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Selected AbstractsA Single Ventilator for Multiple Simulated Patients to Meet Disaster SurgeACADEMIC EMERGENCY MEDICINE, Issue 11 2006Greg Neyman MD Objectives To determine if a ventilator available in an emergency department could quickly be modified to provide ventilation for four adults simultaneously. Methods Using lung simulators, readily available plastic tubing, and ventilators (840 Series Ventilator; Puritan-Bennett), human lung simulators were added in parallel until the ventilator was ventilating the equivalent of four adults. Data collected included peak pressure, positive end-expiratory pressure, total tidal volume, and total minute ventilation. Any obvious asymmetry in the delivery of gas to the lung simulators was also documented. The ventilator was run for almost 12 consecutive hours (5.5 hours of pressure control and more than six hours of volume control). Results Using readily available plastic tubing set up to minimize dead space volume, the four lung simulators were easily ventilated for 12 hours using one ventilator. In pressure control (set at 25 mm H2O), the mean tidal volume was 1,884 mL (approximately 471 mL/lung simulator) with an average minute ventilation of 30.2 L/min (or 7.5 L/min/lung simulator). In volume control (set at 2 L), the mean peak pressure was 28 cm H2O and the minute ventilation was 32.5 L/min total (8.1 L/min/lung simulator). Conclusions A single ventilator may be quickly modified to ventilate four simulated adults for a limited time. The volumes delivered in this simulation should be able to sustain four 70-kg individuals. While further study is necessary, this pilot study suggests significant potential for the expanded use of a single ventilator during cases of disaster surge involving multiple casualties with respiratory failure. [source] A novel reactor for exploring the effect of water content on biofilter degradation ratesENVIRONMENTAL PROGRESS & SUSTAINABLE ENERGY, Issue 2 2003Milinda A. Ranasinghe A novel batch recycle reactor was developed to investigate the effect of water content changes on the biological degradation rate of gas phase contaminants in low water content systems, such as biofilters. The reactor tightly controlled the water content of the unsaturated packing material using the principle of a suction cell. Matric potential in the compost was controlled between ,6 and ,36 cm H2O. A soil water retention curve relating matric potential to gravimetric water content was generated for the compost. Periodic dry weight analyses of reactor samples, together with the water retention curve, verified moisture content control. Runs were performed with toluene as the contaminant using unamended compost at a constant temperature of 30°C. Degradation results indicated a linear, biologically limited degradation region, followed by a non-linear region at lower concentrations. Elimination capacities were calculated for the linear region for different matric potentials along both the wetting and drying curves, and both changes in the water content and direction of approach affected the removal rates in the linear region. The elimination capacity ranged from 155 g/m3 hr to 24 g/m3 hr for toluene over the matric potential range investigated. Repeatability studies indicated that moisture content was most likely the parameter that influenced changes in performance. [source] A new supraglottic airway device: LMA-SupremeÔ, comparison with LMA-ProsealÔACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 7 2009T. HOSTEN Background and objective: The LMA-SupremeÔ (S-LMAÔ) is a new supraglottic airway device that presents combined features of flexibility, curved structure and single use and a different cuff structure. The purpose of this study was to compare the oropharyngeal leak pressures (OLP) of LMA-ProsealÔ (P-LMAÔ) and S-LMAÔ. Methods: Sixty adult patients were prospectively and randomly allocated to undergo insertion of P-LMAÔ (n=30) or S-LMAÔ (n=30). The cuffs were inflated until the intracuff pressure (ICP) reached 60 cm H2O. Orogastric leak pressures, insertion times, first attempt success rates, fiberoptical assessment of position, cuff pressures, orogastric tube (OGT) placement and OGT insertion times were compared. Unblinded observers collected intraoperative data and blinded observers collected post-operative data. Results: The first insertion attempts and time taken to provide an effective airway were similar between the groups. Two patients (P-LMAÔ, n=1; S-LMAÔ, n=1) were intubated due to excessive oropharyngeal leak and in one patient (P-LMAÔ, n=1) due to failed OGT placement. OLPs were similar (P-LMAÔ; 26.9±6.6 S-LMAÔ; 26.1±5.2). ICP increased significantly in the P-LMAÔ at the 30 and 60 min during anesthesia (P-LMAÔ; 80.1±12.8, 92.9±14.4, S-LMAÔ; 68.3±10.9, 73.7±15.6). OGT placement was successful in all patients in the S-LMAÔ, but failed in five patients in the P-LMAÔ (P=0.02). Fiberoptically determined anatomic position was better with the P-LMAÔ (P=0.03). Conclusion: Our findings suggest that S-LMAÔ had leak pressures similar to the P-LMAÔ, and this new airway device proved to be successful during both spontaneous and positive pressure ventilation. [source] In-vitro characterisation of the nebulised dose during non-invasive ventilationJOURNAL OF PHARMACY AND PHARMACOLOGY: AN INTERNATI ONAL JOURNAL OF PHARMACEUTICAL SCIENCE, Issue 8 2010Mohamed E. Abdelrahim Abstract Objectives, Non-invasive ventilation (NIV) with nebulised bronchodilators helps some patients to maintain effective ventilation. However, the position of the nebuliser in the ventilation circuit may affect lung delivery. Methods, We placed the nebuliser proximal (A) and distal (B) to a breathing simulator in a standard NIV circuit with inspiratory (I) and expiratory (E) pressures of 20 and 5 cm H2O, 1 : 3 I : E ratio, 15 breaths/min and a tidal volume of 500 ml. Five milligrams of terbutaline solution was nebulised using an Aeroneb Pro (AERO) and a Sidestream (SIDE) nebuliser. The fate of the nebulised dose was determined and the aerodynamic droplet characteristics were measured using a cooled Next Generation Impactor. Key findings, More terbutaline was entrained on the inhalation filter in position A than in position B (P < 0.001) for both nebulisers. These amounts were greater (P < 0.001) for AERO than SIDE due to a smaller (P < 0.001) residual volume. The mean (SD) fine particle doses for AEROA, AEROB, SIDEA and SIDEB were 1.31 (0.2), 1.13 (0.14), 0.56 (0.03) and 0.39 (0.13) mg. These amounts from AEROA were significantly greater (P < 0.001) than those of the other three methods. Conclusions, The results highlight the differences between nebulisers and the influence on the placement of the nebuliser in the NIV circuit. [source] Effects of PEEP levels following repeated recruitment maneuvers on ventilator-induced lung injuryACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2008S.