PubMed Health⌕ Search

Biomedical subjects

O Korn

Publications and source records attributed to O Korn.

At least 37 records · Page 2Linked to original sources
PubMed1997

Gastroesophageal sphincter: a model.

There is substantial experimental and anatomic evidence suggesting that the human lower esophageal sphincter is not a muscular ring but has its correlate in the arrangement of the so-called muscular clasps and oblique sling fibers at the gastroesophageal junction. We assessed the mode of action of these distinct muscle units in a mechanical model. The arrangement of the clasp and sling fibers at the gastroesophageal junction was simulated with two elastic bands placed perpendicularly around the gastroesophageal junction of four pig specimens. Rapid pullback manometry with four radially oriented pressure transducers was performed in each specimen. The opening pressure was determined, and three-dimensional pressure images were constructed based on the manometric readings. The elastic bands established a competent high-pressure zone at the level of the gastroesophageal junction. The three-dimensional pressure images matched those usually observed in vivo in normal human volunteers. The vector volume of the high-pressure zone correlated with the opening pressure while individual resting pressure values and length of the high-pressure zone were not sufficient to estimate the competence of the gastroesophageal junction in the model. This model supports the contention that the combined action of the clasp and sling fibers establishes the manometric lower esophageal sphincter in humans.

Animals↗
PubMed1997

A new physiologic approach for the surgical treatment of patients with Barrett's esophagus: technical considerations and results in 65 patients.

OBJECTIVE: To determine the results of a new surgical procedure for patients with Barrett's esophagus. SUMMARY BACKGROUND DATA: In addition to pathologic acid reflux into the esophagus in patients with severe gastroesophageal reflux and Barrett's esophagus, increased duodenoesophegeal reflux has been implicated. The purpose of this study was to establish the effect of a new bile diversion procedure in these patients. METHODS: Sixty-five patients with Barrett's esophagus were included in this study. A complete clinical, radiologic, endoscopic, and bioptic evaluation was performed before and after surgery. Besides esophageal manometry, 24-hour pH studies and a Bilitec test were performed. After surgery, gastric emptying of solids, gastric acid secretion, and serum gastrin were determined. All patients underwent highly selective vagotomy, antireflux procedure (posterior gastropexy with cardial calibration or fundoplication), and duodenal switch procedure, with a Roux-en-Y anastomosis 60 cm in length. RESULTS: No deaths occurred. Morbidity occurred in 14% of the patients. A significant improvement in symptoms, endoscopic findings, and radiologic evaluation was achieved. Lower esophageal sphincter pressure increased significantly (p < 0.0001), as did abdominal length and total length of the sphincter (p < 0.0001). The presence of an incompetent sphincter decreased from 87.3% to 20.9% (p < 0.0001). Three of seven patients with dysplasia showed disappearance of this dysplasia. Serum gastrin and gastric emptying of solids after surgery remained normal. Basal and peak acid output values were low. Twenty-four hour pH studies showed a mean value of 24.8% before surgery, which decreased to 4.8% after surgery (p < 0.0001). The determination of the percentage time with bilirubin in the esophagus was 23% before surgery; this decreased to 0.7% after surgery (p < 0.0001). Late results showed Visick I and II gradation in 90% of the patients and grade III and IV in 10% of the patients. CONCLUSIONS: This physiologic approach to the surgical treatment of patients with Barrett's esophagus produces a permanent decrease of acid secretion (and avoids anastomotic ulcer), decreases significantly acid reflux into the esophagus, and abolishes duodenoesophageal reflux permanently. Significant clinical improvement occurs, and dysplastic changes at Barrett's epithelium disappear in almost 50% of the patients.

Adult↗
PubMed1997

Correlation among ultrasonographic and videoscopic findings of the gallbladder: surgical difficulties and reasons for conversion during laparoscopic surgery.

Laparoscopic cholecystectomy is currently the standard procedure for chronic and acute cholecystitis. The purpose of this prospective study was to evaluate the preoperative ultrasound findings of the gallbladder and correlate those aspects with surgical videoscopic and histopathologic findings and the results concerning intraoperative complications and the conversion index to open surgery. Gallbladder findings were classified into three categories according to the gallbladder wall characteristics and the presence of visible lumen and stones. Simple chronic cholecystitis (type I) and acute cholecystitis, with gallbladder wall thickness <5 mm (type IIa) presented significantly lower intraoperative complications without conversion to open surgery. Scleroatrophic (type III) and acute cholecystitis with gallbladder wall thickness >5 mm (type IIB) presented significantly more surgical difficulties and a higher conversion rate to open surgery (p < 0.01). We postulate that this classification will be useful for surgeons in predicting potential problems in individual patients, at least at the initial laparoscopic cholecystectomy experience, and in advising patients of the potential risks of and conversion to open surgery.

Acute Disease↗
PubMed1997

[Gastroesophageal reflux and obesity].

