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Purpose Nissen fundoplication (NF) is the most commonly used surgical treatment for persistent gastroesophageal reflux disease (GERD). We introduced to the alternative Thal fundoplication (TF) (partial anterior wrapping) in 1998. The purpose of this paper is to review and report on the effectiveness of TF in our department. Methods We retrospectively analyzed cases of 281 patients who underwent TF for GERD at our hospital from 1998 to 2019. Results Average age, 16.3 ± 18.1 years; average body weight, 21.0 ± 16.0 kg; average operative time, 89.1 ± 43.0 min; average volume of bleeding, 11.6 ± 29.2 g; enteral feeding commenced after an average of 3.4 ± 1.3 postoperative days (PODs), and average postoperative full enteral feeding was 6.3 ± 1.4 PODs. Five patients (1.8%) had Clavien–Dindo classification III or higher; average hospital stay duration was 10.3 ± 6.0 days, with symptom recurrence affecting 17 patients (6.1%). Conclusion TF may be an effective and simple treatment for GERD that has few recurrences and avoids complications common to NF, but further studies to compare it with other techniques are needed.

Background Spontaneous pneumothorax occurs more often in younger, slim, and shallow-chested men. Although less common, differential diagnoses for secondary pneumothorax in children are asthma, emphysematous blebs, catamenial pneumothorax, and others. We report a patient who presented with pneumothorax and was found to have an inflammatory myofibroblastic tumor (IMT)-like lesion, and present a review of the related literature. Case presentation A 14-year-old girl visited her physician for chest pain that developed while exercising. Although chest drainage was performed, the symptoms associated with a collapsed lung did not improve, and she was referred to our hospital. Computed tomography revealed the presence of a 19 × 17-mm cyst with a thick wall in the apex of the right lung. She was tested for infectious diseases, namely tuberculosis, but the results were not definitive. Catamenial pneumothorax was also suspected because she was menstruating when she presented to our hospital. As a therapeutic diagnosis, we performed a thoracoscopic partial resection of the right upper lobe of the lung. Three small openings were identified inside the cyst, suggesting connection with the bronchiole. The lesion was pathologically diagnosed as an IMT-like lesion. Considering the progress so far, we considered that the final diagnosis to be an IMT. The patient was discharged on postoperative day 3, and we have followed her for the past 6 months with no local recurrence or metastasis. Conclusions IMT is not uncommon in children. Therefore, this lesion should be considered as a possible diagnosis if children and young adults develop spontaneous pneumothorax.

BACKGROUND Split-liver transplantation can be useful in situations of limited donor resources. However, novel preservation methods are required to help the recipient recover from severe ischemic reperfusion injury incurred due to receiving a relatively small liver graft. MATERIAL AND METHODS Our experiment was performed using porcine livers without warm ischemia time, assuming a brain-dead organ. We made porcine split-liver grafts by 75% liver resection at the back table and divided the specimens into 4 groups. Group 1 was preserved with simple cold storage after splitting (CS; n=3), Group 2 was preserved with hypothermic perfusion preservation (HMP) after splitting (SBP; n=3), Group 3 was preserved with HMP after splitting under perfusion preservation (SDP; n=4), and Group 4 had the whole liver perfused as control grafts (Whole Liver; n=3). To assess potential methods of preservation and their effects, all grafts were evaluated by an ex vivo isolated liver reperfusion model using diluted autologous blood. RESULTS Portal vein pressure resistances during reperfusion were low in Group3 (SDP). Hepatic artery pressure resistances during reperfusion were markedly higher in Group 1(CS) than in the other groups. The levels of AST and LDH were high and increased at 2 h after reperfusion in Group 1 (CS). The histological findings show that the liver cell structure was irregular in Group 1 (CS) but remained regular in Groups 2 (SBP) and 3 (SDP). Histological Suzuki scores were also significantly better in Groups 2 (SBP) and 3 (SDP) compared with Group 1 (CS). CONCLUSIONS Splitting the liver under machine perfusion preservation may help restore the function and reduce ischemia-reperfusion injury.

