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Copyright of Acta Universitatis Carolinae Historia Universitatis Carolinae Pragensis is the property of Charles University Prague, Karolinum Press and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study is dedicated to an reappraisal of the sovereign's fief policy in late middle age Austria. While the older research tendencies were mostly based on the idea of a slightly declining system signed by a rigid formalism, a new analysis of the fief structures in the hereditary territories of the Habsburg dynasty shows a slightly different picture. The anatomy of fief letters and books, reverses and letters of conveyance show that the increasing literacy transformed fiefdom into one of the central playgrounds of sovereign chancelleries. Mostly in case of dominion divisions or changes in late medieval rulership that vassality became important. Despite the reification of fiefdom, territorial rule and vasality do not oppose each other. The sovereign fiefdom in the 14 th and 15 th century is considered as an important often monetarised instrument among others, used to enhance and consolidate the sovereign's rule. [ABSTRACT FROM AUTHOR]

An essay is presented on the territorial domain of Duke Frederick III, from the perspective of cultural and social history. The aim of cultural history in the context is, according to Peter Becker, to enable a better understanding of its practices, whereby a differentiated form of contextualization can be presented.

OBJECTIVES:This study aimed to refine the criteria for esophageal hypercontractility in high-resolution esophageal pressure topography (EPT) and to examine the clinical context in which it occurs.METHODS:A total of 72 control subjects were used to define the threshold for hypercontractility as a distal contractile integral (DCI) greater than observed in normals. In all, 2,000 consecutive EPT studies were reviewed to find patients exceeding this threshold. Concomitant EPT and clinical variables were explored.RESULTS:The greatest DCI value observed in any swallow among the control subjects was 7,732 mm Hg-s-cm; the threshold for hypercontractility was established as a swallow with DCI >8,000 mm Hg-s-cm. A total of 44 patients were identified with a median maximal DCI of 11,077 mm Hg-s-cm, all with normal contractile propagation and normal distal contractile latency, thereby excluding achalasia and distal esophageal spasm. Hypercontractility was associated with multipeaked contractions in 82% of instances, leading to the name 'Jackhammer Esophagus.' Dysphagia was the dominant symptom, although subsets of patients had hypercontractility in the context of esophagogastric junction (EGJ) outflow obstruction, reflux disease, or as an apparent primary motility disorder.CONCLUSIONS:We describe an extreme phenotype of hypercontractility characterized in EPT by the occurrence of at least a single contraction with DCI >8,000 mm Hg-s-cm, a value not encountered in control subjects. This phenomenon, branded 'Jackhammer Esophagus,' was usually accompanied by dysphagia and occurred both in association with other esophageal pathology (EGJ outflow obstruction, reflux disease) or as an isolated motility disturbance. Further studies are required to define the pathophysiology and treatment of this disorder. [ABSTRACT FROM AUTHOR]

Background: The manometric diagnosis of distal esophageal spasm (DES) uses “simultaneous contractions” as a defining criterion, ignoring the concept of short latency distal contractions as an important feature. Our aim was to apply standardized metrics of contraction velocity and latency to high-resolution esophageal pressure topography (EPT) studies to refine the diagnosis of DES. Methods: Two thousand consecutive EPT studies were analyzed for contractile front velocity (CFV) and distal latency to identify patients potentially having DES. Normal limits for CFV and distal latency were established from 75 control subjects. Clinical data of patients with reduced distal latency and/or rapid CFV were reviewed. Results: Of 1070 evaluable patients, 91 (8.5%) had a high CFV and/or low distal latency. Patients with only rapid contractions (n = 186 [17.4%] using conventional manometry criteria; n = 85 [7.9%] using EPT criteria) were heterogeneous in diagnosis and symptoms, with the majority ultimately categorized as weak peristalsis or normal. In contrast, 96% of patients with premature contraction had dysphagia, and all (n = 24; 2.2% overall) were ultimately managed as spastic achalasia or DES. Conclusions: The current DES diagnostic paradigm focused on “simultaneous contractions” identifies a large heterogeneous set of patients, most of whom do not have a clinical syndrome suggestive of esophageal spasm. Incorporating distal latency into the diagnostic algorithm of EPT studies improves upon this by isolating disorders of homogeneous pathophysiology: DES with short latency and spastic achalasia. We hypothesize that prioritizing measurement of distal latency will refine the management of these disorders, recognizing that outcomes trials are necessary. [ABSTRACT FROM AUTHOR]