-C. KO Background: Different levels of positive end-expiratory pressure (PEEP) with and without a recruitment maneuver (RM) may have a significant impact on ventilator-induced lung injury but this issue has not been well addressed. Methods: Anesthetized rats received hydrochloric acid (HCl, pH 1.5) aspiration, followed by mechanical ventilation with a tidal volume of 6 ml/kg. The animals were randomized into four groups of 10 each: (1) high PEEP at 6 cm H2O with an RM by applying peak airway pressure at 30 cm H2O for 10 s every 15 min; (2) low PEEP at 2 cm H2O with RM; (3) high PEEP alone; and (4) low PEEP alone. Results: The mean arterial pressure and the amounts of fluid infused were similar in the four groups. Application of the higher PEEP improved oxygenation compared with the lower PEEP groups (P<0.05). The lung compliance was better reserved, and the systemic cytokine responses and lung wet to dry ratio were lower in the high PEEP than in the low PEEP group for a given RM (P<0.05). Conclusions: The use of a combination of periodic RM and the higher PEEP had an additive effect in improving oxygenation and pulmonary mechanics and attenuation of inflammation. [source] Exposure to noise during continuous positive airway pressure: influence of interfaces and delivery systemsACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 1 2008F. CAVALIERE Background: We measured noise intensity and perceived noisiness during continuous positive airway pressure (CPAP) performed with two interfaces (face-mask, helmet) and four delivery systems. Methods: Eight healthy volunteers received CPAP in random order with: two systems provided with a flow generator using the Venturi effect and a mechanical expiratory valve (A: Venturi, Starmed; B: Whisperflow-2, Caradyne Ltd); one ,free-flow' system provided with high flow O2 and air flowmeters, an inspiratory gas reservoir, and a water valve (C: CF800, Drägerwerk, AG); and a standard mechanical ventilator (Servoventilator 300, Siemens-Elema). Systems A, B, and C were tested with a face-mask and a helmet at a CPAP value of 10 cm H2O; the mechanical ventilator was only tested with the face mask. Noise intensity was measured with a sound-level meter. After each test, participants scored noisiness on a visual analog scale (VAS). Results: The noise levels measured ranged from 57±11 dBA (mechanical ventilator plus mask) to 93±1 and 94±2 dBA (systems A and B plus helmet) and were significantly affected by CPAP systems (A and B noisier than C and D) and interfaces (helmet CPAP noisier than mask CPAP). Subjective evaluation showed that systems A and B plus helmet were perceived as noisier than system C plus mask or helmet. Conclusions: Maximum noise levels observed in this study may potentially cause patient discomfort. Less noisy CPAP systems (not using Venturi effect) and interfaces (facial mask better than helmet) should be preferred, particularly for long or nocturnal treatments. [source] Adaptation of Mesenteric Collecting Lymphatic Pump Function Following Acute Alcohol IntoxicationMICROCIRCULATION, Issue 7 2010FLAVIA M. SOUZA-SMITH Please cite this paper as: Souza-Smith, Kurtz, Molina and Breslin (2010). Adaptation of Mesenteric Collecting Lymphatic Pump Function Following Acute Alcohol Intoxication. Microcirculation17(7), 514,524. Abstract Objective:, Acute alcohol intoxication increases intestinal lymph flow by unknown mechanisms, potentially impacting mucosal immunity. We tested the hypothesis that enhanced intrinsic pump function of mesenteric lymphatics contributes to increased intestinal lymph flow during alcohol intoxication. Methods:, Acute alcohol intoxication was produced by intragastric administration of 30% alcohol to conscious, unrestrained rats through surgically implanted catheters. Time-matched controls received either no bolus, vehicle, or isocaloric dextrose. Thirty minutes after alcohol administration, rats were anesthetized and mesenteric collecting lymphatics were isolated and cannulated to study intrinsic pumping parameters. In separate experiments, mesenteric lymphatics were isolated to examine direct effects of alcohol on intrinsic pump activity. Results:, Lymphatics isolated from alcohol-intoxicated animals displayed significantly decreased CF compared to the dextrose group, elevated SVI versus all other groups, and decreased myogenic responsiveness compared to sham. Elevating pressure from 2 to 4 cm H2O increased the volume flow index 2.4-fold in the alcohol group versus 1.4-fold for shams. Isolated lymphatics exposed to 20 mM alcohol had reduced myogenic tone, without changes in CF or SVI. Conclusions:, Alcohol intoxication enhances intrinsic pumping by mesenteric collecting lymphatics. Alcohol directly decreases lymphatic myogenic tone, but effects on phasic contractions occur by an unidentified mechanism. [source] Hyperglycemia Stimulates a Sustained Increase in Hydraulic Conductivity In Vivo without Any Change in Reflection CoefficientMICROCIRCULATION, Issue 7 2007RACHEL M. PERRIN ABSTRACT Objective: Increased microvascular permeability contributes to the development of diabetic microvascular complications and diabetic vasculopathy is correlated with blood glucose levels. The mechanisms underlying increased permeability, however, are poorly understood. Methods: The Landis-Michel technique was used to measure water permeability (hydraulic conductivity, Lp) and macromolecular permeability (reflection coefficient, ,) of exchange capillaries in frogs and rats. Results: Dialysed normoglycemic plasma from diabetic patients had no effect on Lp. The same plasma with 20 mM glucose increased hydraulic conductivity from (mean ± SEM × 10,7 cm · s,1· cm H2O,1) 5.73 ± 2.01 to 13.09 ± 2.67 (P < .01). Nondiabetic control plasma did not affect Lp, but addition of 20 mM glucose increased Lp to a similar degree. The effect of glucose alone was examined. Glucose at 20 mM increased Lp, from 2.82 ± 0.61 to 4.71 ± 1.35 × 10, 7 cm · s, 1· cm H2O,1 (P = .002, n = 13). A similar increase was seen in rat mesenteric microvessels, from 1.04 ± 0.40 in control perfusions to 2.18 ± 0.56, P < .05. The microvascular macromolecular reflection coefficient in all the above experiments was unaltered. The use of specific inhibitors indicated that the glucose-induced increased Lp did not appear to be mediated through protein kinase C (PKC), free radical generation, glucose metabolism, or albumin glycation. Conclusions: These data suggest that hyperglycemia induced increased apparent protein permeability may be secondary to a glucose-mediated change in macromolecular convective flux rather than any change in protein permeability per se. The authors speculate that the increased microvascular permeability to water in vivo is mediated by direct interaction of glucose with the endothelial cells (perhaps with the glycocalyx). [source] Regional Variations of Contractile Activity in Isolated Rat LymphaticsMICROCIRCULATION, Issue 6 2004ANATOLIY A. GASHEV ABSTRACT Objective: To evaluate lymphatic