Objetivo: Avaliar o perfil funcional do esôfago e a prevalência de refluxo gastroesofágico (RGE) em pacientes candidatos a transplante pulmonar. Métodos: Foram analisados prospectivamente entre Junho de 2005 a Novembro de 2006, 55 pacientes candidatos a transplante pulmonar da Santa Casa de Misericórdia de Porto Alegre. Os pacientes foram submetidos a esofagomanometria estacionária e pHmetria esofágica ambulatorial de 24 horas de um e dois eletrodos antes de serem submetidos ao transplante pulmonar. Resultados: A esofagomanometria foi anormal em 80% dos pacientes e a pHmetria revelou RGE ácido patológico em 24%. Os sintomas digestivos apresentaram sensibilidade de 50% e especificidade de 61% para RGE. Noventa e quatro por cento dos pacientes com DPOC apresentaram alteração à manometria, sendo a hipotonia do esfíncter inferior o achado mais frequente (80%). Pacientes com bronquiectasias apresentaram a maior prevalência de RGE (50%). Conclusões: RGE é achado freqüente em pacientes com doença pulmonar avançada. Na população examinada, a presença de sintomas digestivos de RGE não foi preditiva de refluxo ácido patológico. A contribuição do RGE na rejeição crônica deve ser considerada e requer estudos posteriores para seu esclarecimento. / Objective: To assess the prevalecence of gastro-esophageal reflux (GER) and esophageal motor profile in lung transplant candidates. Methods: Between July 2005 and November 2006, a prospective study was conducted in 55 candidates for lung transplantation. Patients underwent esophageal manometry and 24-hour pH testing before undergoing transplantation as an attempt to obtain the prevalence of reflux in this subset. Results: Abnormal esophageal manometry was documented in 80% of the patients and abnormal GER was documented in 24% of the patients. Reflux-related symptoms presented sensitivity and specificity of 50% and 61% for GER, respectively. Ninety-four per cent of the patients with COPD presented an abnormal esophageal manometry, and hipotensive lower esphincter was the most common finding (80%). Bronchiectasis patients presented the highest prevalence of GER (50%). Conclusions: GER is highly prevalent in end-stage lung disease. Reflux-related symptoms was not preditive of gastroesophageal reflux. The contribuition of GER to chronic rejection and allograft dysfunction must be considered and needs to be addressed in future studies.

Background. Obstructive Sleep Apnoea (OSA) is associated with an increase in nocturnal gastro-oesophageal reflux (nocturnalGOR) events and symptoms, however the mechanism for this remains undefined. Treatment of OSA with continuous positive airway pressure (CPAP) has been shown to reduce nocturnalGOR in individuals with OSA however the reasons for this reduction are not clear. The combination of OSA and nocturnalGOR could be particularly problematic for individuals who have had a lung transplant in whom Bronchiolitis Obliterans Syndrome (BOS) limits survival. It is thought that GOR plays a role in the development of BOS in these individuals. Methods and Results. Five interrelated studies were undertaken. The first two studies sought to determine and compare the prevalence and risk factors of nocturnalGOR in OSA patients with the general population. To do this, a GOR questionnaire was completed by 2,042 members of the general community as part of the Busselton Health Survey and by 1,116 patients with polysomnography-diagnosed OSA. Risk of OSA in the general population was determined using a standardised sleep questionnaire. 137 of the OSA patients completed the questionnaire before and after treatment with CPAP. The prevalence of nocturnalGOR symptoms reported more than once a week (frequent symptoms) was greater in OSA patients (10.1%) than the general population (5.8%) (p<0.001), in individuals from the general population at high (11.2%) than low risk of OSA (4.5%) (p<0.001) and in patients with severe (14.7%) than mild OSA (5.2%) (p<0.001). Treatment of OSA with CPAP decreased the prevalence of frequent nocturnalGOR from 9.0% to 3.8% (p=0.04). In the general population, high risk of OSA was independently associated with a 2.4-fold increased risk of frequent ABSTRACT vi nocturnalGOR symptoms than low risk. In the OSA group, disease severity was independently associated with nocturnalGOR symptoms, with an adjusted odds ratio of 1.7 for frequent nocturnalGOR symptoms.

The purpose of this essay is to compile a list of symptoms to aid voice teachers in the early detection of vocal problems resulting from bulimic behavior. Bulimia nervosa (BN) is an eating disorder characterized by bingeing and purging and has a high rate of occurrence among the college population. Entertainers form a high risk group for development of BN yet the effects of BN on the voice are largely ignored in vocal literature. The study begins with a literature review which links several factors that can influence the development of BN with "the singer’s personality." The two main character traits that appear most frequently are perfectionism and anxiety. The study continues with a narrative presentation of interviews by the author with three voice specialists in different fields of voice research and treatment. The research questions on which the interview portion of the study were based are: 1) Are otolaryngologists seeing an increase in vocal problems associated with eating disorders?; 2) Is there a belief among voice specialists that singer-actors are a high risk group for the development of eating disorders?; 3) What vocal symptoms should voice teachers watch and listen for if they suspect a student is bulimic?; 4) How should the voice teacher approach the recommendation of treatment, care, and use of the bulimic voice? This portion of the paper includes a clear and concise list of symptoms associated with BN that are easily identifiable by sight or sound. The paper concludes with a summary of the study results, suggestions for voice teachers training singers with the disorder, and ideas for further research.

