Owen Korn B

Manejo actual de la acalasia del esófago: revisión crítica y experiencia clínica

The therapeutic options for treatment of Achalasia of the esophagus include medical treatment, endoscopic and surgical procedures. The latter can be either conservative, such as cardiomyotomy or more aggressive, such as cardioplasty or esophageal resection. In this article, we discuss the early and long term results after the different therapeutic options. We also present the results of our recent surgical experience. The definitive results seem to be better after surgical treatment compared to medical management or endoscopic procedures (Rev Med Chile 2002; 130. 1055-66).

Sobrevida de pacientes con cáncer de esófago sometidos a esofagectomía total torácica

Background: Esophageal carcinoma has a dismal prognosis. Several authors have reported a very low survival in Chile. Aim: To report the survival of patients with esophageal carcinoma, subjected to esophageal resection. Material and methods: Analysis of 108 patients subjected to thoracic esophageal resection between 1985 and 1996. Patients were classified according to the location of the tumor and its staging. Results: Eleven patients died in the immediate postoperative period and 90 patients were followed. In 53 the exact cause of death was determined. Global five years survival was 29% and median survival was 18 months. Survival was 100% in stage I tumors. Adjuvant therapy resulted in a better survival of stage III tumors. Survival of stage IV tumors was worst than stage I to III tumors. There was no survival difference between squamous carcinoma or adenocarcinoma. Tumors located in the superior third of the esophagus had a worst prognosis. Causes of death were mediastinic metastases, local recidivism, pleural or pulmonary metastases and less frequently, brain, bronchial or bone metastases. Conclusions: The survival of these, patients with esophageal carcinoma did not differ from the figures reported abroad. (Rev Med Chile 2000; 128: 64-74)

Perforación esofágica: Experiencia clínica y actualización del tema

Esophageal perforation is a complicated clinical entity that demands a high level of diagnostic and therapeutic skills. The management alternatives vary from conservative treatment to esophagectomy, including primary suture and esophageal exclusion. This paper is a review of the literature and personal experience with this condition, focusing on etiology, clinical presentation, diagnostic workout, treatment, complications and mortality. Finally, we propose a management algorithm.

Características clínicas y de laboratorio de pacientes con reflujo gastroesofágico crónico patológico

Background: Sixty percent of adults has typical symptoms of gastroesophageal reflux in Chile. Aim: To report the clinical and laboratory features of patients with gastroesophageal reflux. Patients and methods: Five hundred thirty four patients (255 male) with gastroesophageal reflux were included in a prospective protocol that included clinical analysis, manometry and endoscopy in all patients, barium swallow in 427, scintigraphy in 195, acid reflux test in 359, 24 h pH in 175, and differential potential of gastroesophageal mucosa in 73 patients. Results: There was no correlation between the severity of symptoms and the endoscopical severity. Patients with Barret esophagus were 12 years older, were male in a greater proportion and had a higher proportion of manometrically incompetent sphincters than patients with esophageal reflux but without esophagitis or with erosive esophagitis. Severity of acid reflux, measured with 24 h pH monitoring was proportional to the endoscopical damage of the mucosa. There was a close relationship between the mucosal change limit determined with differential potentials and with endoscopy. No short esophagi were found. Conclusions: Patients with symptoms of gastroesophageal reflux must be assessed using several objective measures to determine the severity of their pathological alterations.

Resecabilidad y mortalidad operatoria de la gastrectomía subtotal y total en pacientes con cáncer gástrico avanzado, entre 1969 y 2004

Background: The only curative treatment for gastric cancer is its surgical excision associated to a lymph node dissection. Aim: To study the evolution of resectability and operative mortality of total and subtotal gastrectomy for gastric cancer, in a period of 35 years. Material and methods: Review of medical records of 3000 patients with gastric cancer, operated between 1969 and 2004. Resectability and mortality of total and subtotal gastrectomy was compared in four successive periods (1969 to 1979, 1980 to 1989, 1990 to 1999 and 2000 to 2004). Results: In the four periods there was a steady and significant increase in resectability rate from 49 to 85%. Mortality of total and subtotal gastrectomy decreased significantly from 17 to 2% and from 25 to 1%, respectively. Conclusions: Resectability and mortality rates of total and subtotal gastrectomy have improved with time. Probably a better pre and postoperative care and the experience of the surgical team have an influence in this favorable change (Rev Med Chile 2006; 134: 426-32). (Key words: Gastrectomy; Stomach neoplasms; Surgical procedures, operative)

Progresión de metaplasia intestinal a adenocarcinoma en esófago de Barrett: utilidad de la vigilancia endoscópica

