Esophagus hiatal hernia with special reference to the early stage

In the aged, hiatal hernia should be recognized as it has developed; it develops progressively. Special attention should be given to the early stage of hiatal hernia from the genetic point of view. Like other organs in the aged, aging changes around a hiatus are inevitable; relaxing of esophageal diaphragmatic ligament and weakening of muscle power of diaphragmatic vertebral part move on with age. After all, valve structure at hiatus, Goubaroff's valve, is so weakened its function and in the stomach, "His angle" is so widened, that the stomach becomes wedge shaped against the hiatus. The more the pressure in the stomach increases, the larger the wedge shapes. Under these conditions, when the abdominal pressure rises by the acts of coughing or defecation, hiatus may be widened and the wedge may be pushed into the hiatus. There are no strong valve and or ligament enough to keep the wedge part of stomach in peritoneal cavity. In the stomach, the pressure of the expelling meal is equal to that of the widening wedge. On the other hand, in the peritoneal cavity, pressure produced by the act of defecation is equal to that of ejecting the wedge through hiatus. These are self-evident from the Pascal's principle. Hiatal hernia is produced under these conditions. We, therefore, should call the attention to the early genetic stage of hiatal hernia. In Japan, hiatal hernia has been recognized when it gets larger and fixes out of the peritoneal cavity. But in the early stage, it also must be noted as hiatal hernia

Esophagus hiatal hernia with special reference to the early stage

In the aged, hiatal hernia should be recognized as it has developed; it develops progressively. Special attention should be given to the early stage of hiatal hernia from the genetic point of view. Like other organs in the aged, aging changes around a hiatus are inevitable; relaxing of esophageal diaphragmatic ligament and weakening of muscle power of diaphragmatic vertebral part move on with age. After all, valve structure at hiatus, Goubaroff's valve, is so weakened its function and in the stomach, "His angle" is so widened, that the stomach becomes wedge shaped against the hiatus. The more the pressure in the stomach increases, the larger the wedge shapes. Under these conditions, when the abdominal pressure rises by the acts of coughing or defecation, hiatus may be widened and the wedge may be pushed into the hiatus. There are no strong valve and or ligament enough to keep the wedge part of stomach in peritoneal cavity. In the stomach, the pressure of the expelling meal is equal to that of the widening wedge. On the other hand, in the peritoneal cavity, pressure produced by the act of defecation is equal to that of ejecting the wedge through hiatus. These are self-evident from the Pascal's principle. Hiatal hernia is produced under these conditions. We, therefore, should call the attention to the early genetic stage of hiatal hernia. In Japan, hiatal hernia has been recognized when it gets larger and fixes out of the peritoneal cavity. But in the early stage, it also must be noted as hiatal hernia

Report of a case of severe mechanical joundice -Successfully treated by jejuno-hepatic ducts anastomoses

Jejuno hepatic ducts anastomoses were successfully performed by carefull managements. Because of dense adhesion at hilus of liver, around the gall bladder and choledocus, dissection of common duct, cystic duct, hepatic ducts and even gall bladder was very difficult anatomically. Resecting a inflammatory granulative tumor, including gall bladder, choledocus, lesser omentum and hepatocluodenal ligament en mass, we found that only very short hepatic ducts with inflammatory granulation tissue were remained open. Reconstruction of biliary passages was done using Roux. Y. method with loop jejunum. It needed very carefull procedure to avoid suture failure, ascending infection (cholangitis) and postoperative stenoses at the site of the anastomoses. The anastomoses were performed using atraumatic 3-0 Tefdek ; interrupted and each big bite of duct wall together with surrounding thickend granulative tissue, in order to keep capillary blood supply effective and to minimize the anastomotic trauma which were very important for wound healing. Patient is healthy, enjoying his normal life and his liver function tests are within normal range, 1 1/2 years postoperatively

Lumbar spinal changes over 20 years after posterior fusion for idiopathic scoliosis

Lumbar X-ray findings and clinical manifestations were investigated in 10 patients who underwent posterior fusion with or without Harrington instrumentation for idiopathic scoliosis between 1965 and 1975. The subjects were 4 men and 6 women, who ranged from 10 to 17 years of age at the time of surgery (mean, 12 years and 9 months). The postoperative follow-up period ranged from 20 to 30 years (mean, 24 years and 7 months). All patients were followed-up at our institution. Three patients received posterior fusion without instrumentation, and Harrington instrumentation was used in 7 from 1967 onwards. The distal end of the fusion was L2 in 4, L3 in 4, and L4 in 2 patients. Pain, evaluated by Moskowitz's criteria, was stage 1 in 5 and stage II in 5 patients (none of them had stage III or IV). In X-ray evaluation, graded according to Lawrence's classification, grade III changes were noted in 2 patients; one with thoracolumbar fusion with Harrington instrumentation to the L4 vertebra and the other patient was assessed at 30 years post-surgery. According to White-Panjabi's criteria, instability was noted in 1 patient with Harrington fixation including the L4 vertebra. Clinical manifestations and X-ray abnormalities were less severe than anticipated at 20 years plus post-surgery, although a tendency for deterioration was observed in patients with fusion including the L4 or patients followed up for more than 30 years post-surgery.</p

Towards the String representation of the dual Abelian Higgs model beyond the London limit

We perform a path-integral analysis of the string representation of the dual Abelian Higgs (DAH) model beyond the London limit, where the string describing the vortex of a flux tube has a finite thickness. We show that besides an additional vortex core contribution to the string tension, a modified Yukawa interaction appears as a boundary contribution in the type-II dual superconducting vacuum. In the London limit, the modified Yukawa interaction is reduced to the Yukawa one.Comment: 13 pages, JHEP3.cls is used, no figures. The version accepted for publication in JHE

Results of surgical treatment for ossification of the posterior longitudinal ligament of the thoracic spine.

