reflux symptoms in treated achalasia patients does not exclude the possibility of significant acid reflux.

Published
1997

15. Reproducibility of ambulatory esophageal pH monitoring in the aperistaltic esophagus.

Author

Shoenut JP, Mieflikier AB, Aldor TA, Yaffe CS, and Goldenberg DJ

Subjects
Adult, Aged, Deglutition Disorders etiology, Esophageal Motility Disorders physiopathology, Esophageal Motility Disorders surgery, Esophagus physiopathology, Female, Gastroesophageal Reflux etiology, Humans, Male, Middle Aged, Scleroderma, Localized physiopathology, Time Factors, Esophageal Motility Disorders complications, Hydrogen-Ion Concentration
Abstract

The reproducibility of ambulatory 24-h esophageal pH monitoring was evaluated in 16 consecutive patients by comparing the difference in two consecutive 24-h periods. The study group included 8 patients with scleroderma esophagus and 8 treated achalasia patients. The amount of reflux was expressed as the percentage of time the pH was < 4.0. Both groups demonstrated excellent intrapatient reproducibility overall: 96% in scleroderma patients and 95% in those patients with achalasia. The least concordance was found in the lengths of the longest reflux events-70% when supine in scleroderma patients and 59% when upright in patients with achalasia. There was no significant difference (p > 0.05) between day 1 and day 2 for either group of patients for any of the elements studied. These results indicate that intrapatient variability of gastroesophageal reflux in patients with scleroderma esophagus and treated patients with achalasia is very low and following therapeutic intervention, a high level of confidence can be placed in subsequent pH monitoring as an indicator of treatment effect.

Published
1996
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16. Ambulatory esophageal pH testing. Referral patterns, indication, and treatment in a Canadian teaching hospital.

Author

Shoenut JP and Yaffe CS

Subjects
Adolescent, Adult, Aged, Esophagus physiopathology, Female, Gastroesophageal Reflux therapy, Hospitals, Teaching, Humans, Hydrogen-Ion Concentration, Male, Manometry, Medicine, Middle Aged, Peristalsis, Referral and Consultation, Specialization, Esophagus metabolism, Gastroesophageal Reflux diagnosis, Monitoring, Ambulatory
Abstract

Over a 30-month period, 867 esophageal pH studies were conducted in a Canadian teaching hospital; of these, 315 tests were recorded in patients who were first-time referrals having no chest or upper gastrointestinal surgery and taking no medication that would affect the results. Patients were referred by gastroenterologists, general surgeons, ENT surgeons, thoracic surgeons, and a miscellaneous group. Patients were classified based on: pH results [abnormal = % total time pH < 4.0 (ie, > 6.0%)], manometry (abnormal = LES resting pressure < 5 mm Hg and/or abnormal peristalsis), and gender. Fifty-one percent (162/315) of the patient records demonstrated abnormal reflux. Intergroup comparisons of severity of reflux using two-way analysis of variance demonstrated no significant differences (P = 0.13). In the 162 patients who refluxed, 70% (N = 108) had normal motility studies; however, when the severity of reflux was compared, patients with abnormal motility (N = 54) demonstrated significantly more severe reflux (19.8 +/- 12.8 vs 16.2 +/- 11.3) P = 0.02. In those patients with abnormal manometry, no significant differences (P = 0.44) in the severity of reflux were found among those with abnormal peristalsis (N = 27), low resting pressure (N = 17), or a combination of aperistalsis and low LES pressure (N = 10). Symptomatic patients with reflux (N = 107) demonstrated a significantly greater percent time pH < 4.0 than those with asymptomatic reflux (N = 55); 18.1 +/- 11.5% vs 16.2 +/- 12.7%, P = 0.04. When the severity of reflux by gender was compared, no significant differences were found [18.3 +/- 11.9 (male) N = 91 vs 16.2 +/- 11.9 (female) N = 71, P = 0.11]. The results from this study show that: (1) esophageal pH testing is important in subspecialties other than gastroenterology and that the clinical yield is high in all referring groups, (2) esophageal pH testing and manometry are complimentary tests, but that reflux occurs commonly in association with normal manometry, (3) asymptomatic reflux was found in 34% of the patients with abnormal reflux scores, and (4) the severity of reflux in male and female patients is similar.