contractile activity in different regions of the lymphatic system in a single animal model (the rat thoracic duct, mesenteric, cervical, and femoral lymphatics) in response to changes in lymph pressure and flow. Methods: The systolic and diastolic diameters of isolated, cannulated, and pressurized lymphatic vessels were measured. Contraction frequency, ejection fraction, and fractional pump flow were determined. The influences of incrementally increased transmural pressure (from 1 to 9 cm H2O) and imposed flow (from 1 to 5 cm H2O transaxial pressure gradient) were investigated. Results: The authors determined regional differences in lymphatic contractility in response to pressure and imposed flow. They found the highest pumping (at the optimal pressure levels) in mesenteric lymphatics and lowest pumping in thoracic duct. All lymphatics had their optimal pumping conditions at low levels of transmural pressure. Different degrees of the flow-induced inhibition of the pump were observed in the different types of lymphatics. During high flow, the active lymph pumps in thoracic duct and cervical lymphatics were almost completely abolished, whereas mesenteric and femoral lymphatics still exhibited significant active pumping. Conclusions: The active lymph pumps in different regions of the rat body express variable relative strengths and sensitivities that are predetermined by different hydrodynamic factors and regional outflow resistances in their respective locations. [source] Relationship of Ultrafiltration and Anastomotic Flow in Isolated Rat LungsMICROCIRCULATION, Issue 5 2001WEN LIN ABSTRACT Objective: When arterial and venous pressures are increased to equal values in "stop-flow" studies, perfusate continues to enter the pulmonary vasculature from the arterial and venous reservoirs. Losses of fluid from the pulmonary vasculature are due to ultrafiltration and flow through disrupted anastomotic (bronchial) vessels. This study compared the relative sites of ultrafiltration and anastomotic flows at low and high intravascular pressures. Methods: Isolated rat lungs were perfused for 10 minutes with FITC-dextran, which was used to detect ultrafiltration. Arterial and venous catheters were then connected to reservoirs containing radioactively labeled dextrans at 20 or 30 cm H2O for 10 minutes. The vasculature was subsequently flushed into serial vials, and ultrafiltration and vascular filling during the equal-pressure interval were calculated. Results: Ultrafiltration equaled 0.43 ± 0.11 mL at 20 cm H2O and was similar to the volume of fresh arterial and venous perfusate which entered and remained in the pulmonary vasculature during the equal-pressure interval (0.45 ± 0.10 mL). At 30 cm H2O, 0.80 ± 0.23 mL entered and remained in the vasculature during the equal-pressure interval, replacing the original perfusate, and calculated transudation (0.56 ± 0.09 mL) was not significantly more than at 20 cm H2O. Fluid also entered the airspaces at 30 cm H2O but not at 20 cm H2O. Conclusions: At 20 cm H2O, flow through anastomotic vessels occurs at sites that are at the arterial and venous ends of the microcirculation. Flow in exchange vessels remains minimal, permitting measurements of ultrafiltration and exchange. Losses of perfusate from the pulmonary vessels complicate measurements of ultrafiltration at 30 cm H2O. [source] Restoring voluntary urinary voiding using a latissimus dorsi muscle free flap for bladder reconstructionMICROSURGERY, Issue 6 2001Arnulf Stenzl M.D. We present our data using innervated latissimus dorsi muscle (LDM) free flaps to assist acontractile bladder function. Twelve dogs were used. In group I (n = 3), the LDM flaps were elevated and wrapped around silicon reservoirs; in group II (n = 4), the LDM flaps were transferred into the pelvis and used to reconstruct bladders that had 50% of their detrusor muscle wall removed; group III (n = 5) was the same setup as group II but the bladder mucosa was also removed with 50% detrusor wall. The LDM flaps were electrically stimulated and electromyography, cystography, urodynamic, and hydrodynamic measurements were performed. In clinical studies, LDM flaps were used in 11 patients (age range, 9,68 years). Our animal studies demonstrated that LDM flaps are capable of generating pressures (190 cm H2O at 15 mL and 35 cm H2O at a 10 mL in group I at 6 months) to void the bladder. In group II, contractions were present after 9 months. Eight of 11 patients who underwent LDM free flap were able to void voluntarily and without catheterization. LDM flap activity was confirmed using ultrasonography/tomography. Our clinical studies indicated that contractile function can be restored using LDM free flaps. © 2001 Wiley-Liss, Inc. MICROSURGERY 21:235,240 2001 [source] Trigonal injection of botulinum toxin-A does not cause vesicoureteral reflux in neurogenic patients,,NEUROUROLOGY AND URODYNAMICS, Issue 4 2008Frederico Mascarenhas Abstract Aims We evaluated the effect of botulinum toxin type A (BTX-A) injections in the trigone on the antireflux mechanism and evaluated its short-term efficacy. Materials and Methods Between April and December 2006, 21 patients (10 men and 11 women) were prospectively evaluated. All were incontinent due to refractory NDO and underwent detrusor injection of 300 units of BTX-A, including 50 units into the trigone. Baseline and postoperative evaluation after eight weeks included cystogram, urinary tract ultrasound and urodynamics. Results At baseline, 20 patients had no vesicoureteral (VUR) and one had grade II unilateral VUR. Postoperative evaluation revealed no cases of de novo VUR and the patient with preinjection VUR had complete resolution of the reflux. Ultrasound showed 5 (23.8%) patients with hydronephrosis before BTX-A injection and only one (4.8%) at the followup evaluation (p=0.066). After treatment, 9 (42.8%) patients became dry, 11 (52.4%) were improved and one (4.8%) had no improvement. Improved patients received antimuscarinic treatment and 8 (38.1%) became dry, with a final total continence rate of 80.1%. Cystometric capacity increased from 271±92 to 390±189 ml (p=0.002), reflex volume varied from 241±96 to 323±201 ml (p=0.020) and maximum detrusor pressure reduced from 66±39 to 38±37 cm H2O (p<0.001). Conclusions Our results confirm the safety of trigone injections of BTX-A in terms of development of VUR and upper urinary tract damage. Whether they are beneficial for patients with NDO or other causes of voiding dysfunction will need further studies. Neurourol. Urodynam. 