Tez (Tıpta Uzmanlık)--Süleyman Demirel Üniversitesi, Tıp Fakültesi, Kulak Burun Boğaz Anabilim Dalı, 2004. / Bibliyografya var.

Diss. (sammanfattning) Stockholm : Karolinska institutet, 2002. / Härtill 5 uppsatser.

Diss. (sammanfattning) Stockholm : Karol. inst., 2003. / Härtill 4 uppsatser.

Diss. (sammanfattning) Uppsala : Univ., 2001. / Härtill 5 uppsatser.

Thesis (Ph.D. in Nursing) -- University of Colorado Denver, 2007. / Typescript. Includes bibliographical references (leaves 77-87). Free to UCD affiliates. Online version available via ProQuest Digital Dissertations;

Thesis (doctoral)--Ludwig-Maximilians-Universität zu München, 1979.

Dissertation (PhD)--University of Stellenbosch, 2006. / Bibliography. Also available via the Internet.

abstract: Drinking vinegar is a popularly discussed remedy for relieving heartburn symptom, as can be read on many websites; however, there has been no scientific research or theory to support its efficacy. This randomized, placebo-controlled, double-blind, cross-over research study tested the efficacy of the organic apple cider vinegar, with mother, on alleviation of the heartburn symptom related to Gastro-esophageal reflux disease (GERD). A minimum of one week separated the four trial arms: chili (placebo), antacid after chili meal (positive control), vinegar added to chili, and diluted vinegar after chili meal. Twenty grams of vinegar were used in both vinegar treatments, and 10 grams of liquid antacid were used in the antacid trial. A five-point Likert scale and a 10-cm visual analogue scale (VAS) were used to assess heartburn severity during a 120 minutes testing time. Seven of 15 recruited subjects' data was usable for statistical analysis (age: 39.6 ± 12.2 y, body mass index (BMI): 29.4 ± 4.2 kg/m2, waist circumference: 36.4 ± 4.1 inch). There was no statistically significant difference among the mean and incremental area-under-the-curve (iAUC) heartburn scores among different trials (Likert scale questionnaire p= .259, VAS questionnaire p= .659, iAUC Likert scale p= .184, iAUC VAS p= .326). Seven participants were further divided into antacid responder (n=4) and antacid non-responder groups (n=3). Likert scale mean heartburn score and iAUC data in antacid responder group had significant finding (p= .034 and p= .017 respectively). The significance lay between antacid and 'vinegar added to chili' trials. Effect size was also used to interpret data due to the small sample size: Likert scale: mean heartburn score= .444, iAUC= .425; VAS mean heartburn score= .232, iAUC .611. Effect size for antacid responder group was Likert scale: mean heartburn score= .967, iAUC= .936. Future research is needed to examine whether ingesting organic vinegar benefits alleviation of heartburn symptom related to GERD for people who do not respond well to antacid. / Dissertation/Thesis / Masters Thesis Nutrition 2016

