Case report: rupture of a gastric varix in liver cirrhosis associated with glycogen storage disease type III

Metabolic Cardiomyopathies and Cardiac Defects in Inherited Disorders of Carbohydrate Metabolism: A Systematic Review

Heart failure (HF) is a progressive chronic disease that remains a primary cause of death worldwide, affecting over 64 million patients. HF can be caused by cardiomyopathies and congenital cardiac defects with monogenic etiology. The number of genes and monogenic disorders linked to development of cardiac defects is constantly growing and includes inherited metabolic disorders (IMDs). Several IMDs affecting various metabolic pathways have been reported presenting cardiomyopathies and cardiac defects. Considering the pivotal role of sugar metabolism in cardiac tissue, including energy production, nucleic acid synthesis and glycosylation, it is not surprising that an increasing number of IMDs linked to carbohydrate metabolism are described with cardiac manifestations. In this systematic review, we offer a comprehensive overview of IMDs linked to carbohydrate metabolism presenting that present with cardiomyopathies, arrhythmogenic disorders and/or structural cardiac defects. We identified 58 IMDs presenting with cardiac complications: 3 defects of sugar/sugar-linked transporters (GLUT3, GLUT10, THTR1); 2 disorders of the pentose phosphate pathway (G6PDH, TALDO); 9 diseases of glycogen metabolism (GAA, GBE1, GDE, GYG1, GYS1, LAMP2, RBCK1, PRKAG2, G6PT1); 29 congenital disorders of glycosylation (ALG3, ALG6, ALG9, ALG12, ATP6V1A, ATP6V1E1, B3GALTL, B3GAT3, COG1, COG7, DOLK, DPM3, FKRP, FKTN, GMPPB, MPDU1, NPL, PGM1, PIGA, PIGL, PIGN, PIGO, PIGT, PIGV, PMM2, POMT1, POMT2, SRD5A3, XYLT2); 15 carbohydrate-linked lysosomal storage diseases (CTSA, GBA1, GLA, GLB1, HEXB, IDUA, IDS, SGSH, NAGLU, HGSNAT, GNS, GALNS, ARSB, GUSB, ARSK). With this systematic review we aim to raise awareness about the cardiac presentations in carbohydrate-linked IMDs and draw attention to carbohydrate-linked pathogenic mechanisms that may underlie cardiac complications.

Laparoscopic Insertion of Gastric Electrodes for Electrical Stimulation

Gastric electrical stimulation can provide symptomatic relief for patients with refractory gastroparesis. Traditionally, these wires are placed through a midline laparotomy. This paper describes and illustrates, in detail, the laparoscopic technique for successful implantation. Thirty-one consecutive patients from October 2003 to March 2005 underwent laparoscopic insertion of gastric stimulating wires for gastroparesis. Twenty-six patients were female. Four laparoscopic ports were used to insert a pair of electrodes. Anterior, cephalad retraction of the gastric wall is critical for accurate seromuscular placement of gastric leads. Intraoperative endoscopy was used to verify the seromuscular placement of the leads. Both leads were secured to a subcutaneous generator and electrical parameters were immediately established in the operating room. Patient demographics, operative details, and postoperative morbidities were recorded. All procedures were completed laparoscopically. The mean operative time was 114.4 +/- 20.9 minutes (range, 95-140). No perioperative mortality occurred. Two patients developed cellulitis at the generator site postoperatively and oral antibiotics were prescribed for one week postoperatively. No hardware was removed. Two patients had their generators repositioned due to pain at the pocket site. Gastric electrical stimulation is a novel treatment modality for patients with refractory gastroparesis and can be accomplished safely via laparoscopy. Laparoscopic insertion is successful even in patients with prior surgery and intact gastrointestinal tubes. Long-term follow-up and the current prospective multicenter trial continue to assess the efficacy of this treatment modality.

Laparoscopic revision of gastric pacing wires

Currently, electrical stimulation is utilized to treat morbid obesity, gastroparesis, and diaphragmatic paralysis. Although this technology is in its infancy, numerous case reports and small series appear throughout the literature. Furthermore, electrical stimulation is not relegated to only academic centers and tertiary referral centers. As these technologies continue to evolve and alter the treatment of several different pathophysiologic processes, the general surgeon needs to understand the technical aspects of these devices and their potential complications. This paper presents the management of a gastroparetic patient with chronic abdominal pain following the successful placement of gastric pacing wires. A 45-year-old female with idiopathic gastroparesis underwent laparoscopic placement of gastric pacing wires without complications. Four months postoperatively, she presented with chronic left upper quadrant abdominal pain. Her nausea and vomiting had dissipated and she was tolerating a regular diet. Abdominal and pelvic computed tomography (CT) was normal except for the presence of a generator and pacing wires. Ultimately, she required a diagnostic laparoscopy and an upper endoscopy. The upper endoscopy was normal. The diagnostic laparoscopy showed a wide adhesive band from the seromuscular tunnel of the pacing wires to the abdominal wall in the left upper quadrant. The band was lysed and an omental patch was sutured over the insertion site of the wires. On postoperative day 1, the patient was pain-free and discharged home on a regular diet. This case presents an unusual complication of electrical pacing wires. This patient experienced somatic pain due to an adhesive band from her pacing wires to the abdominal wall. Based on the findings of this case, an omental patch was placed on top of the seromuscular electrode tunnel in order to prevent adhesions and potentially persistent abdominal wall pain.