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Biomedical subjects

T Rådmark

Publications and source records attributed to T Rådmark.

8 recordsLinked to original sources
PubMed1994

Laparoscopic Rosetti fundoplication.

Early experiences with laparoscopic fundoplication using the Rosetti technique are presented and compared with retrospective results from conventional fundoplication procedures. A 360 degrees floppy fundoplication was laparoscopically constructed without division of short gastric vessels. We have performed 60 consecutive procedures. Conversion to open surgery was done in seven cases due to anatomical reasons and in two due to progressive subcutaneous emphysema and CO2-retention. The complication rate was low. The range of postoperative hospital stay is 1-4 days for non-converted patients. Symptomatic follow up has hitherto been performed in 41 patients with a follow-up time of 3-9 months. Regurgitation and heartburn had disappeared in all but one patient. The follow-up results do not differ from those achieved in patients operated upon with the conventional open Nissen (N = 41), Toupét (N = 9) or Rosetti (N = 36) technique. Pre and postoperative control of 24h pH and lower esophageal sphincter pressure (LESP) in 19 laparoscopically treated patients showed normalisation of LESP in all cases and postoperative 24h pH < 4 ranging between 0 and 3%. Assessment of quality of life showed postoperative results in accordance with normal population for all treated groups.

Esophagogastric Junction↗
PubMed1989

Improved lower esophageal sphincter manometry: application of the end-hole recording technique in vivo.

The recommendation to use a thin end-hole catheter for lower esophageal (LES) manometry has a strong theoretic background supported by previous in vitro studies. The pressure in the closed sphincter is measured, and the problem of pressure asymmetry eliminated. In this study the advantage and applicability of an end-hole catheter compared with the composite side-hole catheter for LES manometry was tested in vivo in dogs and human subjects. Pull-through manometry was performed with a continuously infused composite four-lumen catheter with one central channel and three side-hole channels enabling simultaneous end-hole and side-hole recording of LES pressure. A pull-through produced one end-hole and three side-hole pressure registrations. The end-hole recorded resting sphincter pressure was 19.7 +/- 4.5 cm H2O in 6 dogs and 9.9 +/- 6.8 cm H2O in 89 human subjects (volunteers and patients). The side holes recorded higher pressures, longer high-pressure zones, and obvious differences--asymmetry--between the three channels. The correlation between the side-hole and end-hole recordings was equally poor with regard to both pressure and length, with r values from 0.48 to 0.61. The relative difference between the end hole and side holes was most pronounced in low-pressure sphincters. In the dogs the end-hole and one side-hole channel always recorded LES pressure close to the expected 0 pressure during reflux, whereas the other two side-hole channels recorded high pressures. The present study proved the applicability of the end-hole technique for LES manometry in vivo in man. The end hole seemed to record true sphincter pressure.

Animals↗
PubMed1989

Lower esophageal sphincter pressure in normal individuals and patients with gastroesophageal reflux. A comparison between end-hole and side-hole recording techniques.

The advantage of a single-lumen end-hole catheter compared with the usual composite side-hole catheter for lower esophageal sphincter (LES) manometry has been studied in vitro and in vivo. In the present study LES pull-through manometry was performed with a special catheter, enabling simultaneous end-hole and side-hole recording of LES pressure. Eighteen normal individuals with normal 24-h pH-monitoring (control group) and 42 reflux patients with pathologic 24-h pH-monitoring (reflux group) were studied. End-hole recorded resting sphincter pressure (RSP) in the control group was 15.4 +/- 5.0 cm H2O and in the reflux group 6.4 +/- 6.4 (p less than 0.0005). Side-hole recorded RSP (mean S1-S3) was 20.8 +/- 11.6 and 11.9 +/- 6.8, respectively (p less than 0.005). End-hole recorded total sphincter length (SL) in the control group was 34 +/- 9 mm and in the reflux group 27 +/- 12 (p less than 0.025) and abdominal sphincter length (ASL) 23 +/- 7 and 16 +/- 9, respectively (p less than 0.005). Side-hole recorded SL was 30 +/- 7 and 30 +/- 12, respectively (NS) and ASL 22 +/- 6 and 18 +/- 9 respectively (NS). After intake of 500 ml of water both LES pressure and length decreased in both groups but the separation between the groups was neither improved nor impaired. The results support the view that LES insufficiency is an important cause of gastroesophageal reflux. That LES had a lower pressure and was shorter in patients with reflux was best demonstrated by end-hole recorded pressure.

Adult↗
PubMed1989

The contribution of the diaphragm and an intrinsic sphincter to the gastroesophageal antireflux barrier. An experimental study in the dog.

