Gross E esophageal atresia with unique course

The patient was a 15 months-old boy who had been diagnosed CHARGE syndrome, which is a multiple congenital anomaly syndrome caused by mutations in the CHD7 gene. Mechanical ventilation management was initiated 2 hours after birth for dysphagia and respiratory failure, and tracheotomy was performed 3 months after birth for dysphagia and failed extubation. He was repeatedly hospitalized due to pneuomoniae. Approximately 1 year after birth, the boy had two consecutive episodes of sudden ventilatory insufficiency while replacing the tracheotomy cannula. A bronchoscopic examination under general anesthesia revealed a tracheoesophageal fistula directly below the tracheostomy. The patient was diagnosed with Gross E esophageal atresia, and we speculated that the cannula migrated to the esophagus via the fistula during tracheostomy cannula replacement. Gross E esophageal atresia is a rare disease. Its diagnosis is often delayed, and it is discovered by recurrent pneumonia in many cases. A tracheoesophageal fistula may also be found in children with deformities of the respiratory system. Furthermore, tracheoesophageal fistulae are often found in the neck. Therefore, when sudden ventilatory insufficiency occurs in a child with a tracheostomy after replacing the tracheostomy cannula, caution must be exercised since the cannula may have migrated to the esophagus via a fistula

イ ショクドウ ギャクリュウショウ ニ タイスル フククウキョウカ Nissen フンモン ケイセイジュツ ニオケル ショクドウ チョクセツ コテイ ノ ジュウヨウセイ ニ カンスル ケントウ

【Background】 For the neurologically impaired（NI）patients with gastro-esophageal reflux disease（GERD） who underwent laparoscopic Nissen fundoplication, the direct suture between the esophagus and diaphragmatic crus（esophagus direct suture）was changed from one to three stiches in order to prevent the postoperative recurrence due to wrap herniation. Therefore, the postoperative outcome was evaluated before and after this change retrospectively. 【Methods】 Seventy-two NI patients（ ５３ boys and １９ girls, mean age９１. years old）with GERD performed laparoscopic Nissen fundoplication from ２００５ to ２０１２ were enrolled in this study. Surgical procedure was laparoscopic Nissen fundoplication for all patients and additional gastrostomy at the same time for６８cases（９４％）. Patients were divided into the following two groups : early period group（n＝２７）and late period group（n＝４５）. The early period group included the number of esophagus direct suture was one stitch from２００５to２００７and the late period group included the number of esophagus direct suture was three stitches from２００８to２０１２． 【Results】 There was no intraoperative complication in both two groups. In postoperative complication rate, there was no significant difference between the two groups though one case（２．２％）showed a gastric perforation in the late period group. Postoperative recurrence was found ９ cases （１２．５％）due to wrap herniation. In postoperative recurrence rate, the early period group was ２２．２％（n＝６）and the late period group was ６．７％（n＝３）. The modified esophagus direct suture by from one stitch to three stitches had a tendency to decrease the postoperative recurrence rate（p＝０．０５）. For nine recurrent cases, re‐operation was performed in two patients, esophagogastric dissociation in one patients and observation in six patients. 【Conclusions】 Devising the esophagus direct suture in the laparoscopic Nissen fundoplication for NI patients might have the possibility to prevent the recurrence due to wrap herniation

Treatment strategy for successful hepatic resection of icteric liver

Background : The treatment strategy for jaundiced patients with hilar cholangiocarcinoma (HC) is not well established. In this study, we evaluate the feasibility of our perioperative protocol for jaundiced patients with HC. Methods : Twenty patients with HC who underwent hepatic resection at our institute were enrolled, and patients were divided into icteric(n=6) and normal(n=14) group. As a perioperative protocol, Oral administration of Inchinkoto(ICKT), steroid and nafamostat mesilate were introduced. The evaluation of functional future remnant liver(FRL) by asiaroscintigraphy, and postoperative outcomes were retrospectively compared. Results : Indocyanine green dye retention rate at 15 minutes was higher, and LHL15 values was lower in icteric group. However, in the functional evaluation of FRL, which was the sum of GSA uptake of the future FRL, there was no significant difference of LHL15 values of the remnant liver functional reserve between the two groups. As results, according to the difference of liver function, serum AST level was not different between two groups. The number of patients with postoperative morbidity in the two groups was comparable. Conclusions : Even in HC patients with icteric liver, accurate assessment of liver functional reserve and effective perioperative treatment may attribute to successful hepatectomy and favorable post-operative outcomes

Development of Flat Tube Heat Exchanger for Heat Pump Air Conditoner

We developed a new type of a heat pump outdoor unit using an aluminum flat tube heat exchanger in order to improve the energy saving capability of an air conditioner. There are several difficulties in keeping a desired drainage performance, frost formation performance, as well as even distribution of refrigerant, when applying the flat tube heat exchanger to heat pump outdoor units. In order to achieve the same drainage performance and the frost formation performance as those of conventional heat exchangers, we have adopted new plate fins with ellipse cutouts. Flat tubes were inserted in the ellipse cutouts, and the slit position on a plate fin was properly adjusted. In order to achieve the even distribution of refrigerant, an aluminum distributor and 3-way pipes were installed to the evaporator. In this report, first we describe features of the flat tube heat exchanger. Next, we present and explain experimental results of the air-side heat transfer coefficient and the air-side pressure drop on the condition of dry, wet, and frost state respectively. Moreover, we present experimental results of the total heat transfer performance, including the refrigerant performance, under the conditions of the condensation and the evaporation. Finally, we explain the heat transfer performance and the effect of the flat tube heat exchanger to a conventional one in the case that the developed heat exchanger was mounted in heat pump outdoor unit

One-pot carbon-carbon bond formation at the b-position of cyclic ketones: oxidative Michael addition with alkyl malonates

金沢大学大学院自然科学研究科生理活性物質科学金沢大学薬学部金沢大学医学部附属病院薬剤部A carbon-carbon bond was formed at the β-position of cyclic ketones in a one-pot manner by oxidation with N-tert-butylbenzenesulfinimidoyl chloride, followed by the reaction of malonic acid esters or potassium cyanide. © 2007 Elsevier Ltd. All rights reserved