BACKGROUND: There is a possible relationship between gastroesophageal reflux and overweight, that has not been studied extensively. AIM: To study the association between overweight and gastroesophageal reflux in a group of patients and normal controls. SUBJECTS AND METHODS: Body mass index of 85 patients with gastroesophageal reflux and 100 patients with Barrett esophagus, was compared with that of 171 healthy controls. RESULTS: There were no differences in body mass index between healthy subjects and patients with gastroesophageal reflux. However, there was a higher proportion of overweight males and obese females with Barrett esophagus than among healthy controls. CONCLUSIONS: We did not find an association between overweight and gastroesophageal reflux, but patients with Barrett esophagus had a higher body mass index than normal controls.

Adolescent↗
PubMed1996

[Subjective and objective evaluation of the results of laparoscopic antireflux surgery in patients with gastroesophageal reflux].

BACKGROUND: Laparoscopic antireflux surgery is a minimally invasive procedure that should have similar results than classical surgical treatment. AIM: To report the results of a prospective study of laparoscopic antireflux surgery in patients with gastroesophageal reflux. PATIENTS AND METHODS: Thirty two patients with gastroesophageal reflux and without Barret's esophagus, were subjected to endoscopy, manometry and measurement of intraesophageal pH before and after laparoscopic surgery. RESULTS: There were no postoperative deaths or complications. Gastroesophageal sphincter pressure and abdominal sphincter length increased from 9.1 +/- 3.9 to 13.0 +/- 3.5 mm Hg and from 8.1 +/- 6.2 to 13.5 +/- 5.4 cm after surgery (p < 0.01). There was a decrease in acid reflux in 82% of patients. CONCLUSIONS: Laparoscopic antireflux surgery reproduces exactly the results of open surgical procedures.

Adult↗
PubMed1995

Manometric vector volume analysis to assess lower esophageal sphincter function.

The resistance provided by the manometric high pressure zone at the gastroesophageal junction, is the major barrier against gastroesophageal reflux in man. Recent studies have shown that this high pressure zone has its correlate in the architecture of the gastric 'sling' fibres at the gastric notch and the semicircular 'clasps' at the lesser curvature side of the gastroesophageal junction. Pull-back manometry with radially oriented pressure transducers allows to assess these distinct components of the human lower esophageal sphincter. With the recent introduction of personal computers into the manometry laboratory, three-dimensional manometric images of the lower esophageal sphincter can be easily constructed, based on radially oriented pressures. The application of this new technology has shown that calculation of the sphincter pressure vector volume, i.e. the volume circumscribed by the three-dimensional manometric sphincter image, is superior to standard manometric techniques in the assessment of lower esophageal sphincter function. The sphincter pressure vector volume is a particularly helpful parameter to identify patients with gastroesophageal reflux disease who will not benefit from medical therapy and should consequently undergo early antireflux surgery. Vector volume analysis is also helpful in assessing the cause of recurrent symptoms in patients with previous antireflux surgery. In patients with achalasia three-dimensional sphincter imaging and vector volume analysis can illustrate a severely asymmetric and hypertensive sphincter and show the effect of myotomy with or without a concomitant antireflux procedure on the sphincter pressure profile.

Computer Graphics↗
PubMed1995

[Epidemiological and etiological aspects of upper digestive hemorrhage. Multicenter study in nine Chilean hospitals (1980-1990)].

An epidemiological survey about the incidence of upper gastrointestinal bleeding during three periods (1980, 1985 and 1990), was performed in 9 Chilean hospitals. Its annual incidence decreased in 1990, when compared to 1980. Likewise the etiologies changed, with an increase in the incidence of duodenal ulcers and a decrease in the incidence of erosive gastritis and bleeding of unknown origin in 1990. A seasonal variation with higher bleeding rates in autumn was also recorded.

Chile↗
PubMed1994

Late results of primary repair and follow-up in 53 patients with injuries to the common bile duct occurring during cholecystectomy (distal perforation, tears, ligation or suture).

The late results of primary repair of accidental injuries to the common bile duct occurring during cholecystectomy were evaluated in 53 cases. These lesions occurred in 20 patients who had distal perforation produced by the Bakes dilator, in 17 cases with accidental tearing of the anterior or posterior wall of the common bile duct, and in 16 cases in whom the common bile duct was accidentally ligated or sutured. In cases of perforation, choledochostomy plus suturing of the perforation had a high operative mortality and 4 out of 6 cases developed benign stricture soon after surgery. When sphincteroplasty or choledochoduodenostomy was added, a stricture developed in only 1 out of 7 cases. In cases with accidental tears, suturing of the lesion plus choledochostomy produced very good late results. In patients with accidental ligation or suturing of the common bile duct, two different postoperative complications were seen: seven cases had biliary fistula and all developed benign stricture 2 years after surgery. In nine cases jaundice appeared 6 months after surgery, and a benign stricture developed in 7 of them. The most important "treatment" of these lesions is to prevent them from occurring during cholecystectomy by employing a meticulous surgical technique.

Cholecystectomy↗
PubMed1993

[Long-term survival of patients with stomach cancer treated with subtotal gastrectomy].