27:311,314, 2008. © 2007 Wiley-Liss, Inc. [source] Effect of lumbar-epidural administration of tramadol on lower urinary tract function,,NEUROUROLOGY AND URODYNAMICS, Issue 1 2008S.K. Singh Abstract Aims Intrathecal and epidural administration of µ-agonist opioids is associated with urinary retention, a potentially serious adverse-event. In animal studies tramadol has been found not to affect voiding function. We evaluated urodynamic effects of epidural tramadol in humans. Methods Fifteen adults planned for cystoscopy under local-anesthesia underwent urodynamics (UDS) at baseline and 30 min after administration of 100 mg tramadol in lumbar-epidural space. UDS consisted of filling cystometry, pressure-flow study and pelvic floor electromyography (EMG). Subsequently, all underwent cystoscopy and were observed for 6 hr. Results After injection of tramadol, a significant rise was observed in bladder capacity (391.8,±,179.6 ml vs. 432.7,±,208.8 ml; P,=,0.019) and compliance (60.1,±,51.5 ml/cm H2O vs. 83.0,±,63.0 ml/cm H2O; P,=,0.011) without a significant change in filling pressure (22.5,±,13.2 cm H2O vs. 24.1,±,15.1 cm H2O; P,=,0.576). Filling sensations were delayed significantly (P,,,0.05). EMG during filling phase showed a significant fall (P,=,0.027). Peak flow-rate (Qmax), average flow-rate, postvoid residue and detrusor pressure-at-Qmax did not show significant change from baseline (P,>,0.05). Three patients had bladder outlet obstruction which did not worsen after the injection. Guarding reflex was inhibited in seven out of 12 patients who had it at baseline (P,=,0.016). Conclusions Epidural tramadol increases the bladder capacity and compliance and delays filling-sensations, without ill effect on voiding. This seems true even for patients with obstructed outflow; however, due to small number of patients a definite conclusion cannot be derived. These results will guide clinician to avoid catheterization in cases where epidural tramadol is used for postoperative pain. The inhibitory effects of tramadol on EMG activity are intriguing and need further studies. Neurourol. Urodynam. © 2007 Wiley-Liss, Inc. [source] Transobturator tape (TOT): Two years follow-up,NEUROUROLOGY AND URODYNAMICS, Issue 1 2007Saad Juma Abstract Aims The aim of this study is to report the functional results, patient satisfaction, and morbidity of the Transobturator tape procedure (TOT) in the treatment of stress incontinence (SUI). Methods One hundred and thirty patients were prospectively evaluated with history, physical examination, quality of life questionnaire including Incontinence Impact Questionnaire (IIQ), urogenital distress inventory (UDI), and analog global satisfaction scale (GSS), and urodynamic studies. Results One hundred and seventeen patients (90%) had history of SUI, and 78 (60%) had urge incontinence. Pads/day (PPD) used was 2.48,±,2.42, and the score of IIQ 16.13,±,7.86, UDI 10.95,±,3.4, and GSS 1.41,±,1.67. All patients underwent TOT using the ObTapeÔ. Hospital stay was 0.84,±,0.76 days and catheter duration was 1.42,±,2.08 days. At a follow-up of 16.85,±, 4.68 months, 13 patients (10%) have recurrent SUI, 21 (16.15%) persistent urge incontinence, and 1 (1.92%) de novo urge incontinence. The mean PPD is 0.15,±,0.56, IIQ 1.47,±,5.14, UDI 3.28,±,3.09, and GSS 8.29,±,1.64. Two patients (1.52%) developed urethral obstruction, five (3.84%) had vaginal extrusion of the tape, and two (1.52%) had intra-operative bladder perforation. Conclusions These results demonstrate the safety and efficacy of the TOT. The short hospitalization and catheterization, low incidence of de novo urge incontinence and obstructive voiding offers a distinct advantage over existing techniques. No significant difference in outcome between patients with VLPP ,60 cm H2O, and patients with VLPP >60 cm H2O was observed. Neurourol. Urodynam. © 2006 Wiley-Liss, Inc. [source] Clinical and urodynamic features of intrinsic sphincter deficiencyNEUROUROLOGY AND URODYNAMICS, Issue 4 2003Cinzia Pajoncini Abstract Aims A prospective analysis of 92 patients with genuine stress incontinence was performed to identify the clinical and urodynamic features of intrinsic sphincter deficiency (ISD). Methods We divided the patients into two categories: 50 patients affected by pure ISD as they had severe stress incontinence and no urethral mobility; 42 patients suffering from stress urinary incontinence without ISD as they had mild stress incontinence and marked urethral hypermobility. Cystometry was normal in all patients. The presence/absence of ISD was considered the dependent variable and was correlated against the following independent variables: age, vaginal deliveries, menopause, previous urogynecological surgery and/or hysterectomy, supine stress test, irritative and/or obstructive symptoms, Valsalva leak point pressure (VLPP), maximum urethral closure pressure (MUCP), urethral functional length (UFL), and leakage during cystometry. Results The statistical analysis showed close correlations between ISD and age (P,<,0.001), menopausal status (P,<,0.001), previous surgery (P,<,0.0001), supine stress test (P,<,0.0001), leakage during cystometry (P,<,0.001), and UFL (P,<,0.01). The VLPP was below the cut-off value (,60 cm H2O) in 70% of ISD patients (P,<,0.0001), whereas the MUCP in 50% of ISD patients (P,<,0.0001). Multiple logistic analysis showed that lower VLPP, lower MUCP, and previous surgery correlate more significantly with ISD. After backward conditional stepwise logistic regression, the odds ratio of having ISD were VLPP,=,2.3, MUCP,=,7.7, VLPP + MUCP,=,62.8. Conclusions ISD is related to the presence of a more severe clinical picture and case history, but the most significant independent variables are the VLPP and MUCP. Neurourol. Urodynam. 22:264,268, 2003. © 2003 Wiley-Liss, Inc. [source] Changes in bladder neck geometry and closure pressure after midurethral anchoring suggest a musculoelastic mechanism activates closureNEUROUROLOGY AND URODYNAMICS, Issue 3 2003Peter Petros Abstract Aims The aim of this study was to investigate the anatomical origins and clinical significance of cough pressure transmission ratio (CTR) by using virtual-operation (VO) techniques. Methods Thirty-four patients underwent perineal ultrasound examination, standard urethral pressure cough testing both with and without unilateral midurethral anchoring (VO), all tests being performed without urethral elevation. In eight patients where there was no change in CTR, a one-sided fold of suburethral vagina (VO) was taken (pinch test) and the CTR repeated. Results After midurethral anchoring, maximal urethral pressure increased from a mean of 33.25 cm H2O to a mean of 58.06 cm H2O (P,<,0.0001) and restoration of anatomy was noted in all 11 patients who had obvious funneling on straining. Conversion of a <100% CTR to >100% CTR in the proximal urethra was observed in 14 of 22 patients (P,<,0.005), with no significant change noted in the distal urethra. Further conversion of CTR was noted in six of the remaining eight patients with unilateral plication of suburethral vagina (pinch test). Conclusions A musculoelastic closure mechanism most likely activates urethral closure. CTR is most likely an index of changed intraurethral area, not necessarily closure, and may be a more sensitive objective test than perineal ultrasound for diagnosing urethral narrowing, especially when used with virtual-operation techniques. Neurourol. Urodynam. 