Bakgrund: Venduplex har på senare år vuxit fram som den mest använda metoden vid diagnostik av venös insufficiens eftersom det är en ofarlig, kostnadseffektiv, non-invasiv metod med hög sensitivitet och specificitet där både den anatomiska placeringen av insufficiensen samt den funktionella förändringen av venen kan påvisas direkt vid undersökningen. Olika manövrar kan genomföras för att påfresta venklaffarna och därmed framkalla en eventuell reflux, men det är oklart om de olika manövrerna kan påverka den reflux som provoceras fram och därmed också påverkar bedömningen av insufficiensgraden. Syfte: Syftet med studien var att undersöka om det förelåg skillnad i graderingen av insufficiensen samt om den maximala refluxhastigheten påverkades beroende på vilken manöver som användes för att framkalla en reflux. Metod: 20 v. saphena magna mitt på låret med påvisad reflux deltog i studien. Två upprepade mätningar genomfördes där venklaffarna provocerades med hjälp av en blodtrycksmanschett över vaden, med en manuell kompression över låret samt med en manuell kompression över vaden. Resultat: Den maximala refluxhastigheten blev 0,33±0,20m/s när en blodtrycksmanschett över vaden användes, 0,31±0,22m/s när en manuell handkompression över vaden användes samt 0,17±0,16m/s när en manuell lårkompression genomfördes. Slutsats: Ingen signifikant skillnad på maximal refluxhastighet kunde konstateras när en automatisk uppblåsbar blodtrycksmanschett över vaden jämfördes med en manuell handkompression över vaden. En signifikant högre maximal refluxhastighet konstaterades när en manuell vadkompression jämfördes med en manuell lårkompression.

Ofri luftväg kan uppstå på grund av bakåtfallen tunga hos den medvetslösa patienten eller om luftvägen blir tilltäppt av sekret, blod, maginnehåll eller främmande kropp. Att kunna säkerställa fri luftväg hos den medvetandesänkta patienten är en kompetens som varje anestesisjuksköterska måste behärska för att kunna säkerställa adekvat ventilation. Syftet med studien var att beskriva om larynxmask (LMA) är en patientsäker metod för att skapa fri luftväg och upprätthålla adekvat ventilation. Studien genomfördes som en litteraturstudie där 19 vetenskapliga artiklar analyserades. Resultatet av de granskade artiklarna gav följande fem teman; LMA är en säker metod för att skapa fri luftväg, LMA är en säker metod för att upprätthålla adekvat ventilation, personalens kompetens vid användning av LMA, aspirationsrisk vid användning av LMA med undertema LMA vid övervikt samt LMA vid elektiva- och akuta situationer. Litteraturstudiens resultat visar att LMA är en säker metod för att skapa fri luftväg och upprätthålla adekvat ventilation. Framtida studier skulle kunna belysa om LMA kan användas vid kirurgi till patienter med ökad aspirationsrisk, till exempel vid sectio och obesitaskirurgi. Studier skulle också kunna fokuseras på patienternas postoperativa upplevelser av att ha haft LMA jämfört med trakeal intubation. / Airway obstruction can in the case of an unconsciousness patient be caused by the tounge that falls back in the throat or by secretion, blood, stomach fluid or foreign body. The knowledge of airway management of the unconsciousness patient is a necessary qualification in every nurse anesthetist. The purpose of this study was to describe if laryngeal mask airway is a safe method to establish a secure airway and adequate ventilation. The study was performed as a literature study in which 19 articles were analysed. During the analyse five themes occurred: LMA is a secure way for airway management, LMA is a secure way to maintain adequate ventilation, the staff competence when using LMA, the risk of aspiration when using LMA with subtheme LMA in overweight and LMA in elective and acute situations. The result of the study shows that LMA is a secure way to establish a safe airway and adequate ventilation. Further studies could study if LMA can be used to elective patients with increased risk of aspiration, for example in cesarean and obesity surgery. Studies could also focuse on the patients´ postoperative experiences between LMA and tracheal intubation.

Thesis (M.Med.)--University of Natal, Durban, 1997.

Bibliography: leaves 231-266. / 271 leaves : col. ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Indicates that injections under the ureteric orifice can cure VUR and that the tissue response to the plastics becomes quiescent. Research into embolisation from solid implants from intravenous tubing and the possibility of antibody formation to implanted plastics is also included. A model for fetal VUR has been developed to clarify focus of the uncertainity about reflux disease. / Thesis (Ph.D.)--University of Adelaide, Dept. of Paediatrics, 1999

Bibliography: leaves 231-266. / 271 leaves : col. ill. ; 30 cm. / Title page, contents and abstract only. The complete thesis in print form is available from the University Library. / Indicates that injections under the ureteric orifice can cure VUR and that the tissue response to the plastics becomes quiescent. Research into embolisation from solid implants from intravenous tubing and the possibility of antibody formation to implanted plastics is also included. A model for fetal VUR has been developed to clarify focus of the uncertainity about reflux disease. / Thesis (Ph.D.)--University of Adelaide, Dept. of Paediatrics, 1999

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2006. / Härtill 4 uppsatser.

Diss. (sammanfattning) Stockholm : Karol inst., 2004. / Härtill 4 uppsatser.