Transcutaneous. Another route of cannabinoid exposure that avoids first- pass metabolism and improves THC bioavailability is topical administration . A transcutaneous monitor (TCM) uses a noninvasive technique to measure the . The sleep recording should display the same values that the TC monitor. Introduction. 2. Pharmacokinetics of Cannabinoids. Absorption. Smoking. Oral. Oromucosal. Rectal. Transcutaneous.
Zhu reported normal transverse ED as Mateen measured the transverse diameter as 6. We measured the cervical anteroposterior ED as 5. No significant differences were determined between proximal and total reflux patient groups and the other subgroups with regard to ED. There was no difference between the other groups regarding ELD.
Peak ED was given as 22 mm during physiologic swallows with 15 mL water[ 19 ]. PR volume has not been accurately diagnosed to date, though esophageal continuous aspiration and scintigraphic studies have been used in an effort to obtain results about the reflux volume[ 39 ]. The distal esophageal distension and the cross-sectional area CSA are known to be wider than the proximal esophagus[ 19 ].
Mittal reported that healthy asymptomatic individuals had comparable esophageal diameter and CSA measurements according to spontaneous fluid GER and 5 mL swallow. It is difficult to differentiate between the ingested fluid and the refluxate of esophageal content. Mittal made the differentiation by looking at transient LES relaxations synchronously. We measured the esophageal refluxate during a non-swallowing period. Similar observations were also made using impedance techniques.
They concluded the gas-dominant or mixed reflux episodes could be the contributory factor[ 19 ]. In contrast to this finding is the short reflux period which was determined by color Doppler CD US but not by pH monitoring[ 45 ]. The positive relation could be explained by presence of refluxate in the esophageal lumen. Although there was positive correlation between ED and WT, no significant difference was found between groups.
This could be explained by the small patient groups. Esophageal motor disorders can cause abnormal fluid or viscous bolus transit[ 37 , 46 ]. Esophageal dysmotility can cause reflux esophagitis and reflux can cause esophageal dysmotility[ 12 , 37 ]. The possible manometric disorders that could be responsible for the PR were also evaluated in our study. We did not observe any patients with achalasia, DES or nutcracker esophagus.
There is a gradual increase in muscle thickness, thickening of the muscularis propria and increase in CSA from the proximal to distal esophagus in primary spastic esophageal motor disorders like achalasia, DES, nutcracker esophagus, hypertensive LES, and atypical LES relaxation, and in non-spastic esophageal motor disorders like hypotensive LES, IEM, and incomplete LES relaxation[ 12 , 15 , 37 , 41 ]. The corresponding abnormal values were 2. We found no difference in anterior CE WT in patient subgroups divided according to esophageal manometry.
In our study, the esophageal measurements were taken at the thyroid gland level, while corresponding values in the literature were measured at the GEJ or 2 or 10 cm above the GEJ.
IEM is characterized by low amplitude esophageal contractions, which could cause ineffective acid clearance and aid the reflux pathogenesis[ 37 ]. None of the patients with isolated PR had manometric impairment. We did not observe any pathology which could cause impairment in esophageal transit in 11 of 38 patients Since we did not investigate non-acid reflux, the probable reflux patterns in these 11 patients are unknown.
ELD with refluxate of 4. The fact that h pH monitoring and manometry were not performed in subjects without refluxate during TCEUS is a limitation of this study. Esophageal refluxed material can be recognized in ultrasonographic images. TCEUS can not substitute for h pH monitoring or esophageal manometry, but it can serve as a complementary technique by aiding in the estimation of proximal reflux, GER and motility disorders which could cause impairment in bolus transit.
To our knowledge, there is no study in the available literature showing refluxate presence in the cervical esophageal lumen and measuring the TCEUS parameters at the thyroid gland level transcutaneously while correlating pH monitoring and esophageal manometry findings in adults. We express our thanks to Eylul Ozturk and Mahmut Kacar for their guidance and help.
The content of liquid refluxate, whether acidic or not, did not affect the sonographic appearance. Liquid can be present in the esophageal lumen in gastroesophageal reflux GER and esophageal motility disorders. Esophageal ultrasonography is currently being used to evaluate the gastroesophageal junction by transabdominal route, especially in newborns and children, and endosonographic studies have been used especially for motility disorders.
We evaluated the possible pathologies in h pH monitoring and esophageal manometry in patients with refluxate in the lumen of the cervical esophagus during TCEUS. Our study is distinct from other studies evaluating the GER and esophageal manometry pathologies with ultrasonographic methods due to our usage of TCEUS. We performed esophageal manometry and h pH monitoring in patients with refluxate in the esophageal lumen.
