Thesis (doctoral)--Groningen, 1984.

This Research thesis is focused on the influence of body position on the function of pelvic floor muscles (PFM). Anatomical structures, kinesiology and neurophysiology of the PFM are described in the theoretical part of this thesis. It also discusses the methodology used for objective evaluation of the PFM. For the practical part of this thesis, 30 healthy subjects (aged 20 - 30 years, 15 male, 15 female) where chosen via a questionnaire. The subjects were examined via the method of anorectal manometry. The goal of the examination was to measure the distribution of a) resting pressure in the anal canal in selected positions, b) pressure during voluntary maximal contraction of PFM and sphincters in selected positions, c) pressure during 20 seconds of voluntary contraction. Selected positions are: lying on the back; lying on the back with legs elevated and held in "three flexion"; kneeling on all fours with palm support; kneeling on all fours with elbow support; squatting, and standing. Results: a) The resting pressure is influenced by the body position. Highest resting pressure was observed in squatting and standing positions, lowest resting pressure was measured on subjects while kneeling on all fours with elbow support. No significant difference was observed between male and female subjects in...

The diploma thesis aims to describe the functional disorders of the upper gastrointestinal tract with an emphasis on gastroesophageal reflux disease. The theoretical part describes the anatomy, pathophysiology, etiology of GERD and treatment options. In the practical part is measured postural reactivity of the diaphragm in the selected 15 probands with GERD. We measured the postural reactivity of the diaphragm using high resolution manometry in various postural situations: lying on the back with flexion of lower limbs above the surface, standing and standing on the AIREX mat, for standing patients, we used weights of 3,6 and 9 kilos inside and outside the center of gravity. Patients also completed the GERD Health-Related Quality of Life questionnaire. The measurements confirmed an increase in resting pressure in all positions except standing, which correlated with the highest occurrence of reflux episodes in standing. The results were compared with a healthy control group. The activation of the crural part of the diaphragm was the same in both groups. We found in patients with GERD decreased coordination, delayed and influent activation of the crural diaphragm. The most significant increase in pressure in GERD patients occurred in the postural position of the flexed lower limbs and in standing...

Background: Achalasia is a primary esophageal motility disorder that can be classified into three types (I-III) based on high-resolution manometry (HRM). Exact pathogenesis is unknown, but immune-mediated processes and genetic predisposition play a role, which is supported by finding of a genetic risk variant (rs28688207 insertion) in HLA-DQB1 gene that is strongly associated with achalasia. Per-oral endoscopic myotomy (POEM) has become a standard treatment for achalasia, but the long-term efficacy, safety and impact on esophageal physiology are not fully understood. The aims of our studies were to perform the first genotype-phenotype analysis investigating the frequency of rs28688207 accross three HRM types of achalasia, to evaluate the efficacy and safety of POEM and to assess the post-POEM esophageal motility patterns. Patients and methods: These were three retrospective studies of prospectively collected data. Genotyping of the rs2868827 insertion was performed using real-time PCR in 347 patients from Czech Republic (n = 163), Germany (n = 114), Greece (n = 70). The efficacy and safety of POEM were evaluated in 133 patients treated in our center. The post-POEM esophageal motility was assessed using the Chicago Classification in 237 patients in whom HRM was performed prior to and after POEM....