The aim of this work was to determine the 5 and 12 years survival of 233 patients with gastric cancer subjected to subtotal gastrectomy. Patients with early gastric cancer (n = 51) had a 95% survival and those with intermediate cancer (n = 19) a 87% survival. Patients with advanced gastric cancer (n = 163) subjected to curative surgery had a 60% survival, whereas none subjected to palliative surgery survived. Those patients that survive more than 24 months after the surgical procedure, have an excellent long term prognosis.

Adult↗
PubMed1993

[Biliary surgery mortality in Chile in 1990. Cooperative study in 17 hospitals].

A survey about surgical procedures performed in 1990 was answered by 17 surgical services. With these data the operative mortality of biliary surgery was analyzed. During 1990, 39,643 patients were subjected to major surgery of which 9,654 (24.3%) corresponded to benign biliary tract diseases. Forty nine percent of patients had chronic cholecystitis, 36% acute cholecystitis and 16% choledocholithiasis. Global mortality of these procedures was 0.58% and mortalities for chronic cholecystitis, acute cholecystitis and choledocholithiasis were 0.06, 0.6 and 2% respectively. These numbers increased significantly in patients over 60 years old, are lower than those reported 10 years ago and could be useful as "gold standards" for laparoscopic cholecystectomy.

Biliary Tract Diseases↗
PubMed1990

Classification and treatment of anastomotic leakage after extended total gastrectomy in gastric carcinoma.

A new classification of anastomotic fistulas of esophagojejunostomy after total extended gastrectomy for advanced gastric carcinoma is presented. In a group of 230 consecutive patients submitted to total gastrectomy within a 10-year period, there were 20 patients with Type I fistula (8.8%) and 18 cases with Type II (7.8%). Type I or subclinical fistula corresponded to a local leakage around the anastomosis, with no septic complications, which heals with prolongation of enteral feeding up to 20 days after surgery. The mortality rate was 5% in this group. Type II or clinical leakage corresponded to patients with early septic manifestations after surgery, in whom the methylene blue test was positive, that is, immediate appearance of the stain in any drain was observed after oral ingestion, confirmed by radiological studies. The mortality rate in this group was 78%. Resuturing of the fistula was a complete failure. Cervical lateral esophagostomy produced complete healing in two cases. Parenteral and enteral feeding, antibiotics and successful surgical drainage are measured that can provide good results in these cases.

Anastomosis, Surgical↗
PubMed1990

[A giant diverticulum of the colon].

A male patient complaining of abdominal pain developed rectal bleeding and a painful mass located in the left side of the abdomen. Barium enema revealed a giant diverticulum of the colon. Surgical resection was performed successfully. A brief review of the literature follows.

Colectomy↗
PubMed1989

Late subjective and objective evaluations of antireflux surgery in patients with reflux esophagitis: analysis of 215 patients.

The results of late subjective and objective evaluations of antireflux surgery in 215 patients with reflux esophagitis who were included in a prospective, controlled study are reported. A special protocol--including analysis of reflux symptoms, radiology, endoscopy, esophageal manometry, and standard acid reflux test--was designed. The surgical technique used was as follows: (1) highly selective vagotomy, (2) closure of the hiatus, (3) calibration of the cardia, (4) posterior gastropexy, and (5) fixation of the gastric fundus to the diaphragm. The operative mortality rate was 0.4%, and postoperative complications occurred in 5% of the patients. Only 5% of the patients were lost from the late follow-up. A total of 150 patients with more than 5 years since operation were completely evaluated. Reflux symptoms greatly decreased after surgery. Radiologic studies were normal in 93% of the patients, and endoscopy showed a long-standing healing of macroscopic esophagitis in 83% of the cases. Manometric features were analyzed in 159 patients before and in 115 patients 1 year after surgery. A significant increase in lower esophageal sphincter pressure was demonstrated, as well as an increase in the total length and abdominal length of this sphincter (p less than 0.0001). The increase in gastroesophageal sphincter was evaluated in 46 patients 1 year and 5 years after surgery, and this showed a maintenance of sphincter competence. Esophageal clearance markedly improved after surgery, and the standard acid reflux test, which was positive in 100% of cases before surgery, persisted positive in 16% (p less than 0.001). Final clinical evaluation 5 years after surgery demonstrated excellent and good results in 85% of the patients and failure or reoperation in 8% of the patients.

Adolescent↗
PubMed1988

Anomalies of extrahepatic biliary duct and gallbladder associated with intestinal malrotation: a case report.

Knowledge of congenital anomalies in abdominal viscera is important for surgeons, if they are to treat such patients and solve their problems adequately. This article presents an unusual case of reversed rotation of the intestine associated with anomalies in the biliary tract and gallbladder. This patient underwent surgery because of a bleeding duodenal ulcer. During surgery the following viscera positions were detected: the gallbladder was located to the left of the round ligament, the choledochus was in front of the first portion of the duodenum, the small intestine was in the left portion of the abdomen, and the colon was exclusively at the right side of the abdomen. This reversed rotation is a rare condition, only occasionally reported in the literature. However, the simultaneous association with anomalies in the gallbladder position (in the left lobe) and the biliary tract (the choledochus located in front of the duodenum) makes this a case unlike any other described in the medical literature.

Adult↗