22:191,197, 2003. © 2003 Wiley-Liss, Inc. [source] Baseline abdominal pressure and valsalva leak point pressures-correlation with clinical and urodynamic dataNEUROUROLOGY AND URODYNAMICS, Issue 1 2003Shahar Madjar Abstract Aims: To characterize the factors contributing to changes in baseline abdominal pressure (Pabd) and the correlation between ,VLPP, VLPPtot, and other clinical and urodynamic variables. Methods: Two hundred sixty-four female patients who had undergone an anti-incontinence procedure between February 1994 and October 1999 were retrospectively reviewed. The urodynamics performed for each patient included abdominal and vesical pressures measured in a standardized manner with the patient sitting upright and the pressure sensors maintained at the level of the symphysis pubis. VLPP was determined at bladder volumes of 200 mL during a gradually increasing Valsalva maneuver. Results: Baseline Pabd varied between 10 and 55 cm H2O (mean, 32.7,±,8.8) and were significantly correlated with patient weight (P<0.001) and with patient body mass index (P<0.001). Baseline Pabd was not found to be correlated with patient age, Baden and Walker Classification of the grading of pelvic floor prolapse, degree of incontinence (determined by the number of pads used per day), or prior surgical procedures for stress incontinence. Higher baseline Pabd were significantly correlated with the peak abdominal pressure reached during the Valsalva maneuver (P<0.0001) and with VLPPtot (P<0.0001) but not with ,VLPP. Higher VLPPtot significantly correlated with decreased age (P=0.004), less severe incontinence (P=0.004), higher peak Valsalva pressure (P<0.0001), and the ability to increase abdominal pressure for a longer period of time (time to peak Pabd during Valsalva). VLPPtot and ,VLPP had similar statistical correlation with all the clinical variables examined and neither could predict the outcome of any anti-incontinence surgery. By using a VLPP of 60 cm H2O as a cutoff to differentiate severe ISD from GSUI, 211 (67.4%) of the patients would be categorized as having ISD according to their ,VLPP compared with only 106 (40.1%) by using the VLPPtot. Conclusions: Baseline Pabd varies considerably among patients, is correlated with patient weight and habitus. In addition, it varies with both the ability to be increased for longer periods of time and with VLPPtot. Looking at VLPPtot and ,VLPP will result in a different categorization of the type of incontinence in at least 25% of patients and, thus, affect the physician's selection of an anti-incontinence procedure for an individual patient. Neurourol. Urodynam. 22:2,6, 2003. © 2003 Wiley-Liss, Inc. [source] Comparison of the experience with acute and chronic electrically stimulated detrusor myoplasty,NEUROUROLOGY AND URODYNAMICS, Issue 5 2002John G. Van Savage Abstract Aims To evaluate the acute and chronic urodynamic effects of electrically stimulated detrusor myoplasty in dogs. Methods Eight female mongrel dogs were studied acutely and six dogs chronically (0 to 12 weeks postoperatively). Bladders were wrapped with the rectus abdominis muscle, keeping an intact blood supply and at least two intercostal nerves of the flap preserved. Bladders were electrically stimulated with bipolar electrodes inserted into the muscle. Urodynamics and post void residual were measured post operatively in the acute studies and every 2 weeks for 3 months in chronic studies. Results Acutely, the increase in intravesical pressure was 45±7 cm H2O, which resulted in a postvoid residual of 26±3%. In the chronic study, increases of intravesical pressure sufficient to empty the bladder during myoplasty electrical stimulation were not sustained, although detrusor compliance and flap viability were preserved. Conclusions The electrically stimulated detrusor myoplasty worked well acutely to increase vesical pressure sufficient to empty the bladder, but the chronically stimulated myoplasty did not maintain efficient bladder emptying primarily due to electrode problems. Further studies with improved electrode material and placement are required before clinical application of the electrically stimulated detrusor myoplasty can be assessed. Neurourol. Urodynam. 21:516,521, 2002. © Wiley-Liss, Inc. [source] Assessment of the intrinsic urethral sphincter component function in postprostatectomy urinary incontinenceNEUROUROLOGY AND URODYNAMICS, Issue 3 2002Christian Pfister Abstract Postprostatectomy incontinence remains a disabling condition. Sphincter injury, detrusor instability, and decreased bladder compliance have been previously reported as major factors. The aim of this study was to evaluate the urethral sphincter intrinsic component, which may provide passive continence. A urodynamic evaluation was performed in 20 patients undergoing a radical retropubic prostatectomy in the preoperative period and 3 months after surgery. Patients with disabled urinary incontinence underwent a new urodynamic evaluation 6 months later. The urethral pressure profile was measured just before, then 10, 20, and 30 minutes after the injection of 0.5 mg/kg moxisylyte chlorhydrate, an alpha adrenergic blocker. Three different pressure components were defined in urethral sphincter capacity: baseline, adrenergic, and voluntary. A postoperative intrinsic urethral sphincter pressure component was found in 17 patients and its value was under 6 cm H2O in five cases of severe incontinence. No significant difference was observed for these patients on urethral profile components 6 months later. In contrast, in cases of significant intrinsic component value, no incontinence was observed in most patients. Passive continence after radical prostatectomy should be a matter of concern and may also explain paradoxical incontinence, despite high voluntary urethral pressure obtained after reeducation. A follow-up evaluation of the intrinsic sphincter component is suggested, by using an alpha receptor blockage test during urodynamic studies in the management of patients with postprostatectomy incontinence. Neurourol. Urodynam. 