Hintergrund: Organische Störungen des Schluckvorganges treten im Rahmen peripherer anatomischer Läsionen sowie im Rahmen neurologischer und neuromuskulärer Grunderkrankungen auf. Dabei wird die Pathologie der oropharyngealen Phase des Schluckvorganges bisher nur unzureichend objektiv erfasst. Ziel der vorliegenden Untersuchung ist es, mit oraler Manometrie und simultan durchgeführter flexibler Nasopharyngoskopie ein verbessertes multimodales diagnostisches Konzept vorzustellen. Patienten und Methode: Untersucht wurden 24 konsekutive Patienten (44-82 Jahre; 20m/4w) aus der Abteilung für Mund-, Kiefer- und Gesichtschirurgie der Universitätsmedizin Göttingen. Alle Patienten wiesen einen Tumor im orofazialen Bereich auf. 30 kombiniert manometrisch-endoskopische Untersuchungen in der prä- und postoperativen Phase wurden durchgeführt. Die orale Manometrie erfolgte während der intraoralen Bolusapplikation mit kontinuierlicher Druckmessung über ein zu diagnostischen Zwecken umgerüstetes Silencos-Mundstück in Kombination mit einem Manometer. Die nasopharyngeale Endoskopie erfolgte parallel mit dem flexiblem Laryngo-Fiberskop und angeschlossener Videokette. Alle Patienten wurden klinisch untersucht und erhielten einen Fragebogen zur Selbsteinschätzung der Schluckfunktion. Das Untersuchungsprotokoll bestand aus drei Phasen mit aktivem Ansaugen eines Wasserbolus durch den Patienten (AWB) sowie der intraoralen Applikation eines Wasserbolus (PWB) und eines Breibolus (PBB) durch den Untersucher. Es wurden jeweils 10 Wiederholungen für den Saugvorgang und jeweils 5 für die passive Applikation aufgezeichnet. Die nasopharyngeale Endoskopie erfolgte aus einer supravelaren Position für die ersten 5 Versuche und aus einer mesopharyngealen Position für alle weiteren Bolusapplikationen. Auswertung: Die Resultate wurden nach der Defektsituation der Patienten aufgeschlüsselt. Mehrfachuntersuchungen waren möglich. Maßgeblich ist das Fehlen von funktionell relevantem Gewebe. Als Defektsituationen wurden definiert: D0 ohne, D1-D5 mit Operationsdefekt. Defektsituation im anterioren oralen Bereich durch T1-/T2-Tumoren: D1, durch T3-/T4-Tumoren: D2; im posterioren oralen Bereich durch T1-/T2-Tumoren: D3, durch T3-/T4-Tumoren: D4; sonstige: D5. Ergebnisse: Manometrie. In der Phase AWB ergaben sich signifikante Unterschiede im Paarvergleich von D0 mit D1-D5 für alle untersuchten Parameter, das heißt Häufigkeit des Auftretens mono- bzw. polyphasischer Schluckmuster (Anzahl der negativen (p<0,01) und positiven (p=0,02) Amplituden), maximaler (p=0,04) und mittlerer (p=0,04) Saugdruck. Für D0 ergab sich ein maximaler Saugdruck von 83,9 mbar und ein mittlerer von 62,7 mbar. Für D1-D5 ergab sich ein maximaler Saugdruck von 51,0 mbar und eine mittlerer von 28,8 mbar. In der Phase PWB wurden keine, in der Phase PBB wurde nur ein signifikanter Unterschied (p=0,03) beim Vergleich von D0 mit D1-D5 in der Anzahl der positiven Amplituden gefunden. Defektklassenbezogen zeigte D2 im Vergleich zu D0 eine geringe und unregelmäßige Druckgeneration, die orale Saug- und Schluckfunktion von D3 war meist deutlich schlechter als die von D4. D5 zeigte mittlere Resultate. Endoskopie. Es wurde ein physiologisches pharyngeales Schluckvermögen bei D0 beobachtet. Passagestörungen des Meso- und Hypopharynx zeigten die anderen Defektklassen. In den Phasen AWB und PWB gab es im Vergleich von D0 mit D1-D5 signifikante Unterschiede (p=0,02 und p<0,01). In allen drei Phasen war bei den Patienten mit D2 und D4 die pharyngeale Schluckfunktion schlechter als bei D1 und D3. Die zwei Patienten in D5 hatten mit Rezidiv im Velumbereich die schlechteste pharyngeale Schluckfunktion. Die Selbsteinschätzung durch die Patienten war nicht aussagekräftig. Schlussfolgerungen: Die manometrisch-endoskopische Untersuchung liefert diagnostisch nutzbare Informationen der oralen und pharyngealen Schluckphasen bei Tumorpatienten. Manometrisch lässt sich die Amplitudenhöhe beim Wassersaugen zur graduierten Differenzierung von Patienten mit und ohne Defekt nutzen; der Breibolus ergibt kaum Unterschiede. Das Schluckmuster in Form von mono- bzw. polyphasischen Druckverläufen ermöglicht die klinische Diagnostik von muskulären Dyskoordinationen und Kompensationsstrategien. Endoskopisch ist die dichotome Bewertung der nasalen Regurgitation, posterioren Leckage, Residuen, Penetration und Aspiration aussagekräftig; nur bei Tumoren des anterioren Mundbodens besteht meistens eine Korrelation mit den manometrischen Ergebnissen, jedoch nicht bei allen Patienten. Eine kombinierte Anwendung der Methoden ist daher zu empfehlen.