Background: The potential progression from intestinal metaplasia to low grade dysplasia, to high grade dysplasia and to adenocarcinoma represents a well recognized sequence in patients with Barretts esophagus (BE). The time required for this transformation is not well known. Aim: To report the results of a 10 years follow up of patients with BE. Material and methods: Between 1989 and 2000 we followed 402 patients with BE. Results: Sixty six subjects (16.2%) presented low grade dysplasia at the time of diagnosis and 10 patients (2 women/8 men) developed adenocarcinoma during the follow-up period. Four out of these 10 patients were operated because of gastro-esophageal reflux disease, but after 3-5 years, reflux symptoms recurred. The other 6 patients rejected surgery and were on Omeprazole with good symptomatic results. Two patients had a short BE ( 10 cm BE. The mean time elapsed from intestinal metaplasia to low grade dysplasia was 9 months, to high grade dysplasia 56 months and to adenocarcinoma 82 months. From low grade dysplasia to early cancer it was 18 months, from high grade dysplasia to early cancer 14 months and from high grade dysplasia to advanced transmural cancer 14 months. All patients were subjected to esophagectomy. Five patients detected at State I are alive without any evidence of recurrence after 36 to 130 months after surgery. Five patients with advanced transmural carcinoma subjected to radical esophagectomy died because of progression of the malignancy between 3 and 24 months after surgery. Conclusions: Progression to adenocarcinoma may occur even in absence of reflux symptoms while on acid suppression therapy. Detection at early stage intestinal metaplasia in the esophagus offers a high chance of cure after surgical resection (Rev Med Chile 2003; 131: 587-96)

Hemoperitoneo espontáneo por rotura de várices intraabdominales en un paciente con cirrosis hepática. Caso clínico

Spontaneous hemoperitoneum secondary to intraabdominal variceal rupture, is an uncommon and highly lethal complication of cirrhosis. We report a case of a 68 years old male submitted because of abdominal pain and fainting. The clinical and laboratory work up concluded that the patient had cirrhosis and hemoperitoneum. He was operated on and the exploration showed a massive hemoperitoneum caused by bleeding gastro-splenic varices. The patient died in the immediate postoperative period (Rev Med Chile 2002; 130: 433-436)

Prevalencia de mucosa cardial o fúndica y presencia de Helicobacter pylori en la unión de mucosas escamoso-columnar en pacientes con reflujo gastroesofágico crónico patológico sin metaplasia intestinal comparados con controles

Background: The mucosa distal to the endoscopic mucosal change zone can have easily diagnosed early alterations, in patients with chronic gastroesophageal reflux. Aim: To determine the type of mucosa existent in the zone distal to the squamous-columnar junction in patients with chronic gastroesophageal reflux without intestinal metaplasia. Patients and methods: One hundred thirty four controls and 208 patients with chronic gastroesophageal reflux lasting two years were studied. Forty three of these patients had a normal endoscopy, 54 had an erosive esophagitis and 111 had a short columnar epithelium covering the distal esophagus, without intestinal metaplasia. In all subjects, four biopsies were obtained from a zone distal to the squamous-columnar junction and two from the distal gastric antrum. Results: In 59% of control subjects, fundic mucosa was present in the zone distal to the squamous-columnar junction. Cardial mucosa was present in the rest. In patients with chronic gastroesophageal reflux, cardial mucosa was predominant. Helicobacter pylorii infection decreased along with increasing extension of cardial mucosa covering the distal esophagus. Conclusions: In patients with chronic gastroesophageal reflux there is a metaplasia of fundic mucosa towards cardial mucosa. On the other hand, Helicobacter pylorii infection decreases gradually.

Tratamiento quirúrgico de la acalasia esofágica: Experiencia en 328 pacientes

Resumen es: Objetivos: Evaluar la evolucion postoperatoria inmediata y morbimortalidad en 328 pacientes con acalasia sometidos a tratamiento quirurgico en un periodo...

Neumomediastino espontáneo: A propósito de un caso

Presentamos el caso de neumomediastino espontaneo en un hombre joven sin asociacion a algun desencadenante o patologia, que consulta por dolor cervical irradiado a region supraclavicular derecha y con examen fisico compatible con enfisema cervical. La evaluacion inicial incluyo estudio radiologico de cuello, columna cervical y torax. La tomografia axial computada demostro un neumomediastino con extension al cuello sin patologia pulmonar subyacente, se complemento el estudio con esofagograma. La evolucion del paciente fue satisfactoria y asintomatica, como se describe en los casos reportados en la literatura internacional. Se discute la fisiopatologia del neumomediastino