Looking For A Suitable Methodology To Compare The Intrinsic Diagnostic Specificity Of Esrt And

Systematic research has never been carried out on this subject. Nevertheless I think it is of particular interest for all practitioners who wish to combine both methods to obtain maximum information on their patients.

Table 7.2 compares the diagnostic abilities of ESRT and PPT in identifying symptoms of some systems and disorders:

a. musculoskeletal apparatus b. teeth and TMJ dysfunction c. nervous system d. mental disorders e. metabolic disorders f. gastrointestinal tract g. cardiovascular system h. skin disorders i. genitourinary tract.

Table 7.2 Diagnostic success rates obtained on various apparatus and disorders in 325 patients with two

methods, ERST (—) and PPT, and comparison with paired samples t-test

a) Musculoskeletal apparatus

Diagnostic success rate

ESRT (-) = 35.89%

PPT = 43.82%

Two methods combined =

55.84%

Comparison (paired samples t-test)

Mean difference

CI 95% for mean

P

ESRT (—) vs. PPT

-7.93%

(-11.10% ; -4.76%)

<0.001

ESRT (—) + PPT vs. ESRT (—)

19.95%

(17.68% ; 22.22%)

<0.001

ESRT (—) + PPT vs. PPT

12.02%

(10.18% ; 13.86%)

<0.001

b) Teeth and TMJ dysfunction

Diagnostic success rate

ESRT = 14.02%

PPT = 54.21%

Two methods combined =

59.81%

Comparison (paired samples f-test)

Mean difference

CI 95% for mean

P

ESRT (—) vs. PPT

-40.19%

(-51.62% ; -28.5%)

<0.001

ESRT (—) + PPT vs. ESRT (—)

3.28%

(36.20% ; 55.39%)

<0.05

ESRT (—) + PPT vs. PPT

45.79%

(1.18% ; 10.04%)

<0.001

c) Nervous system

Diagnostic success rate

ESRT = 19.30%

PPT = 47.95%

Two methods combined =

53.22%

Comparison (paired samples f-test)

Mean difference

CI 95% for mean

P

ESRT (—) vs. PPT

-28.65%

(-37.08% ; -20.23%)

<0.001

ESRT (—) + PPT vs. ESRT (—)

33.92

(26.75% ; 41.09%)

<0.005

ESRT (—) + PPT vs. PPT

5.26

(1.88% ; 8.64%)

<0.001

d) Mental disorders

Diagnostic success rate

ESRT = 50.51%

PPT = 44.95%

Two methods combined =

74.46%

Comparison (paired samples f-test)

Mean difference

CI 95% for mean

P

ESRT (—) vs. PPT

5.56%

(0.74% ; 10.39%)

<0.05

ESRT (—) + PPT vs. ESRT (—)

23.95%

(21.13% ; 26.77%)

<0.001

ESRT (—) + PPT vs. PPT

29.51%

(26.49% ; 32.53%)

<0.001

e) Metabolic disorders

Diagnostic success rate

ESRT = 13.68%

PPT = 8.42%

Two methods combined =

18.95%

Comparison (paired samples f-test)

Mean difference

CI 95% for mean

P

ESRT (—) vs. PPT

5.26%

(-2.80% ; 13.30%)

NS

ESRT (—) + PPT vs. ESRT (—)

5.26%

(0.69% ; 9.84%)

<0.001

ESRT (—) + PPT vs. PPT

10.43%

(4.24% ; 16.81%)

<0.05

Continued

Table 7.2 Diagnostic success rates obtained on various apparatus and disorders in 325 patients with two

methods, ERST (—) and PPT, and comparison with paired samples t-test—cont'd

f) Gastrointestinal tract

Diagnostic success rate

ESRT = 26.69%

PPT = 19.93%

Two methods combined

= 40.88%

Comparison (paired samples t-test)

Mean difference

CI 95% for mean

P

ESRT (—) vs. PPT

6.76%

(2.00% ; 11.51%)

<0.01

ESRT (—) + PPT vs. ESRT (—)

14.19%

(11.37% ; 17.01%)

<0.001

ESRT (—) + PPT vs. PPT

20.95%

(17.66% ; 24.23%)

<0.001

g) Cardiovascular system

Diagnostic success rate

ESRT = 29.29%

PPT = 27.27%

Two methods combined

= 47.81%

Comparison (paired samples t-test)

Mean difference

CI 95% for mean

P

ESRT (—) vs. PPT

2.05%

(-5.12% ; 9.17%)

NS

ESRT (—) + PPT vs. ESRT (—)

18.52%

(15.92% ; 25.16%)

<0.001

ESRT (—) + PPT vs. PPT

20.54%

(14.08% ; 22.96%)

<0.001

h) Skin disorders

Diagnostic success rate

ESRT = 28.57%

PPT = 26.79%

Two methods combined

= 45.24%

Comparison (paired samples t-test)

Mean difference

CI 95% for mean

P

ESRT (—) vs. PPT

1.79%

(-7.26% ; 10.84%)