Background Congenital intestinal atresia develops in 1 in 1500 to 20,000 births. Colonic atresia, which accounts for 1.8–15% of intestinal atresia cases, is accompanied by other gastrointestinal atresias such as small intestinal atresia, gastroschisis, imperforate anus, and intestinal malformation in 47–80%. Although a report shows that patients with multiple colonic atresias are 8.9% of those with colonic atresia. Case presentation A male infant did not have the first bowel movement within 36 h of birth and had abdominal distention/vomiting. Radiography showed significant dilation of the intestinal tract. A contrast enema examination at 3 days of age showed a microcolon and disruption in the descending colon. We performed an emergency decompressive loop enterostomy in the distended segment. At the age of 7 months, imaging from the stoma showed disruption of the contrast medium in the intestinal tract at the right lower abdomen, and the continuity of the intestinal tract was not clarified. Intestinal malrotation was found during the second surgery, and the enterostomy was located in the ileum proximal to Bauhin’s valve. Continuity of the intestinal serosal surface was maintained. However, multiple membranous obstructions (three atresias and one stenosis) were observed in the distal segment of the bowel, which was penetrated by intraluminal advancement of a urethral catheter. Therefore, he was diagnosed with multiple colonic atresias. The intestinal tract was longitudinally incised, and membranectomy and mucosal/lateral suture were performed. Conclusions It is important for neonates with intestinal atresia to evaluate and prepare for distal patency of the colon before radical anastomosis. In addition, anomalies associated with colon atresia should also be assessed.

We report an 80-year-old woman with rheumatoid arthritis (RA) who was found to have subchondral insufficiency fracture of the right femoral head after total knee arthroplasty (TKA). Initially, plain radiographs showed no obvious changes, but magnetic resonance imaging (MRI) revealed an irregular, discontinuous, low-intensity band on T1-weighted images of the right hip. She underwent hemiarthroplasty of the hip. This report describes a rare case of subchondral insufficiency fracture of the femoral head after TKA in a patient with RA.

The growing teratoma syndrome (GTS) secondary to a testicular nonseminomatous germ cell tumor has been well described since the first case was reported in 1982. In addition, radiological findings of male GTS have also reported in several studies; however, its occurrence secondary to an ovarian germ cell tumor is extremely rare. We experienced a 5-year-old girl who had GTS secondary to immature teratoma of the right ovary. In this article we present radiological findings of female GTS with clinical and pathological correlation.

Atypical Epstein-Barr virus (EBV) infection developed in a patient under intermittent administration of FK506 (one dose in 10 days) after living-related liver transplantation. The clinical course was similar to severe chronic active EBV infection syndrome (SCAEBV), which is characterized by extremely high titers of antibody to EBV antigens. The clinical symptoms improved without graft rejection even after the cessation of FK506; however, the titers of antibody to EBV antigens remained at high levels. It was considered that: (i) even intermittent use of FK506 could influence the immune response, which then induced atypical EBV infection similar to SCAEBV; and (ii) the impaired immune response, especially to EBV antigens, remained after complete cessation of FK506.

The water absorption behavior of karaya gum ointment, which improves perianal dermatitis following definitive operation for diseases, such as Hirschsprung was investigated to elucidate the mechanisms of its action. Forty percent karaya gum ointment (10g) swelled and absorbed 7. 5 and 16g of saline solution under the experimental condition of after 6 and 24hr, respectively. The water absorption was not saturable during the experimental periods. The linear square root of time plots suggested that the water absorption properties of karaya gum ointment are controlled by the diffusion model of water into ointment, and the observed absorption rate constant of 40% ointment was 0.426g/10gitnin1/2. Distilled water as a tested fluid was absorbed more rapidly than saline solution.The effect of concentration on the absorption behavior for the karaya gum and CMC-Na ointment showed that CMC-Na ointment is more absorbent in intermediate concentrations. The water absorption pattern of ointments containing other high molecular compounds was also studied. The order of water absorbency was CMC-Na, sodium alginate, karaya gum, tragacanth gum and acacia at concentration of 40%. Karaya gum ointment exhibited water absorbency comparable to those of the marketed skin barriers containing karaya gum. These results suggest that the water absorption effect of karaya gum ointment is associated with one of the mechanisms by which it improves perianal dermatitis.

