Biomedical subjects

R E Knight

Publications and source records attributed to R E Knight.

6 recordsLinked to original sources

PubMed2000

Esophageal dysmotility as an important co-factor in extraesophageal manifestations of gastroesophageal reflux.

OBJECTIVE: Esophageal motility problems have been demonstrated in patients with noninflammatory typical gastroesophageal reflux (GER) and esophagitis, but the frequency of motility disorders in patients with extraesophageal manifestations of GER has not been studied. The primary aim of this study was to assess the frequency of esophageal motility disorders in patients with atypical GER. METHODS: A prospective study of 112 consecutive patients with laryngopharyngeal reflux (LPR) symptoms and demonstrated physical findings consistent with LPR were studied. Patients were divided into one of the following diagnostic categories: hoarseness; chronic cough; dysphagia or globus pharyngeus; and paroxysmal laryngospasm. Of the 112 patients, 81 (72%) underwent esophageal manometry and ambulatory 24-hour pH monitoring (pH-metry), 19 (17%) had motility studies only, and 12 (11%) had pH-metry studies only. Only patients who had motility studies were included in the analysis. Therefore the study population was 100 patients. Associations between diagnostic category, motility disorder, and abnormal reflux were evaluated with contingency-table analyses. RESULTS: Of the 100 patients, 29 (29%) presented normal motility function, 48 (48%) had ineffective esophageal motility, 10 (10%) had hypertensive lower esophageal sphincter (LES), and 9 (9%) and 4 (4%) had nutcracker esophagus and achalasia, respectively. There was a significant association between esophageal dysmotility and extraesophageal manifestations of GER However, there was no statistically significant association between esophageal motility disorders and abnormal acid reflux in our patients with atypical GER. CONCLUSIONS: In the present study, the frequency of esophageal motility problems in patients with extraesophageal or atypical manifestations of GER was 73% and suggested that these problems exist as an accompanying condition or pathogenic co-factor in some patients with atypical GER.

Adolescent↗

PubMed1988

Circadian rhythms in patients with abdominal pain syndromes.

Circadian rhythms for cortisol, 6-sulphatoxy melatonin and core body temperature were compared in control subjects and patients with functional abdominal pain. There were 20 patients with biliary pain after cholecystectomy, ten with biliary pain without cholecystectomy and 14 with irritable bowel syndrome. Rhythms were determined by urine collections at intervals of 4 h for 48 h and by overnight monitoring of core body temperature using the Vitalog system. Data were fitted to a sine curve to yield the time of maximal urinary excretion/lowest temperature and the amplitude of each rhythm. Urinary excretion of free cortisol was similar in patients and control subjects. For urinary 6-sulphatoxy melatonin, the timing (phase) of rhythms was similar in patients and controls but those with pain had a lower urinary excretion of 6-sulphatoxy melatonin (p less than 0.05) and a rhythm of lower amplitude (p less than 0.02). The amplitude of the temperature rhythm was also lower in patients with biliary pain with and without prior cholecystectomy (p less than 0.05). Functional abdominal pain is associated with 6-sulphatoxy melatonin and temperature rhythms of low amplitude, presumably because of suppression of circadian oscillators.

Abdomen↗

PubMed1986

Neurologic syndrome associated with low levels of vitamin E in primary biliary cirrhosis.

A 41-yr-old woman with primary biliary cirrhosis developed weakness and wasting in proximal muscles, areflexia, and decreased proprioceptive and vibratory sensation. Investigations revealed law serum levels of vitamin E and electromyographic and muscle biopsy changes consistent with a neuropathy. Sural nerve histology demonstrated axonal dystrophy with patchy demyelination. These features closely resemble a neurologic syndrome associated with chronic cholestatic liver disease and vitamin E deficiency in children. Adults with chronic cholestasis may also be susceptible to neurologic damage from prolonged malabsorption of vitamin E.

Adult↗

PubMed1984

Office videofiberoptic laryngoscopy.

Precise photographic documentation is of significant importance for proper diagnosis and management of physiological and pathological conditions of the larynx. Since the fiberscope serves an important role in the daily practice of laryngologists, its value is greatly enhanced when coupled with a video camera. Fiberoptic videolaryngoscopy permits instant and simultaneous voice and visual recordings for later study. The procedure is most useful for analysis of respiration, phonation, singing, and other laryngeal functions such as glottic closure, swallowing, and protective-compensatory movements. The procedure also allows investigation of various pathological conditions. The purpose of this paper is to present the authors' method of fiberscopic videolaryngoscopy and its relevant clinical implications. Advantages and disadvantages of the procedure are discussed.

Ambulatory Care↗

PubMed1981

Recurrent laryngeal nerve section in the treatment of spastic dysphonia.

Spastic dysphonia is a severe vocal disability in which the patient speaks with hyperadducted vocal folds. The resulting abnormality is characterized by excessively low pitch, vocal tremor, laryngospasms, and strain-strangle voice quality. Until recently the disorder was regarded as psychogenic and treated unsuccessfully with speech therapy and psychotherapy. New evidence supports the theory that the etiology is neurologic, requiring management designed to alter neurophysiologic function. Section of the recurrent laryngeal nerve provides immediate results and a new voice virtually free of the previous unpleasant characteristics.

Adult↗

PubMed1975

Auditory versus audio-visual intelligibility measurements of alaryngeal speech: a preliminary report.

This investigation supports the notion that audio-visual presentations of esophageal speech to 32 university student judges yield a relative increase in rated intelligibility in contrast with esophageal speech presented auditorily. Implications suggest that to construct realistic therapeutic goals of an esophageal speaker more effectively, the audio-visual component should be included in the clinical assessment.

Aged↗