Childhood achalasia: A comprehensive review of disease, diagnosis and therapeutic management

Achalasia is an esophageal motility disorder characterized by failure of lower esophageal sphincter (LES) relaxation and is rare in children. The most common symptoms are vomiting, dysphagia, regurgitation, and weight loss. Definitive diagnosis is made with barium swallow study and esophageal manometry. In adults, endoscopic biopsy is recommended to exclude malignancy however; it is not as often indicated in children. Medical management often fails resulting in recurrent symptoms and the ultimate definitive treatment is surgical. Laparoscopic Heller myotomy with or without an anti-reflux procedure is the treatment of choice and has become standard of care for children with achalasia. Peroral endoscopic myotomy is a novel therapy utilized with increasing frequency for achalasia treatment in adults. More experience is needed to determine the safety, efficacy, and feasibility of peroral endoscopic myotomy in children

Thoracoscopic-Assisted Esophagectomy and Laparoscopic Gastric Pull-Up for Lye Injury

BACKGROUND: Acquired esophageal strictures in children are often the result of ingestion of caustic agents. We describe 2 children with severe esophageal strictures following lye ingestion, who successfully underwent esophagectomy and gastric pull-up utilizing combined thoracoscopic and laparoscopic techniques. METHODS: This was a retrospective chart analysis of both patients. CASE 1: A 17-year-old female, who ingested a lye-containing substance, which lead to the need for gastrostomy and esophageal dilatations, developed an esophageal stricture. Thoracoscopic esophagectomy, laparoscopic gastric conduit creation, pyloroplasty, gastric pull-up, and esophagogastric anastomosis was performed one year later. She was tolerating a regular diet for almost 4 years following esophageal replacement when she developed a gastric ulcer with gastrobronchial fistula that required open repair via a right thoracotomy. She has since recovered and resumed her regular diet. CASE 2: A 13-month-old female who ingested a lye-based cleaner underwent tracheostomy and gastrostomy on the day of injury, and esophageal dilatations beginning 1 month later. Despite dilatations, she developed severe strictures for which at age 21 months she underwent thoracoscopic esophageal mobilization, laparoscopic creation of gastric conduit, pyloroplasty, and esophagogastric anastomosis. A right thoracotomy was necessary to negotiate the conduit safely up to the neck. She is tolerating feeds and has not developed any complications for nearly 3 years following esophageal replacement. CONCLUSIONS: Esophagectomy and gastric pull-up for esophageal lye injuries can be accomplished utilizing a combination of thoracoscopy and laparoscopy with excellent results. Long-term follow-up is necessary to manage potential complications in these patients

Laparoscopic Management of Delayed Recurrent Intussusception in an Older Child

BACKGROUND: Intussusception is the most common cause of bowel obstruction in infants and children. Although early recurrence is not uncommon, recurrence years later is rare. METHODS: A 13-year-old male with a history of recurrent intussusception at ages 2 and 5 presented with recurrent intussusception 8 years later. The diagnosis was made using computed tomography, and the patient underwent a laparoscopic ileocecectomy with an uneventful postoperative course. RESULTS: The specimen was remarkable for findings of multiple enlarged lymph nodes over the serosal surface of the ileum and the terminal ileum with focal edema, prominent lymphoid hyperplasia and large hemorrhagic areas. CONCLUSION: This case highlights the fact that in a child with a delayed recurrence of intussusception, the presence of a lead point should be suspected, and operative therapy should be strongly considered over hydrostatic reduction. The current management of recurrent intussusception is reviewed and applied to this case

Phase-stepping interferometry of GaAs nanowires: determining nano-wire radius

Phase stepping interferometry is used to measure the size of near-cylindrical nanowires. Nanowires with nominal radii of 25 nm and 50 nm were used to test this by comparing specific measured optical phase profile values with theoretical values calculated using a wave-optic model of the Phase stepping interferometry (PSI) system. Agreement within 10% was found, which enabled nanowire radii to be predicted within 4% of the nominal value. This demonstration highlights the potential capability for phase stepping interferometry to characterize single nanoparticles of known geometry in the optical far-field.This research was supported by Australian Research Council Grant Nos. LE110100024 and DP130102674, a Macquarie University Research Development Grant, and the Australian National Fabrication Facility (ANFF)

Observations of Persistent Leonid Meteor Trails. 1. Advection of the Diamond Ring

From a single image of a persistent trail left by a -1.5 magnitude Leonid meteor on November 17, 1998, the relative winds between 92.5 and 98 km altitude are derived, where the altitudes are determined by a sodium lidar. These are converted to true winds 82 sec after the appearance of the meteor by fixing the winds at 98 km to match the results of following the trail with the lidar for twelve minutes. The image and winds reveal a fine example of the effects of a gravity wave having a vertical wavelenth of 5.50 ± 0.02 km, a horizontal wavelength of 2650 ± 60 kin, an intrinsic period of 19.5 ± 0.4 hours, and an observed period of 8.6 ± 0.1 hours. Effects of the gravity wave are still present in the wind field 70 rain later

Laparoscopic Versus Open Nissen Fundoplication in Infants After Neonatal Laparotomy