The present study was performed to evaluate the synovium in patients with rheumatoid arthritis (RA) treated with anti-tumor necrosis factor alpha agents (anti-TNFalpha). Synovial tissue specimens were obtained during total knee arthroplasty (TKA) from 42 RA patients (12 men, 30 women). Twenty-one RA patients were given anti-TNFalpha agents (infliximab, n = 12; etanercept, n = 9), while the remaining 21 RA patients were given no such agents.The histopathological findings were compared between specimens from these groups using the histological scoring system reported by Rooney, which consists of six items:degree of synovial hyperplasia, fibrosis, number of blood vessels, perivascular lymphocyte infiltration, focal aggregates of lymphocytes, and diffuse infiltrates of lymphocytes.Clinical laboratory data including C-reactive protein(CRP), matrix metalloproteinase-3 (MMP-3), and disease activity scores including a 28-joint count (DAS28), disease duration, methotrexate (MTX) dose, and glucocorticoid dose were also assessed before surgery. There were no significant differences in total score between anti-TNFalpha and no anti-TNFalpha groups. However, significant differences were observed in scores of synoviocyte hyperplasia and perivascular infiltrates of lymphocytes between the groups. These results suggested that these agents have a suppressive effect on cell proliferation in the lining layer and on perivascular lymphocyte infiltration. However, further studies are necessary to elucidate the mechanisms of these effects.

Extraosseous uptake of Tc-99m MDP has been reported in various pathologic conditions. In colon cancer, Tc-99m MDP uptake in the primary lesion is unusual, although uptake in metastatic lesions has been observed frequently. Presented here is a rare case of juvenile colon cancer in which Tc-99m MDP uptake by the primary lesion was clearly demonstrated on bone scintigraphy.

The computer simulations of the time dependent dielectric breakdown (TDDB) percolation path are performed for ultrathin gate oxides. With our new percolation model, an interesting and new behavior of TDDB distribution was found. Weibull slope decreases monotonously with decreasing oxide thickness, and has a gap at an oxide thickness of approximately the effective defect size. This behavior can be understood well if we consider that an overlap of two neighboring defects becomes necessary to cause a sudden breakdown when oxide thickness exceeds the effective defect size. This phenomenon is very important because Weibull slope has a large effect on device reliability.

The delivery of nitric oxide (NO) via a nasopharyngeal tube is an alternative to endotracheal intubation. A male infant with end-stage pulmonary hypertension (PH) due to a severe hypoplastic lung developed a PH crisis on day 145 and received NO inhalation via a nasopharyngeal tube. Clinical improvement was maintained for 7 days with 18-22 ppm NO inhalation. The patient remained in close physical contact with his parents without the use of sedation. Blood methemoglobin levels remained below 1%. The environmental NO levels were less than 0.06 ppm and NO2 less than 0.3 ppm throughout the treatment, well within the safety margin. On day 152, the patient succumbed to hypoxemia and heart failure. The use of a nasopharyngeal NO delivery system without sedation, as an alternative to endotracheal intubation with sedation, was a practical method in treating a patient with PH while maintaining a certain quality of life for the patient and the family.

The effect of long-term high temperature stress on the filler-induced failure in high density MOS RAMs was investigated. High temperature storage causes volume reduction in some plastic resins which enhances the local strong stress to RAM chip resulting in the filler-induced failure. This phenonenon is well explained by the increase of leakage current in p-n junction under local strong stress.

In fine structured n-channel MOS VLSI circuits, it is unavoidable that the n+ diffusion layer for the power supply line (VDD) is located near that for the ground line (VSS). The breakdown voltage between VDD and VSS is reduced significantly by the substrate current generated in the surrounding MOSFET's. The resultant current flowing from VDD to VSS becomes large enough to cause various kinds of catastrophic destructions. This phenomenon is well explained by considering the effect of the increased substrate potential of the parasitic VSS-substrate-VDD bipolar transistor.

The differences of impact ionization current between PMOS and NMOS which have similar channel conductance are discussed in detail. It is not always true that PMOS is more free of the hot carrier problems than NMOS. PMOS has two orders of magnitude larger peak-gate-current than NMOS, which can be well explained by the lower barrier height and higher electric field in PMOS.

The moisture induced aluminum corrosion in practical 64 kbit dynamic RAM's is described. In the unimproved RAM's, moisture induced failures are composed of two Weibull-distributions, that is, the random failures of short lifetime and the wear-out failures of long lifetime. Improvement of the passivation films reduced the random failures dramatically. The instantaneous failure rate of the improved RAM's is estimated to be less than 24 FIT throughout 10 years of operation at 40°C/60%.

The temperature dependence of the threshold voltage shift has been studied for long term device degradations. The threshold voltage shift strongly depends on temperature and this is mainly caused by the temperature dependence of the effective trap density. The model assuming that the traps with an emission probability higher than 10-5∼10-6 are useless as electron traps agrees well with the experimental results.