21:194,197, 2002. © 2002 Wiley-Liss, Inc. [source] Involuntary detrusor contractions: Correlation of urodynamic data to clinical categoriesNEUROUROLOGY AND URODYNAMICS, Issue 3 2001Lauri J. Romanzi Abstract Data regarding the prevalence and urodynamic characteristics of involuntary detrusor contractions (IDC) in various clinical settings, as well as in neurologically intact vs. neurologically impaired patients, are scarce. The aim of our study was to evaluate whether the urodynamic characteristics of IDC differ in various clinical categories. One hundred eleven consecutive neurologically intact patients and 21 consecutive neurologically impaired patients, referred for evaluation of persistent irritative voiding symptoms, were prospectively enrolled. All patients were presumed by history to have IDC, and underwent detailed clinical and urodynamic evaluation. Based on clinical evaluation, patients were placed into one of four categories according to the main presenting symptoms and the existence of neurological insult: 1) frequency/urgency; 2) urge incontinence; 3) mixed stress incontinence and irritative symptoms; and 4) neurogenic bladder. IDC was defined by detrusor pressure of ,,15,cm H2O whether or not the patient perceived the contraction; or <,15,cm H2O if perceived by the patient. Eight urodynamic characteristics of IDC were analyzed and compared between the four groups. IDC were observed in all of the neurologically impaired patients, compared with 76% of the neurologically intact patients (P,<,0.001). No correlation was found between amplitude of IDC and subjective report of urgency. All clinical categories demonstrated IDC at approximately 80% of cystometric capacity. Eighty-one percent of the neurologically impaired patients, compared with 97% of the neurologically intact patients, were aware of the IDC at the time of urodynamics (P,<,0.04). The ability to abort the IDC was significantly higher among continent patients with frequency/urgency (77%) compared with urge incontinent patients (46%) and neurologically impaired patients (38%). In conclusion, when evaluating detrusor overactivity, the characteristics of the IDC are not distinct enough to aid in differential diagnosis. However, the ability to abort IDC and stop incontinent flow may have prognostic implications, especially for the response to behavior modification, biofeedback, and pelvic floor exercise. Neurourol. Urodynam. 20:249,257, 2001. © 2001 Wiley-Liss, Inc. [source] Tubeless combined high-frequency jet ventilation for laryngotracheal laser surgery in paediatric anaesthesiaACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 4 2000G. Ihra Background: High-frequency jet ventilation (HFJV) is an alternative ventilatory approach in airway surgery and for facilitating gas exchange in patients with pulmonary insufficiency. We have developed a new technique of combined HFJV utilising two superimposed jet streams. In this study we describe the application of tubeless supralaryngeal HFJV during laryngotracheal laser surgery in infants and children. Methods: Tubeless combined HFJV characterised by the simultaneous supralaryngeal application of a low-frequency (LF) and a high-frequency (HF) jet stream was evaluated in a clinical study in 10 children undergoing elective laryngotracheal CO2 laser surgery. Additionally, pressure and flow characteristics were determined with the use of a paediatric test lung. HFJV was applied by means of a modified Kleinsasser laryngoscope with integrated metal injectors. In addition to pulse oximetry, monitoring of ECG, heart rate and blood pressure, supraglottic airway pressure was measured and arterial blood gases were analysed. Results: Tubeless combined HFJV was used in 10 infants and children (mean age 4.6 yr, range 2 months,10 years) undergoing 17 consecutive endoscopic procedures with CO2 laser microsurgery of the larynx or the trachea under general anaesthesia. The mean duration of supralaryngeal HFJV was 46 min (range 15,75 min). Mean driving pressures of the HF and the LF jet streams were 0.75 bar and 0.95 bar, respectively. Inspiratory oxygen ratios were in the range 0.4,1.0. HFJV resulted in mean PaO2 and PaCO2 values of 19.7 kPa and 6.1 kPa, respectively. No complications during HFJV were observed. In the test lung, combined HFJV applied with driving pressures of 0.7,1.0 bar and 0.9,1.2 bar for HF and LF jet ventilation, respectively, resulted in maximum peak and baseline distal airway pressures of 17.6 cm H2O and 5.4 cm H2O, respectively. Conclusion: The application of the combined double frequency HFJV was effective in maintaining gas exchange in the presence of laryngeal or tracheal stenoses. It provided good visibility of anatomical structures and offered space for surgical manipulation, avoiding the use of combustible material inside the larynx or trachea. [source] Nitric oxide inhalation therapy in very low-birthweight infants with hypoplastic lung due to oligohydramniosPEDIATRICS INTERNATIONAL, Issue 1 2004Naoki Uga AbstractBackground: Although nitric oxide inhalation (iNO) therapy improves arterial oxygenation and reduces the rate of extracorporeal membrane oxygenation in term neonates, the efficacy of this therapy in premature infants is controversial. The objective of the present study was to determine whether iNO therapy improves the survival of very low-birthweight infants with pulmonary hypoplasia due to prolonged rupture of membrane. Methods: A retrospective comparative study of very low-birthweight infants with pulmonary hypoplasia due to oligohydramnios who had or had not been treated with iNO therapy, was performed (iNO-treated group, eight infants; control group, 10 infants). A neonate was considered to have pulmonary hypoplasia due to oligohydramnios if the following conditions were satisfied: (i) artificial surfactant treatment did not improve the respiratory distress; (ii) prolonged rupture of membrane (PROM) continued for more than 5 days with oligohydramnios; and (iii) sufficient arterial oxygenation did not occur even after giving 100% oxygen, and more than 8 cm H2O of mean airway pressure was needed to maintain arterial oxygenation. Results: Nitric oxide inhalation improved arterial oxygenation rapidly and consistently in all eight infants with pulmonary hypoplasia. All eight iNO-treated infants survived longer than 28 days, while five of the 10 control infants died within 24 h of birth (P < 0.05). Before starting iNO, seven of the eight treated infants had shown persistent pulmonary hypertension, which was confirmed by echocardiography. No iNO-treated infant had IVH greater than grade 1, while one control infant had grade 2 IVH. All six long-term survivors in the iNO-treated group are developing normally, while only two of the control infants are developing normally as of February 2002. Conclusions: The majority of the infants with pulmonary hypoplasia due to oligohydramnios had persistent pulmonary hypertension. iNO improved the arterial oxygenation and significantly improved the survival rate. A controlled study to determine whether iNO therapy improves the survival rate of preterm infants with pulmonary hypoplasia due to oligohydramnios is necessary. [source] Which pulmonary volume should be used in physiotherapy to obtain higher maximal inspiratory pressure in COPD patients?PHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 4 2005Patricia EM Marinho Abstract Background and Purpose Patients with chronic obstructive pulmonary disease (COPD) present pulmonary hyperinflation as the main cause of mechanical disadvantage in respiratory muscles. Measurement of the force generated by those muscles is converted into pressure changes. The aim of the present study was to evaluate the maximal inspiratory pressure (MIP) from the residual volume (RV) and from the functional residual capacity (FRC), in patients with COPD, and to