Published
1996
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17. Bile duct disease: prospective comparison of ERCP, CT, and fat suppression MRI.

Author

Semelka RC, Shoenut JP, Kroeker MA, Hricak H, Minuk GY, Yaffe CS, and Micflikier AB

Subjects
Adult, Aged, Aged, 80 and over, Bile Duct Neoplasms diagnosis, Contrast Media, Evaluation Studies as Topic, Female, Gadolinium DTPA, Humans, Male, Middle Aged, Organometallic Compounds, Pentetic Acid, Prospective Studies, Bile Duct Diseases diagnosis, Cholangiopancreatography, Endoscopic Retrograde, Magnetic Resonance Imaging, Tomography, X-Ray Computed
Abstract

The authors compared computed tomography (CT) and endoscopic retrograde cholangiopancreatography (ERCP), techniques commonly used to study the biliary tree, with pre- and post-Gd-DTPA breath-hold fast low angle shot (FLASH) and fat suppressed spin-echo in 28 consecutive patients with bile duct abnormalities detected on ERCP, including 11 patients with malignant disease and 17 patients with benign disease. ERCP, CT, and magnetic resonance (MR) images were prospectively interpreted in a blinded fashion and reviewed by consensus. ERCP characterized all cases of malignant disease by the presence of a narrowed bile duct lumen with irregular margins. CT and MRI detected all cases of malignant disease and characterized nine of 11 as malignant. In seven of these cases, CT and MRI showed thickening of extrahepatic bile duct walls greater than 5 mm. MRI images showed intrahepatic-enhancing periportal tissue in four cases, which was not seen on CT images, and which was biopsy-proven tumor extension. Benign disease was characterized on ERCP images by the demonstration of smooth tapered narrowings in 16 cases, whereas on CT and MR images it was characterized by mild to moderate dilatation of the intrahepatic bile ducts and wall thickness less than 5 mm in 13 cases. Overall ERCP correctly characterized 27 cases as benign or malignant and CT and MRI both characterized 25. The results of this study show a trend that ERCP is superior to CT and MRI for characterizing bile duct disease.

Published
1992
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18. The effect of transcutaneous electric nerve stimulation on postoperative pain and pulmonary function.

Author

Ali J, Yaffe CS, and Serrette C

Subjects
Abdomen surgery, Adult, Humans, Lung physiology, Middle Aged, Residual Volume, Skin, Vital Capacity, Cholecystectomy adverse effects, Electric Stimulation Therapy, Lung Diseases prevention & control, Pain, Postoperative therapy
Abstract

Surgery on the upper abdomen is associated with marked postoperative pulmonary dysfunction that results largely from restriction of lung expansion secondary to incisional pain. This study, utilizing three groups of patients (a control group, a sham group, and a group receiving transcutaneous electric nerve stimulation [TENS] for pain control), was designed to determine whether this modality is effective in alleviating postoperative pain. Spirometry, arterial blood gases, clinical as well as radiologic evidence of postoperative pulmonary complications, and the frequency of analgesic requests were determined. Of the 40 patients studied, the 15 receiving TENS required only 4.7 +/- 2.5 doses of narcotic analgesics in the first 72 hours as opposed to 10.1 +/- 2.7 and 10.4 +/- 2.7 in the other two groups (P less than 0.005). There were a total of six postoperative pulmonary complications, all occurring in the groups not receiving TENS. Postoperative arterial Po2, vital capacity, and functional residual capacity were least depressed in the TENS group. The data suggest that TENS minimizes the tendency toward postoperative alteration in respiratory mechanics and decreases the incidence of pulmonary complications by alleviating incisional pain.

Published
1981

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