Surgical approach after failed enteryx injection for GERD.

OBJECTIVE: We report on 3 patients who underwent laparoscopic antireflux procedures for persistent symptoms of GERD after biopolymer injection. METHODS: Experienced laparoscopic surgeons completed all 3 procedures laparoscopically. In 2 patients, there was an extramural extravasation of the polymer outside and adherent to the esophageal wall. In these patients, a partial posterior fundoplication was used. The third patient, who had the polymer material deposits removed preoperatively by endoscopic mucosal resection, underwent a Nissen fundoplication. RESULTS: Postoperative recovery was uneventful in all cases. At follow-up of 6 to 12 months, all patients were symptom free, off medical therapy, and experiencing no dysphagia. CONCLUSION: Surgical therapy for patients after failed biopolymer injection is safe and effective. The choice of surgery may depend on whether the polymer mass can be removed preoperatively.     

Mesothelial/monocytic incidental cardiac excrescence.

Mesothelial/monocytic incidental cardiac excrescence (MICE) is a very uncommon lesion. Diagnosis is incidental and may simulate thrombotic lesions. One of the hypotheses with regard to the etiology of this lesion is a previous cardiac procedure especially mitral valve repair or commissurotomy. Herein, we describe a MICE incidentally found in a patient who underwent mitral valve replacement, as a thrombotic lesion on the left atrial auricle. Histopathologic examination suggested MICE lesions and immunohistochemical stains confirmed it.     

Effects of GLP-1 on Gastric Emptying, Antropyloric Motility, and Transpyloric Flow in Response to a Nonnutrient Liquid

Glucagon-like polypeptide 1 (GLP-1) may be amajor enterogastrone, slowing gastric emptying whenreleased by intestinal nutrients. In six conscious dogs,we studied the effects of GLP-1, on antropyloric motility, gastric emptying, and transpyloricflow after instillation of 500 ml of saline into thestomach. The meal was given and recordings were started15 min after intravenous bolus and infusion of either saline or three different doses of GLP-1.Intravenous GLP-1 produced a dose-related retardation ofgastric emptying associated with a decrease in thenumber and volume of flow pulses in comparison tosaline. This change in transpyloric flow was associatedwith an inhibition of antropyloric pressure waves, astimulation of isolated pyloric pressure waves, and anincrease in basal pyloric tone induced by intravenous GLP-1 infusion. Our findings show that GLP-1has a potent dose-dependent inhibitory effect ontranspyloric flow and gastric emptying. This effect istemporally associated with inhibition of antralpumping and stimulation of pyloricbraking mechanisms.