nÃo hà / INTRODUÃÃO: DoenÃa do Refluxo GastresofÃgico (DRGE) à uma sÃndrome cuja uma das causas à uma alteraÃÃo funcional ou anatÃmica dos mecanismos de contenÃÃo do conteÃdo gÃstrico. à uma desordem crÃnica com estimativa de prevalÃncia alta e variÃvel (10 a 50% da populaÃÃo). IntervenÃÃes na mecÃnica respiratÃria, como o uso de CPAP, podem modificar a ocorrÃncia de RGE, melhorando a pressÃo basal e a taxa de relaxamento espontÃneo do EEI. O principal mÃsculo respiratÃrio à o diafragma, cuja parte crural compÃe a barreira antirrefluxo. O diafragma crural à um mÃsculo esquelÃtico, e como tal, passÃvel de treinamento. Assim, pergunta-se se seria possÃvel melhorar a barreira antirrefluxo atravÃs do treinamento fisioterapÃutico do diafragma. OBJETIVO: Mostrar que o treinamento diafragmÃtico pode ter efeito significativo na barreira antirrefluxo e nos sintomas de pacientes com esofagite de refluxo. MÃTODO: Estudo intervencional onde foram medidas as pressÃes (em mmHg) basal (Pb), e a pressÃo inspiratÃria do esfÃncter esofÃgico inferior (EEI) durante as manobras de arritmia sinusal respiratÃria (Pasr), e com carga inspiratÃria (Threshold IMTÂ) de 17 (Pth17), 35 (Pth35) e 70cmH2O (Pth70). Utilizou-se um sistema de manometria de baixa complacÃncia, perfusional e uma sonda com âdentsleeveâ de 6 cm. O treinamento diafragmÃtico foi realizado durante oito semanas com carga inicial de 30% da pressÃo inspiratÃria mÃxima (PimÃx), com acrÃscimos semanais de 5%. Cada intervenÃÃo de treinamento consistia em 10 sÃries de 15 incursÃes inspiratÃrias, com repouso de 30s a 60s entre as sÃries, e duraÃÃo em mÃdia de 30 min. RESULTADOS: Foram selecionados doze pacientes com DRGE sem hÃrnia hiatal, de ambos os gÃneros (18-50 anos). O estudo demonstrou que a Pb aumentou significativamente apÃs o treinamento diafragmÃtico (19,7  2,4 versus 28,5  2,1; p = 0,0009; n = 12), assim como a Pasr (95,87,8 versus 122,512,7, p=0,0218). A pressÃo inspiratÃria do esfÃncter esofÃgico inferior (EEI) durante a manobra com carga resistiva de 17 cmH20 foi maior apÃs o treinamento diafragmÃtico (117,312,8 versus 138,810,8, p=0,0308). A pressÃo inspiratÃria do EEI durante a manobra com carga resistiva de 35 cmH20 foi semelhante apÃs o treinamento diafragmÃtico (130,713,4 versus 138,810,8, p=0,5085). A pressÃo inspiratÃria do EEI durante a manobra com carga resistiva de 70 cmH20 foi maior apÃs o treinamento diafragmÃtico, apesar de nÃo alcanÃar significÃncia estatÃstica (127,314,0 versus 146,19,5, p=0,0909). O nÃmero de relaxamento transitÃrio do esfÃncter esofÃgico inferior (RTEEI) durante uma hora diminuiu significativamente apÃs o treinamento diafragmÃtico [20,00 (18,0 - 30,3) versus 13,5 (10,7 - 19,5); p = 0,0059)]. Os escores de pirose e regurgitaÃÃo, baseados na frequÃncia de sintomas, foram significativamente menores apÃs o treinamento diafragmÃtico [3,0 (1,0-4,0) versus 0 (0,0-1,0); p = 0,0035;] e [2,5 (0,0-4,0) versus 0 (0,0-4,0); p = 0,0084, respectivamente]. CONCLUSÃO: O treinamento diafragmÃtico inspiratÃrio aumenta a pressÃo basal e inspiratÃria do EEI, diminui a taxa de RETEEI e a sintomatologia na doenÃa do refluxo gastresofÃgico. / INTRODUCTION: The Gastroesophageal Reflux Disease (GERD) is a syndrome wicth one of the causes is a functional or anatomical change in the barrier mechanisms of gastric contents. It is a chronic disorder with a high and changeable estimated prevalence (from 10 to 50% of the population). Interventions in respiratory function, such as the use of CPAP (Continuous Positive Airway Pressure), can alter the occurrence of GERD, improving basal pressure and the rate of spontaneous relaxations of the Lower Esophageal Sphincter (LES). The main respiratory muscle is the diaphragm, whose crural part forms the anti-reflux barrier. The crural diaphragm is a skeletal muscle and hence it can be trained. Therefore, the main question is whether we could improve the anti-reflux barrier through physical therapy training of the diaphragm. OBJECTIVE: To show the training diaphragm may have significant effect on the antireflux barrier and symptoms in patients with reflux esophagitis. METHODS: Intervencional study it was measured the Baseline pressures (Bp) and the inspiratory pressures from the LES, both in mmHg. These measurements were done during the maneuvers of Respiratory Sinus Arrhythmia (RSA) and with inspiratory load (Threshold  IMT) of 17 (Pth17), 35 (Pth35) and 70cmH2O (Pth70).We used a system of low-compliance perfusion manometry, and a sonde with a "dentsleeve" of 6cm. The diaphragmatic training was conducted during eight weeks with initial load of 30% of Maximal Inspiratory Pressure (MIP), with weekly increments of 5%. Each training session consisted of 10 series of 15 inspiratory incursions, with a pause from 30s to 60s between the series, and aberage of 30 minutes duration. RESULTS: Intervencion study with twelve patients carried GERD without hiatal hernia, of both genders (18-50 years old) The study has showed that the Bp increased significantly after the diaphragmatic training (19.7  2.4 versus 28.5  2.1, p = 0.0009, n = 12), as well as the RSA pressure (95,87,8 versus 122,512,7, p=0,0218). The LES pressure, during the maneuver with a resistive load of 17 cmH20, was higher after diaphragmatic training (117,312,8 versus 138,810,8, p=0,0308), white with a resistive load of 35 cmH20 it was similar (130,713,4 versus 138,810,8, p=0,5085). The LES pressure, during the maneuver with a resistive load of 70 cmH20, was higher after diaphragmatic training, although not statistically significant (127,314,0 versus 146,19,5, p=0,0909). The number of transient lower esophageal sphincter relaxations (tLESR), during one hour, decreased significantly after diaphragmatic training [20.00 (18.0 to 30.3) versus 13.5 (10.7 to 19.5), p = 0.0059)]. The scores of heartburn and regurgitation, based on the frequency of symptoms, were significantly lower after diaphragmatic training [3.0 (1.0 to 4.0) versus 0 (from 0.0 to 1.0), p = 0.0035] and [2.5 (0.0 to 4.0) versus 0 (from 0.0 to 4.0), p = 0.0084, respectively]. CONCLUSION: The diaphragmatic training improves the baseline pressure, decreases the tLESR and the symptoms of the GERD.