Conservative treatment is ineffective for ossification of the posterior longitudinal ligament (OPLL) in the thoracic spine, and surgical treatment is indicated for most cases, while such cases are not often experienced. In the present study, the results of surgical management involving mainly posterior decompression for this disease were evaluated clinically. The study included 9 patients (1 man and 8 women) who underwent surgical treatment for OPLL of the thoracic spine between 1984 and 1993. Laminectomy was performed in 5 patients, and laminectomy plus anterior decompression of the OPLL via the posterior approach based on Otsuka's method was performed in 2 patients. In 1 patient, laminoplasty for OPLL of the cervical spine was combined with laminectomy of the symptomatic lesion in the thoracic spine. One patient underwent anterior decompression and fusion. The results were evaluated using the Japanese Orthopaedic Association score (JOA score) and recovery rate. The postoperative follow-up period ranged from 1 year to 10 years and 3 months (mean, 4 years and 6 months). The mean JOA score was 4.8 before surgery and improved to 7.6 at the final examination. This was a mean recovery rate of 50.1%. Symptoms caused by OPLL in the thoracic spine can be alleviated by posterior decompression where OPLL extends from the upper to the middle thoracic spine or extends from the middle to the lower thoracic spine. It seems, however, that OPLL localized to the middle thoracic spine requires anterior decompression.</p

New Surgical Procedure for Pancreas Head

In this study, we demonstrate two new methods for pancreaticoduodenectomy (PD). One method is the mini‐laparotomic PD by Shuriken‐shaped umbilicoplasty with the real‐time moving window‘s method. The other method is the new pancreaticojejunostomy (PJ) by punctured stent slide guiding method (PSSGM). This procedure could be performed by complete mini‐laparotomy under direct vision, and the final major wound is only 2 cm of round navel. PSSGM prevents the difference of caliber between pancreatic anastomosis and the inside out of jejunal mucosa in theory. Ten cases of mini‐lap PD were successfully performed under new PJ anastomosis. The pancreatic leakage (PL) was only one case of ISGPF grade A, and its frequency was 9% (1/11). Our mini‐lap PD by Shuriken‐shaped umbilicoplasty might be a useful way for overcoming the obstacles about safety, complication risk, cosmetic demand, and medical cost compared to laparoscopic PD. Also, our new device of PJ reconstruction by PSSGM might be an easy and useful device for the prevention of PL

Living with Family Is Directly Associated with Regular Dental Checkup and Indirectly Associated with Gingival Status among Japanese University Students: A 3-Year Cohort Study

Although some studies showed that lifestyle was associated with oral health behavior, few studies investigated the association between household type and oral health behavior. The aim of this prospective cohort study was to investigate the association between household type, oral health behavior, and periodontal status among Japanese university students. Data were obtained from 377 students who received oral examinations and self-questionnaires in 2016 and 2019. We assessed periodontal status using the percentage of bleeding on probing (%BOP), probing pocket depth, oral hygiene status, oral health behaviors, and related factors. We used structural equation modeling to determine the association between household type, oral health behaviors, gingivitis, and periodontitis. At follow-up, 252 students did not live with their families. The mean +/- standard deviation of %BOP was 35.5 +/- 24.7 at baseline and 32.1 +/- 25.3 at follow-up. In the final model, students living with their families were significantly more likely to receive regular dental checkup than those living alone. Regular checkup affected the decrease in calculus. The decrease in calculus affected the decrease in %BOP over 3 years. Living with family was directly associated with regular dental checkups and indirectly contributed to gingival status among Japanese university students

Improvement of dynamic range and repeatability in refractive-index-sensing optical comb by combination of saturable-absorber-mirror mode-locking with intracavity multi-mode interference fiber sensor

Mode-locked fiber comb equipped with multi-mode-interference fiber sensor functions as high-precision refractive-index (RI) sensor benefitting from precise radio-frequency measurement. However, its dynamic range and repeatability are hampered by inherent characteristics in nonlinear-polarization-rotation mode-locking oscillation. In this article, we introduce saturable-absorber-mirror mode-locking for RI sensing with wide dynamic range and high repeatability. While the RI dynamic range was expanded to 41.4 dB due to high robustness to cavity disturbance, self-starting capability without the need for polarization control improves the RI sensing repeatability to 1.10×10-8 every mode-locking activation. Improved dynamic range and repeatability will be useful for enhanced performance of RI sensing