BACKGROUND: Nissen fundoplication is an effective treatment of gastroesophageal reflux in infants. Laparoscopic procedures after previous laparotomy are technically more challenging. The role of laparoscopic Nissen fundoplication after neonatal laparotomy for diseases unrelated to reflux is poorly described. METHODS: This was a retrospective review of open vs laparoscopic Nissen fundoplication in infants after neonatal laparotomy. Of 32 infants who underwent neonatal laparotomy, 26 required a surgical antireflux operation within the first year of life. Twelve infants underwent laparoscopic Nissen fundoplication versus 14 infants who underwent open Nissen fundoplication. Parameters like age, weight, operative time, number of previous operations, length of stay following fundoplication, time to feedings, and complications were compared between the 2 groups. RESULTS: No statistically significant differences existed between most of the parameters compared following laparoscopic vs open Nissen fundoplication. No conversions to open procedures were necessary in infants undergoing laparoscopic fundoplication, and these infants resumed enteral feeds earlier than those who underwent the open procedure. CONCLUSION: Laparoscopic compared with open Nissen fundoplication performed in infants after a neonatal laparotomy were comparable procedures across most data points studied. However, a laparoscopic fundoplication did allow for earlier return to enteral feeds compared with the open approach. Laparoscopic Nissen fundoplication is technically feasible, safe, and effective in the treatment of gastroesophageal reflux in infants with a previous neonatal laparotomy

Anasazi Communities at Dolores: Early Small Settlements in the Dolores River Canyon and Western Sagehen Flats Area

This volume reports on a series of investigations in the Dolores River canyon and the western Sagehen Flats area of the Dolores Project. Included in the collection are an overview of the Grass Mesa Locality (with summary of Dolores Archaeological Program systematics), the results of the 1979-1980 Grass Mesa Locality Testing Program, and 6 site reports that describe excavations undertaken between 1979 and 1983. The excavated sites reported include: (1) LeMoc Shelter (5MT2151), which exposed 5 Anasazi occupations between A.D. 750 and 950; (2) Prince Hamlet (5MT2161), a Pueblo I habitation occupied between A.D. 720-840; (3) Hamlet de la Ofla (5MT2181), with a primary occupation between A.D. 780 and 810 and a later field house manifestation; (4) Kin Hush (5MT2336), with multiple occupations assigned to the A.D. 760-850, A.D. 850-975, and A.D. 1050-1200 periods; (5) Pozo Hamlet (5MT4613), a pithouse and associated features with construction traits of both Basketmaker III and Pueblo I periods between A.D. 600 and 780; and (6) Poco Tiempo (5MT2378), a Basketmaker III site dating between A.D. 690 and 730

Laparoscopic Splenectomy in Children

BACKGROUND: Laparoscopic splenectomy is being performed more commonly in children, although its advantages are not clear. We sought to determine whether laparoscopic splenectomy was superior to open splenectomy. METHODS: The records of all pediatric patients undergoing splenectomy without significant comorbidities over a 12-year period were examined. The patients were divided into those undergoing laparoscopic splenectomy and those undergoing open splenectomy. Demographics, operative time, estimated blood loss, spleen size, length of stay, and total charges were compared between the groups. RESULTS: Eighty-one (58%) children underwent laparoscopic splenectomy, and 59 (42%) children underwent open splenectomy. The groups were similar in age and sex; hereditary spherocytosis was more common in the LS group. Operating time was longer in the laparoscopic splenectomy group (231 +/- 10 min vs 138 +/- 9 min; P\u3c0.001), but blood loss and complication rates were similar. Twelve (15%) conversions were necessary primarily due to spleen size. Although children undergoing LS had a shorter length of stay (2.4 +/- 0.1 vs 4.1 +/- 0.3 days; P\u3c0.001), they incurred higher charges (dollars 21199 +/- 664 vs dollars 15723 +/- 1737; P\u3c0.002). CONCLUSION: Laparoscopic splenectomy is a safe procedure in children, resulting in shorter hospital stay, which may translate into earlier return to activity and a smaller burden on the child\u27s caretakers

Dynamic ham-sandwich cuts in the plane

We design efficient data structures for dynamically maintaining a ham-sandwich cut of two point sets in the plane subject to insertions and deletions of points in either set. A ham-sandwich cut is a line that simultaneously bisects the cardinality of both point sets. For general point sets, our first data structure supports each operation in O(n1/3+ε) amortized time and O(n4/3+ε) space. Our second data structure performs faster when each point set decomposes into a small number k of subsets in convex position: it supports insertions and deletions in O(logn) time and ham-sandwich queries in O(klog4n) time. In addition, if each point set has convex peeling depth k , then we can maintain the decomposition automatically using O(klogn) time per insertion and deletion. Alternatively, we can view each convex point set as a convex polygon, and we show how to find a ham-sandwich cut that bisects the total areas or total perimeters of these polygons in O(klog4n) time plus the O((kb)polylog(kb)) time required to approximate the root of a polynomial of degree O(k) up to b bits of precision. We also show how to maintain a partition of the plane by two lines into four regions each containing a quarter of the total point count, area, or perimeter in polylogarithmic time.Engineering and Applied Science