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.     

Activation of Classical Complement Pathway by Naturally Occurring Heteroantibodies in Normal Rabbit Serum. Effect on Subpopulations of Human Lymphoid Cells

Heteroantibodies present in normal rabbit serum (NRS) are toxic to human B lymphocytes, T lymphocytes, and monocytes. Even NRS, which exhibits little back ground cytotoxicity for human lymphoid cells in conventional HLA or B-cell lymphocytotoxic assays, can be shown to contain considerable activity by making two modifications in usual procedures: by washing cells in saline or balanced salt solutions devoid of protein or sugar substances, and by increasing incubation time for 1 h to 3--4 h. Using such modifications, the cytotoxic activity of NRS towards human lymphoid cells was investigated and was found to involve activation of the classical complement pathway rather than activation of the alternate complement pathway. Residual unwanted background cytotoxicity of NRS toward human lymphoid cells can be decreased without loss of desired complement activity either by heating NRS for 15 min at 50 degrees C or by mixing NRS with small amounts of normal human serum.     

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.     

“Porcupine” polymers and double-star polymers

Anionic block copolymerization of styrene and divinylbenzene is known to lead to the formation of star-shaped macromolecules. This “arm-first” method has been widely used and studied. The present paper is devoted to two special aspects of this method: The first is concerned with the efficiency of the protection exerted by the arms on the crosslinked core, preventing gelation of the reaction medium. A number of “porcupine” polymers involving bulky cores, fitted with a large number of arms, were synthesized and characterized. The second deals with the possibility of using the “living” carbanionic sites present in the cores, either for purpose of functionalization, or to grow new branches from the core. The presence of remaining unsaturations in the core was evidenced. This is a drawback, since the possibility for “transverse” bonds to be formed results in couplings, inducing gelation.