The shortcomings of the study were that 1 we did not perform manometry or pH monitoring in patients without refluxate and 2 we did not evaluate the non-acid reflux. Different patient groups and volunteers without refluxate can be evaluated for different study designs. During swallowing, the presence of saliva mixed with air and downward movement of refluxate generated a strong echogenic appearance; TCEUS parameters: Wall thickness WT of the esophagus: Distance between adventitia and the mucosa, with esophageal wall layers; Esophageal diameter ED: Distance between the adventitia outer to outer ; Esophageal luminal diameter ELD with or without refluxate: Distance between the mucosa inner to inner.
The authors studied transcutaneous cervical esophageal ultrasound TCEUS as a possible diagnostic procedure in gastroesophageal reflux. TCEUS has been forgotten in the diagnosis of esophageal diseases, however, it is a non-invasive, available and high sensitive technique.
This manuscript is in principle an interesting topic for the readers of World Journal of Gastroenterology. National Center for Biotechnology Information , U. Journal List World J Gastroenterol v. Published online Oct Author information Article notes Copyright and License information Disclaimer. All authors contributed equally to the work. Ambulatory h pH monitoring, Cervical esophageal ultrasound, Gastroesophageal reflux, Esophageal manometry, Esophageal refluxate.
Open in a separate window. Statistical analysis Descriptive and comparative statistical analyses were performed using statistical software system SPSS v Manometric findings abnormal Manometric findings normal h pH monitoring Acid reflux 7 Table 5 h pH monitoring and esophageal manometry results.
Table 6 Cut-off values for esophageal luminal diameter ELD to determine acid reflux. Research frontiers We evaluated the possible pathologies in h pH monitoring and esophageal manometry in patients with refluxate in the lumen of the cervical esophagus during TCEUS. Innovations and breakthroughs Our study is distinct from other studies evaluating the GER and esophageal manometry pathologies with ultrasonographic methods due to our usage of TCEUS.
Applications Different patient groups and volunteers without refluxate can be evaluated for different study designs. Peer review The authors studied transcutaneous cervical esophageal ultrasound TCEUS as a possible diagnostic procedure in gastroesophageal reflux.
Gomes H, Menanteau B. Correlation of color Doppler sonographic findings with pH measurements in gastroesophageal reflux in children. Ultrasound picture of gastroesophageal junction in children with reflux disease. Sonographic measurement of the abdominal esophagus length in infancy: Support color conversion shaders in glsl on Android and iOS. Support for deinterlacing for higher bit depth and XYZ colorspace.
New anaglyph filter for side-by-side 3D. Add hardware decoding for Android using MediaCodec. Audio fingerprinting using AcoustID. Support for screen input on OSX Lion and later. Support for Microsoft Smooth Streaming, developed by Viotech. Improved MKV support for seeking, and resiliancy. Considerable evidence is available in support of an independent association between obstructive sleep apnoea syndrome OSAS and cardiovascular disease, which is particularly strong for systemic arterial hypertension and growing for ischaemic heart disease, stroke, heart failure, atrial fibrillation and cardiac sudden death.
The pathogenesis of cardiovascular disease in OSAS is not completely understood but likely to be multifactorial, involving a diverse range of mechanisms including sympathetic nervous system overactivity, selective activation of inflammatory molecular pathways, endothelial dysfunction, abnormal coagulation and metabolic dysregulation, the latter particularly involving insulin resistance and disordered lipid metabolism. The present report, which arose out of a European Union Cooperation in the field of Scientific and Technical Research COST action on OSAS COST B26 , reviews the current evidence for an independent association and proposes research priorities to identify the underlying mechanisms involved, with a view to identifying novel therapeutic strategies.
Large-scale collaborative studies of carefully defined patient populations with obstructive sleep apnoea syndrome, adequately controlled for potential confounders, are needed. Such studies carry the prospect of evaluating potential interactions between different basic mechanisms operating in obstructive sleep apnoea syndrome and cardiovascular disease, and interactions with other related disorders, such as obesity, diabetes and dyslipidaemia.
Furthermore, translational studies involving cell culture and animal models linked to studies of obstructive sleep apnoea syndrome patients are necessary to integrate basic mechanisms with the clinical disorder. Epidemiology of obstructive sleep apnea. A population health perspective. State of the art. On the subject of methods of determining blood pressure. Rules, Terminology and Technical Specifications. Normal aging, in Principles and Practice in Sleep Medicine.
Abnormal endotheliumdependent vascular relaxation in patients with essential hypertension. Most researchers use their institutional email address as their ResearchGate login. Keep me logged in.
There are only a few studies about the transcutaneous cervical esophagus .. the GEJ wall was observed as ± () mm, which was significantly thicker. 18 Figure The simple model. . 46 Figure Traditional equivalent circuit of transcutaneous electrode placed on the skin .. 46 Figure The. Inhalation Drug Delivery Transdermal Drug Delivery Transmucosal Drug Delivery Nonsteroidal Anti-Inflammatory Drugs.