NS

ESRT (—) + PPT vs. ESRT (—)

16.67%

(12.53% ; 24.38%)

<0.001

ESRT (—) + PPT vs. PPT

18.45%

(10.97% ; 22.36%)

<0.001

i) Genitourinary tract

Diagnostic success rate

ESRT = 24.50%

PPT = 19.21%

Two methods combined

= 37.09%

Comparison (paired samples t-test)

Mean difference

CI 95% for mean

P

ESRT (—) vs. PPT

5.30%

(-3.57% ; 14.16%)

NS

ESRT (—) + PPT vs. ESRT (—)

12.58%

(7.23% ; 17.93%)

<0.001

ESRT (—) + PPT vs. PPT

17.88%

(11.70% ; 24.60%)

<0.001

Practitioners should, however, be aware that the clusters of points they are going to identify with both methods often represent a puzzle which can be solved only through sufficient medical knowledge.

To compare the diagnostic abilities of ESRT and PPT, I applied the following methodology. An independent assessor randomly chose 20-40 patients with the same symptom and a sex- and age-matched control group containing the same number of subjects without this symptom. The number of tender points or reduced ESR sector by sector was first analyzed in the group with a given symptom and in the control group by means of paired samples t-test. The second analysis was then made in the first group comparing the concentration of points identified in each sector with ESRT and PPT. The clusters of points were graphically reproduced on the Sectogram with a size which was directly proportionate to the percentage of the total; clusters with a percentage below 5% were not included in the figures in this chapter.

Let us consider, for example, the case of irritable bowel syndrome (IBS).

Two randomly selected groups were chosen for the first analysis: the first was composed of 40 patients with diarrhea- or constipation-predominant discomfort; the second group consisted of 40 subjects without this disorder. Only two sectors (15 and 16, related to liver and pancreas-gallbladder) showed a significantly higher number of points with PPT in the IBS group compared to the control group, whereas for ESRT no differences were found. Much more interesting was the comparison between ESRT and PPT: the first showed a significant concentration of points with lower ESR on the colon area represented in sectors 23-25 (on the left in Fig. 7.2), whereas PPT showed a significantly higher number of tender points on sectors 16-19 and 4-8 (on the right of Fig. 7.2). The interpretation of these areas is not immediate but becomes easier when circumscribing the clusters of points located on these sectors. With regard to the first group of sectors identified with

PPT, the significant sensitization comes from the sum of clusters belonging to the liver-pancreas-gallbladder area with the Chinese abdomen area (AH8 fu) and the elbow-wrist area. In trying to solve this puzzle we may be reassured by the fact that the area of the abdomen also has indications, for example, for diarrhea with abdominal distension and pain, which are typical symptoms of IBS. Also the sensiti-zation of the elbow-wrist area, which I consider related to allergy and food intolerance, should not be considered out of place since, for example, a lactose intolerance could mimic the symptoms of IBS.

As regards the lower group of sectors, a significant difference of sensitization was found for sectors 4-6 (P<0.05) and for sectors 7-8 (P<0.01). One cluster was found on the antitragus, on the Chinese forehead area, representing the tendency to sinusitis or migraine in these patients; another cluster was found on the posterior part of the ear lobe representing depressed mood. It is noteworthy that headache, depression and fibromyalgia have been

Fig. 7.2 Cluster of points with low ESR in 40 patients with irritable bowel syndrome on the left; cluster of tender points with PPT of the same patients on the right. The colored sectors correspond to a significantly higher concentration of points, respectively, for ESRT vs. PPT on the left side or for PPT vs. ESRT on the right side of the figure. Colored areas = lateral surface; blank areas = medial surface.

Fig. 7.2 Cluster of points with low ESR in 40 patients with irritable bowel syndrome on the left; cluster of tender points with PPT of the same patients on the right. The colored sectors correspond to a significantly higher concentration of points, respectively, for ESRT vs. PPT on the left side or for PPT vs. ESRT on the right side of the figure. Colored areas = lateral surface; blank areas = medial surface.

identified by several authors as co-morbidities or medical conditions accompanying IBS.3,4

This methodological approach, as appealing as it may appear, is, however, not free from limitations:

1. The patients of my group were middle-aged (on average 53.2 years) and their auricles showed the representation of somatic and functional symptoms related to several bodily systems.

2. The patients of the control group, randomly selected among those without IBS, nevertheless belonged to the main group itself and therefore could not be regarded as truly healthy or asymptomatic subjects. In my opinion this is a frequent limitation of current clinical research which does not take into consideration a sufficient number of clinical and instrumental parameters in the control group, to exclude co-morbidity or a possible medical condition associated to the disorder which is the object of the study.

Curing Irritable Bowel Syndrome

Curing Irritable Bowel Syndrome

Everyone has an upset stomach from time to time. You probably know the sort of thing I mean – sometimes you’ve got gas and at other times you feel queasy or nauseous. There may be times<br />when you can’t seem to go to the toilet for days, constipated as can be, but there are other days when diarrhea strikes and you can’t stop going!

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