Orientadores: Maria Aparecida Marques dos Santos Mezzacappa, José Dirceu Ribeiro / Tese (doutorado) - Universidade Estadual de Campinas, Faculdade de Ciências Médicas / Made available in DSpace on 2018-08-18T05:32:42Z (GMT). No. of bitstreams: 1 Mendes_ThaisdeBarros_D.pdf: 2709718 bytes, checksum: 980600cf933c0edd1c628440ceb42c40 (MD5) Previous issue date: 2010 / Resumo: Recém-nascidos (RN) com displasia broncopulmonar (DBP) apresentam alta frequência de tratamento para doença do refluxo gastroesofágico (DRGE). O agravamento da evolução desta doença pulmonar é atribuído à associação entre as duas entidades. Em virtude das indefinições quanto à ocorrência da DRGE em RN com DBP e dadas as possíveis consequências sobre a sua morbidade, bem como as altas frequências de tratamento clínico, considerou-se ser de interesse estudar a presença de anormalidades da monitorização prolongada do pH esofágico em RN com e sem DBP. Objetivos- Determinar a prevalência de índice de refluxo (IR) ?10% na monitorização prolongada do pH esofágico em RNMBP com e sem o diagnóstico de DBP e estabelecer fatores associados. Métodos- Foi realizado um estudo prospectivo e de corte transversal com um componente longitudinal. Foram selecionados 35 casos com DBP e 15 sujeitos para o grupo de comparação que foram submetidos à monitorização prolongada do pH esofágico distal, no período de abril de 2004 a dezembro de 2008. Foram analisadas as variáveis demográficas, de evolução pós-natal, referentes a procedimentos e medicamentos no período neonatal, bem como os escores de gravidade clínica e radiológica da DBP e de gravidade da doença pulmonar na primeira semana de vida. Foram empregados os testes de Qui-quadrado e Exato de Fisher para as variáveis categóricas, e para as numéricas o teste U de Mann-Whitney. Em seguida foi realizada a análise por regressão logística univariada e múltipla para determinar o odds-ratio (OR) e o seu intervalo de confiança (IC) de 95%. Resultados- A prevalência de IR ?10% nos grupos com e sem DBP foi de 65,7% e 93,3%, respectivamente. O peso ao nascer foi o fator preditor independente de risco para o IR ?10% (OR 1,769 IC95% 1,172-2,669). Conclusão- Foi encontrada uma prevalência de IR ?10% em RN com DBP de 65,7% e no grupo de comparação de 93,3% sem sinais clínicos de DRGE. A chance de IR ?10% aumentou em 76,9% a cada aumento de 100 gramas no PN. Os resultados deste estudo permitem concluir que a prevalência de IR ?10% não é maior em RN com DBP do que no grupo de comparação. RN assintomáticos ou com apneia da prematuridade podem apresentar IR ?10%, sendo assim o diagnóstico de DRGE baseado nos resultados da monitorização do pH esofágico e a indicação de qualquer modalidade terapêutica precisa ser criteriosa até que se definam quais são os RN que necessitam de tratamento / Abstract: Neonates with bronchopulmonary dysplasia (BPD) present high frequency of treatment for gastroesophageal reflux disease (GERD). The relationship between these illnesses is controversy. Due to indefinations for ocorrency of GERD in newborns with BPD and considering the possible consequences about his morbidity so as the high frequency of clinical treatment, seems to us important to study the presence of abnormalities in the prolonged esophageal pH monitoring in neonates with and without BPD. Objectives- To determine the prevalence pH esophageal monitoring alterations in very low birth weight infants with and without BPD and establish associated factors for reflux index (RI) ?10%. Methods- A prospective, cross-sectional study, with a longitudinal component was realized, including 35 newborns with BPD and 15 subjects for the comparison group, that were submitted to 24 hours esophageal pH monitoring and studied from April 2004 to December 2008. Were evaluated variables demographics, postnatal evolution, procedures and medications used in the neonatal period, scores of clinical and radiologic severity and initial lung disease in the first week of life. For the statistic analysis were utilized the chi-square test and the Fisher's exact test for the category variables, and Mann-Whitney's test for numerical variables. Multiple logistic regression was used for to determine odds-ratio (OR) and confidence interval (CI) of 95%. Results- The prevalence of RI ?10% in the groups with e without BPD was 65.7% and 93.3%, respectively. The birth weight (BW) was the independent predictor factor for RI ?10% (OR 1.769 CI95% 1.172-2.669). Conclusions- High frequency of RI altered was demonstrated in newborns with BPD and the comparison group without clinics signs of GERD. The chance of RI ?10% increased in 76.9% in each increase of 100 grams in the BW. The results showed that the prevalence of RI ?10% not is major in neonates with BPD. Asymptomatic newborns or infants with apnea of prematurity may present IR ?10%, so the diagnosis of GERD based on the results of esophageal pH monitoring and indication of any therapeutic modality needs to be careful until a definition of which are infants who need treatment / Doutorado / Saude da Criança e do Adolescente / Doutor em Saude da Criança e do Adolescente