determine which pulmonary volume should be used in physiotherapy so as to obtain higher MIP results. Method An investigation of 18 male patients with stable COPD. Patients were examined using a manual vacuometer to measur the MIP of 20 daily manoeuvres. Ten measurements were taken from the RV and 10 from the FRC, taken alternately with an interval of 1 minute between each measurement, for five consecutive days. Results Increases in MIP were obtained from the RV measurements (mean ± SE) from 59.7 (±5.2) to 66.6 (±5.3) cm H2O (F (4,64) = 3.34; p < 0.015) and from the FRC measurements, from 55.4 (±4.9) to 64.4 (±4,8) cm H2O (F (4,64) = 6.72; p < 0.001). Post hoc analysis showed an increase, over consecutive days, in both RV and FRC. For FRC, an increase was revealed on the second and third days, a fall was found on the fourth day and a new increase was found on the last day. MIP reached different levels, between RV and FRC, on the first (t = 2.888; p = 0.010) and fourth ( t = 2.165; p = 0.045) days. Conclusion In the present study, MIP reached higher levels at FRC during the five days of evaluation, and a learning effect occurred in the patients. Motor units from the respiratory muscles may have been recruited in order to performe the manoeuvres during the days of evaluation. The study suggests that there is good evidence for the use of the FRC as a parameter to find the major MIP value. Copyright © 2005 John Wiley & Sons, Ltd. [source] Feedback withdrawal and changing compliance during manual hyperinflationPHYSIOTHERAPY RESEARCH INTERNATIONAL, Issue 2 2002Julie Hila Abstract Background and Purpose The performance of manual hyperinflation by physiotherapists can be improved by the availability of a pressure manometer. The present study aimed to test whether these benefits could be maintained when the manometer is withdrawn and whether the availability of a manometer affects the pressures delivered under changing respiratory compliances. Method Manual hyperinflation breaths were delivered to a test lung by student physiotherapists, with a target peak airway pressure of 30 cm H2O under control, feedback and feedback-withdrawal conditions. The breaths were delivered for three trials under each testing condition at each of three respiratory compliance settings. Results The availability of augmented feedback increased the accuracy and reduced the variability of performance; however, these improvements were not maintained when feedback was withdrawn. Changing respiratory compliance significantly affected the accuracy and variability during the control and withdrawal conditions, but the availability of a manometer negated these differences. Conclusions The availability of a pressure manometer negates the influence of respiratory compliance on the achievement of target peak airway pressures during manual hyperinflation in the laboratory environment, however these benefits are not retained when feedback is withdrawn. Therefore, it is recommended that a pressure manometer should be routinely available during manual hyperinflation in clinical practice to optimize treatment safety and effectiveness. Copyright © 2002 Whurr Publishers Ltd. [source] Phonation threshold pressure estimation using electroglottography in an airflow redirection systemTHE LARYNGOSCOPE, Issue 12 2009Adam L. Rieves BS Abstract Objectives/Hypothesis: The present study proposed to estimate phonation threshold pressure (PTP) noninvasively using airflow redirection into a pneumatic capacitance system. Study Design: Prospective study. Methods: Subjects phonated into the device, which interrupts airflow mechanically and redirects the flow into a pneumatic capacitor. Five interruptions were effected per trial. PTP was estimated as the difference between subglottal pressure (SGP) and transglottal pressure at phonation offset. The novel method was tested for consistency in 20 normal human subjects at low (75 dB) and high (85 dB) sound pressure levels. The device was tested for validity on a tracheotomy patient. Results: Mean SGP was 9.02 ± 3.27 cm H2O, and mean PTP was 3.68 ± 1.41 cm H2O. Intrasubject coefficient of variation, a measure of intrasubject consistency, was 0.33 ± 0.23. Statistically significant differences existed between the means of SGP but not PTP at 75 dB and 85 dB. The correlation coefficient between accepted and experimental SGP in a tracheotomy patient was 0.947 (P < .001). Conclusions: Measurements corresponded well to previously reported values, and intrasubject variability was low, indicating the device was consistent. Testing on a tracheotomy patient demonstrated validity. More research is needed to determine the sensitivity and specificity of the device in differentiating between normal and pathological voices. This device may have clinical application as a noninvasive and reliable method of estimating PTP and indicating that laryngeal health is likely abnormal. Laryngoscope, 2009 [source] The effect of multilevel upper airway surgery on continuous positive airway pressure therapy in obstructive sleep apnea/hypopnea syndrome,,THE LARYNGOSCOPE, Issue 1 2009FACS, Michael Friedman MD Abstract Objective: To investigate the effect of multilevel upper airway surgery (USA) on subsequent continuous positive airway pressure (CPAP) therapy in patients with obstructive sleep apnea/hypopnea syndrome (OSAHS). Study Design: Fifty-two patients who underwent multilevel UAS with persistent symptoms of OSAHS represent the cohort for this study. All patients had undergone manual CPAP titrations both pre- and postoperatively. Patients were used as their own controls and were compared pre- and postoperatively with regard to body mass index, full night polysomnography (PSG), optimal CPAP pressure settings, presence of rapid eye-movement (REM) sleep, identification of mouth leakage, and CPAP compliance. Results: Postoperative values for apnea index (AI), apnea hypopnea index (AHI), and minimum oxygen saturation (min SaO2) were all significantly decreased from their preoperative levels. Compliance with CPAP therapy significantly increased from a mean 0.02 ± 0.14 hours per night prior to surgery to a 3.2 ± 2.6 hours per night following surgery (P < .001). In addition, the optimal CPAP pressure setting decreased significantly for a preoperative value of 10.6 ± 2.1 cm H2O to 9.8 ± 2.1 cm H2O following surgery. Fifty of the 52 patients (96.2%) studied were able to maintain optimal pressure settings without mouth leak, postoperatively. Conclusions: In this study, most patients who had persistent symptoms of OSAHS after multilevel UAS did not have significant mouth leak that would preclude CPAP therapy. In this cohort of patients, CPAP pressure setting as well as compliance was significantly improved postoperatively. Laryngoscope, 119:193,196, 2009 [source] A comparison of stroke volume variation measured by the LiDCOplus and FloTrac-Vigileo systemANAESTHESIA, Issue 9 2009R. B. P. De Wilde Summary The aim of this study was to compare the accuracy of stroke volume variation (SVV) as measured by the LiDCOplus system (SVVli) and by the FloTrac-Vigileo system (SVVed). We measured SVVli and SVVed in 15 postoperative cardiac surgical patients following five study interventions; a 50% increase in tidal volume, an increase of PEEP by 10 cm H2O, passive leg raising, a head-up tilt procedure and fluid loading. Between each intervention, baseline measurements were performed. 