The thesis examines the relationship between the level of intra-abdominal pressure and abdominal wall expansion. The theoretical part brings an overview of knowledge about the function of intra-abdominal pressure and about the possibilities of objectification of postural functions. There are described studies which dealt with the influence of intra-abdominal pressure on the stability of spine. Theoretical part also includes detailed description of individual invasive and non-invasive methods of measurement of intra-abdominal pressure and activation of abdominal muscles. Work methodology: In the practical part the intra-abdominal pressure was measured using anorectal manometry and abdominal wall expansion by utilizing DNS brace device. 31 healthy examinees with average age of 26.77 (SD 3.01) were measured in five different standing postural situations: during resting breathing, Valsalva Maneuver, Müller's maneuver, diaphragm test and in the situation with added external load in the form of static holding of dumbbell. Results of the thesis: Among the values of the pressure gathered from the DNS brace device and from anorectal manometry was proven statistically important correlation (p < 0.001) in all five tested situations. In all situations the Pearson Correlation Coefficient was higher than 0.6...

No description available.

The aim of this thesis is to present a complex information about the etiology, diagnosis and treatment of gastroesophageal reflux disease (GERD) and to further elucidate the function of the diaphragm as the external esophageal sphincter and as a part of the antireflux barrier in patients with GERD. The study included 87 patients with verified GERD. Patients were subjected to a set of postural and respiratory maneuvers - caudal position of chest, abdominal breathing and measuring of the maximal respiratory pressures, all performed on the basis of tolerance to position and maneuver. The high-resolution manometry (HRM) was chosen to record the changes in pressure in the lower esophageal sphincter and for the measurement of respiratory pressures was used the spirometric system MasterScope. It was found that postural and respiratory maneuvers, that activate the diaphragm, increase the pressure in the EGJ. The most significant increase occurred during the maximal inspiratory maneuver, which increased LES pressure up to 261.2 %. The results also show that patients with GERD have reduced the strength of respiratory muscles, especially inspirational muscles. Reaching only 66.5 % of predicted PImax. We have demonstrated that patients with GERD have significantly lower diaphragm muscle strength, what...

Multiorgan dysfunction syndrom is the major driving pathophysiological mechanism of morbidity and mortality in critically ill patients. Gastrointestinal dysfunction usually develops as a result critical illness and it is believed to play a key role in the development and progression of multiple organ dysfunction. Moreover, any primary disorder of the gastrointestinal tract, if severe enough, can lead to a critical state and secondary multiorgan dyfunction. Despite intensive experimental and clinical research, reliable tools for monitoring and evaluation of the severity of gastrointestinal dysfunction remain unknown. In the same line, therapy of this complex pathology remains largely supportive. The aim of this thesis was first to explain the severity of the most common and most serious nosocomial infection of the digestive tract, second to elucidate the safety and effectiveness of the endoscopic dual enteral probe insertion in ventilated critically ill patients, and, third to evaluate new diagnostic tools of the gastrointestinal dysfunction. Finally, we present an ongoing project aimed at investigating esophageal dysfunction in mechanically ventilated critically ill patients.

The aim of this thesis is to describe information about GERD, its etiology, anatomy, pathology, treatment options and rehabilitation in patients with GERD. Lower oesophageal sphincter and antireflux barrier. The study was approved by the ethics committee. 30 probands were included in the study and their health status was verified using the Health Related Quality of Life questionnaire. A manometric catheter was inserted, proband was instructed to maintain various postural positions. Lying supine with lower limbs elevated above the surface, lying supine with lower limbs elevated above the surface with head fixated manualy, sitting and standing position, load in the center of gravity 3/6/9 kg, load outside the center of gravity 3/6/9 kg, lifting of the office chair. It has been shown that LES pressure increases in all postural positions compared to resting pressure. The positions activate the diaphragm to demonstrate the postural function of the diaphragm. The most significant change in LES pressures was in the postural position of lying supine with lower limbs elevated above the surface, the LES resting pressure of 20.34mmHg changed to the pressure of LES 40.92mmHg. Clinical experience and studies have shown that patients with GERD have disposition for respiratory and / or vertebrogenic difficulties....