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“Objective: Surgical management of massive hernias and complex gastroesophageal reflux disease requires a tension-free repair with reliable reflux control. The aim of this observation was to evaluate the functional results of a modified Collis-Nissen gastroplasty with a transverse widening fundoplasty.

Methods: Between 1995 and 2007, 26 patients underwent a 3-cm cut elongation gastroplasty with a transverse widening of the fundus followed by a 3-cm total (n = 24) or partial (n = 2) fundoplication. Indications for the operation were symptomatic massive hiatal hernias (n = 4), hiatal hernias with Barrett’s esophagus (n = 8), or correction of previously failed antireflux fundoplications (n = 14). Barrett’s esophagus was documented in 19 of the 26 patients. Pre- and postoperative assessment included Selleckchem VE-822 symptoms, barium swallow, endoscopy, manometry, and 24-hour pH monitoring.

Results: see more There was no postoperative mortality. Complications were recorded in 6 patients. Median follow-up was 105 months. Reflux symptoms present in all patients before the operation were found

in 5 patients postoperatively (P < .001). Radiologic assessment documented an intact fundoplication in all patients. Lower esophageal sphincter gradient increased from a mean of 7.5 to 15 mmHg (P = .003). Acid exposure (17% preoperatively) decreased significantly to 1% postoperatively (P < .001). Endoscopically, mucosal damage quantification decreased (3.1 preoperatively to 1.5 postoperatively; P < .001). All mucosal breaks healed but the columnar-lined metaplasia persisted.

Conclusions: This modified elongation gastroplasty provided a reliable repair for massive hernias, shortened Barrett’s esophagus, and reoperations. The lower esophageal sphincter gradient was restored and remained stable. Reflux exposure was reduced, and acute mucosal damage disappeared. Columnar-lined metaplasia remained unchanged.”
“HIV-1 infection affects white matter circuits linking frontal, parietal, and subcortical regions that subserve visuospatial attention processes. Normal

perception requires the integration of details, STI571 solubility dmso preferentially processed in the left hemisphere, and the global composition of an object or scene, preferentially processed in the right hemisphere. We tested whether HIV-related callosal white matter degradation contributes to disruption of selective lateralized visuospatial and attention processes. A hierarchical letter target detection paradigm was devised, where large (global) letters were composed of small (local) letters. Participants were required to identify target letters among distractors presented at global, local, both or neither level. Attention was directed to one (global or local) or both levels. Participants were 21 HIV-1 infected and 19 healthy control men and women who also underwent Diffusion Tensor Imaging (DTI).