136 data pairs were obtained. SVVli ranged from 1.4% to 26.8% (mean (SD) 8.7 (4.6)%); SVVed from 2.0% to 26.0% (10.2 (4.7)%). The bias was found to be significantly different from zero at 1.5 (2.5)%, p < 0.001, (95% confidence interval 1.1,1.9). The upper and lower limits of agreement were found to be 6.4 and ,3.5% respectively. The coefficient of variation for the differences between SVVli and SVVed was 26%. This results in a relative large range for the percentage limits of agreement of 52%. Analysis in repeated measures showed coefficients of variation of 21% for SVVli and 22% for SVVed. The LiDCOplus and FloTrac-Vigileo system are not interchangeable. Furthermore, the determination of SVVli and SVVed are too ambiguous, as can be concluded from the high values of the coefficient of variation for repeated measures. These findings underline Pinsky's warning of caution in the clinical use of SVV by pulse contour techniques. [source] A randomised crossover trial comparing the i-gel supraglottic airway and classic laryngeal mask airway,ANAESTHESIA, Issue 6 2009C. Janakiraman Summary In a randomised cross-over study, we compared the performance of the single use i-gel supraglottic airway and reusable classic laryngeal mask airway (cLMATM) in 50 healthy anaesthetised patients who were breathing spontaneously. Primary outcome was successful insertion at first attempt. Secondary outcomes included overall insertion success rate, ease of insertion, leak pressure and fibreoptic position. Success rate for insertion at the first attempt was significantly different (54% with i-gel vs 86% with cLMA; p = 0.001). Overall success after two attempts (when the anaesthetist was allowed to change the size of the device) improved to 84% with i-gel vs 92% with cLMA; p = 0.22. In 14 patients, the i-gel when used first needed to be replaced with a larger size. Leak pressure was higher for the i-gel (median [IQR] 20 [14,24] cm H2O than the cLMA 17 [12,22] cm H2O; p = 0.023). The fibreoptic view through the device was significantly better with the i-gel than the cLMA, which was statistically significant (p = 0.03). We conclude that, with its current sizing recommendations, the i-gel is not an acceptable alternative to cLMA. However because of the significantly improved success rate after a larger sized i-gel was used, we recommend the manufacturer to review the sizing guidelines to improve the success rate. [source] 78 Use of a rabbit model to investigate the feasibility of using an innervated neosphincter transplant for the treatment of stress urinary incontinence.BJU INTERNATIONAL, Issue 2006A.D. SHAFTON Aim:, To examine the feasibility of using an innervated smooth muscle wrap as a neosphincter in a rabbit model of urinary incontinence. Methods:, Rabbits were rendered incontinent surgically by lesion of the proximal urethral wall to the level of the submucosa (n = 20). In twelve animals a strip of dartos smooth muscle was wrapped around the lesioned urethra to create a new urethral sphincter and stimulating electrodes were inserted into the muscle. After a recovery period of at least one-week cystometrograms were established for control (urethra intact), lesioned and lesion plus neosphincter animals. Results:, Infusion of saline into the bladder of control animals caused a slow rise in bladder pressure until, at approximately 20,30 ml, there was an increase in pressure that rose steeply and was associated with bladder emptying. The threshold for this reflex emptying was 2,3 cm H2O, and the maximum pressure during the reflex was 6,15 cm H2O. After the bladder emptied, the pressure dropped to 0,2 cm H2O. In rabbits with lesioned sphincters, it was not possible to obtain a normal cystometrogram because there was leakage of fluid from the urethral opening before a volume and pressure sufficient to elicit a reflex was achieved. The loss of the majority of fluid often occurred without a significant pressure increase, that is, there was no true emptying reflex. Similar results were observed in animals in which the urethra had been lesioned and implanted with the smooth muscle neosphincter. Prior to electrical stimulation of the neosphincter, with constant current pulses at 2 Hz, substantial leak occurred at 11.4 ± 2.5 ml, whereas during stimulation voiding occurred at 17.8 ± 1.4 ml. At void or emptying, the peak pressure was 6.1 ± 0.1 cm H20 in control, 0.7 ± 0.2 in operated but not stimulated and 3.5 ± 0.6 in the same animals during stimulation. A satisfactory improvement of continence was observed for a period of up to 6½ months postsurgery. At the end of the study, histological examination confirmed the neosphincter to be both healthy and viable. Conclusion:, Smooth muscles of the dartos display contractile properties which make them suitable for use as transplantable sphincters. A smooth muscle neosphincter, controlled by electrical stimulation, can restore continence after urethral damage. [source] Cerebrospinal fluid opening pressure measurements in acute headache patients and in patients with either chronic or no painACTA NEUROLOGICA SCANDINAVICA, Issue 2010S. H. Bø Bø SH, Davidsen EM, Benth J,, Gulbrandsen P, Dietrichs E. Cerebrospinal fluid opening pressure measurements in acute headache patients and in patients with either chronic or no pain. Acta Neurol Scand: 2010: 122 (Suppl. 190): 6,11. © 2010 John Wiley & Sons A/S. Objective,,, To observe cerebrospinal fluid opening pressure (CSFOP) in different clinical settings and in patients with acute, chronic and no pain and to observe possible differences because of age and sex. Method,,, In this prospective study, CSFOP was measured in lumbar puncture in three different settings of clinical investigations; patients with acute headache investigated for subarachnoidal haemorrhage (n = 222), patients with sciatica undergoing myelography (n = 61), and patients in an outpatient neurological clinic (n = 65). Results,,, The mean CSFOP in cm H2O was 17.3 for the myelography patients, 19.1 for the outpatients, 19.3 for the primary headache patients and 22.4 for the patients with secondary headache. Large proportions of patients in all groups had CSFOP above 20 cm H2O. The female patients in all groups had lower mean CSFOP than the male patients. Conclusion,,, The CSFOP levels found in clinical practice among patients without intracranial lesions or infectious conditions were broader than expected. Measurement of CSFOP is of limited value as diagnostic procedure if not closely linked to clinical symptoms and finds. [source] | ||||||||||||||||||||||