The components of the mechanical gastroesophageal antireflux barrier were studied in anesthetized dogs (15-18.5 kg). Pressure in the gastroesophageal junction area was recorded by pull-through manometry (using an infused end-hole-provided catheter) during gastric filling (distension) with water. In addition, the gastric volume at which reflux occurred was used as a measure of function and competence. Each dog was studied while intact and spontaneously breathing, after muscle relaxation, after excision of the left half of the diaphragm, and after death. In the intact dogs a barrier with a mean resting pressure of 20 (range, 14-26) cm H2O was recorded. During gastric filling the barrier pressure initially increased to 32 (16-42) cm H2O before steadily decreasing until reflux occurred. The highest pressure was recorded with 625 ml (250-1500 ml) in the stomach. Reflux occurred at a gastric volume of 3200 ml (2300-4000 ml). Muscle relaxation changed neither resting pressure nor reflux volume significantly. After excision of the left half of the diaphragm a barrier with a resting pressure of 15 (6-22) cm H2O was still recorded. Reflux then occurred at a gastric volume of 1400 ml (500-2500 ml). In dead dogs no pressure barrier could be recorded, and reflux was provoked already by 500 ml (250-750 ml) in the stomach. The presence of a mechanical barrier also after excision of the left half of the diaphragm, as evidenced by both pressure and reflux volume, can only be explained by an intrinsic sphincter, a lower esophageal sphincter (LES). However, the experiments also showed that the diaphragm contributed to the competence of the LES. This contribution was at first passive.

Animals↗
PubMed1988

The problem of lower esophageal sphincter manometry. An experimental study in vitro.

The relation between sphincter pressure recorded by manometry and sphincter function was studied in three different in vitro models of the lower esophageal sphincter (LES). - A LES was simulated on gastroesophageal specimens by application of external pressure (A Starling model - model I), rubber band(s) (model II), or loaded plastic band loop(s) (model III). - Pressure in the simulated sphincters (SP) was recorded by pull-through manometry using either a continuously infused 4.5 mm thick composite catheter with three sidehole channels and a central longer thin endhole channel or a simple thin endhole catheter. SP was recorded with empty stomach (RSP), during gastric filling and at reflux. Gastric pressure at which reflux occurred - opening pressure (OP) - was used as a measure of function of the simulated sphincter. - RSP recorded by the sideholes was the same or higher in model I, higher in model II, and lower in model III than RSP recorded by the endhole. OP was equal to RSP (endhole) in model I but lower than RSP (endhole) in models II and III. External support to the esoPhageal specimen was recorded by the corresponding sidehole as increased pressure. - The models demonstrated a complex relation between recorded SP and OP that, however, could be explained by the different properties of the three models and La Place's law. Both sideholes and endhole seemed to record true pressures but the endhole recorded the pressure in the closed sphincter and was insensitive to pressure asymmetria caused by external support. These studies suggest that RSP recorded by a thin endhole catheter is a direct measure of sphincter strength which we expect determines sphincter function.

Esophagogastric Junction↗
PubMed1986

Instrumental perforation of the oesophagus. A ten year study from two ENT clinics.

During the 10-year period 1972-1981, 3,688 and 867 oesophagoscopies were performed at two ENT clinics of a university hospital and of a county hospital with an incidence of oesophageal perforation of 0.8 per cent and 1.1 per cent respectively. Rigid instruments were used in all cases, most often in combination with dilatation of a benign stricture.

Adult↗
PubMed1986

Studies of the dynamic response of esophageal manometry systems.

Manometry with fluid-filled catheter systems remains an important technique to study esophageal physiology. The influence of mode of infusion, infusion flow rate, and catheter dimensions on the dynamic response and compliance of such systems was studied. To test the dynamic response, a method based on the step response was developed and applied. A pressure impulse--a step function--was produced by burning off a balloon connected to the system. The response to this well-defined impulse recorded by the system--the step response--was analyzed. The highest frequency to which the system responded satisfactorily--the limiting frequency--was calculated and used as a measure of performance. Compliance and inherent postocclusion pressure rise rate were also determined. In low-compliance systems noninfused or infused by hydraulic capillary infusion, limiting frequencies from 8 to 20 Hz were found, and this was much higher than in a high-compliance system infused by a syringe infusion pump. Smaller diameter and increased length of the manometry catheter decreased the limiting frequency. Increased infusion flow rate did not increase the limiting frequency. The step response test seems to be a simple test of dynamic response that can contribute to better understanding of problems involved in pressure recording with fluid-filled catheter systems. Well-performing fluid-filled manometry systems are adequate for esophageal manometry. Inherent postocclusion pressure rise rate is not a measure of dynamic response, and compliance is not the only determinant of performance.

Catheterization↗