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To present the utility of the recently introduced Maniceps septum stitch device for suturing of the nasal septum.
This paper describes nasal septum suturing techniques using the Maniceps septum stitch device following septoplasty to prevent post-operative complications such as haematoma and nasal septum perforation.
Nasal septum suturing using the Maniceps septum stitch device appears to be a safe and easy surgical procedure to help prevent post-operative complications and may reduce the incidence of nasal septum perforation following septoplasty.
A case of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after failed radiation therapy and vertical partial laryngectomy had successful oncological and functional outcomes. This is the first reported application of salvage supracricoid laryngectomy with cricohyoidoepiglottopexy after the failure of two major treatments.
A 65-year-old man was referred for salvage supracricoid laryngectomy with cricohyoidoepiglottopexy. The right recurrent hemilarynx was successfully resected. After pexis, the right lobe of the thyroid gland was repositioned to overlap and reinforce the pexis gap and fill the devoid portion of the strap muscular closure. Multiple scattered foci (recurrent tumour–node–metastasis stage T2) were identified around the arytenoid cartilage and beneath the musculocutaneous flap. Four years after supracricoid laryngectomy with cricohyoidoepiglottopexy, the patient's recovery was following a favourable course and he had satisfactory laryngeal function.
Appropriate case selection and proficient surgical skills were essential for a successful outcome. Head and neck surgeons should not be afraid to adopt functional preservation open surgical procedures in well-selected and well-motivated patients. A requirement for more challenging surgical procedures and meticulous rehabilitation processes should not exclude appropriate treatments from a surgeon's repertoire.
An ultra-small tactile sensor with functions of signal processing and digital communication has been prototyped based on MEMS-CMOS integration technology. The designed analog-digital mixed signal ASIC allows many tactile sensors to connect each other on a common bus line, which drastically reduces the number of wire. The ASIC capacitively detects the deformation of a force sensor and sends digital data to the common bus line when the force exceeds a threshold. The digital data contain a physical ID of each sensor, 32-bit sensing data and 16-bit cyclic redundancy check (CRC) code. In this study, a novel wafer-level integration and packaging technology were developed, and a chip-size-packaged tactile sensor with a small footprint (2.5mm×2.5mm) and a low profile (0.27mm) was prototyped and tested. The sensor autonomously sends digital data like a tactile receptor of human.
Supracricoid laryngectomy with cricohyoidoepiglottopexy is an organ-preserving procedure used to treat laryngeal cancer. However, the post-operative neoglottis tends to be variable in form and difficult to predict.
We retrospectively analysed three-dimensional images reconstructed from multidetector-row computed tomography data for 21 patients, assessing arytenoid motion and minimum neoglottic gap cross-sectional area.
While mean transverse and coronal motion was similar for bilateral and unilateral arytenoids, movement along the sagittal axis was greater for unilateral than bilateral arytenoids. The neoglottic gap during respiration was wider in patients with bilateral arytenoids, but both groups had a similar neoglottic gap during phonation.
Anterior shifting of the unilateral arytenoid plays an important role in compensating for the inability to achieve neoglottic closure. These two results demonstrate that the unilateral arytenoid alone is capable of achieving sufficient neoglottic narrowing to compensate for the resected arytenoid. Three-dimensional analysis was useful to evaluate the physiological status of the neoglottis after supracricoid laryngectomy with cricohyoidoepiglottopexy.
After the Great Hanshin-Awaji Earthquake, the disaster countermeasures concerning medical care in Japan changed drastically. In 2005, the Japanese government began to develop a domestic, rapid, medical response system called Disaster Medical Assistance Team (DMAT) for the purpose of rapid medical correspondence in the acute phase. As of 12 July 2010, 393 institutions and 734 teams (3,700 persons) were trained. A DMAT is important not only to the response to large disasters such as earthquakes, but also the response to local disasters. It is important to establish the DMAT system of each prefecture and district.
The DMAT system at the local level was described at the 15th World Congress on Disaster and Emergency Medicine. During the present Congress, the development and activities of the DMAT system over the past three years will be reported.
Results and Conclusion
Eight local districts in the DMAT system have been developed, and progress has been made in the fields of policy, operative plans, and agreement among each province. The system of inter-prefecture mutual aid must be built upon in the near future.
To examine how did Hyogo prefecture renovate disaster medical services system from the lessons of the Great Hanshin -Awaji Earthquake.
Countermeasures after the experience of the Earthquake were 1. Establishment of disaster-related medical information network which was introduced to each of various institutions to collect and disseminate medical information at the time of disaster. 2. Designation of sixteen hospitals as Disaster Medical Centers, which were expected to play leading role in disaster management,and to receive many patients at a time of disasters. 3. Construction of Hyogo Emergency Medical Center which was designated as a main Disaster Medical Center to train medical staffs, to operate the Emergency Medical Information Control Center.
We have several training courses for medical staffs. The most important training course is the DMAT (Disaster Medical Assistant Team)training course. DMAT trainigs held at two main Disaster Medical Centers, east National Disaster Medical Center, west Hyogo Emergency Medical Center. More than three hundreds teams have been cultivated now. We experienced five disasters in Hyogo prefecture in these seven years. 2 were natural disasters by the typhoon. 3 were a collision of the ship, the collision of the truck, train derailments each. A big JR train accident occurred in Amagasaki city of Hyogo on April 25,2005. Hyogo Emergency Medical Center worked as the emergency information control center, dispatched doctor attended ambulance, performed on-site triage and first aid, dispatched second team by helicopter, received four severe cases by helicopters, dispatched third team in the evening and provided confined space medicine, and took initiative of surveillance study of the casualties.
Disaster medical services system from the lessons of the Earthqukake functioned at the time of the JR Train accident.
Supracricoid laryngectomy with cricohyoidoepiglottopexy is an organ-preserving surgical technique used to treat laryngeal cancer. This procedure resects the vocal folds; however, it is unclear how the sound source and airway morphology are involved in phonation through the post-operative neoglottis.
Multidetector helical computed tomography scanning was performed on two patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy. The cricoid and arytenoid cartilages and the airway were visualised using three-dimensional images.
The mobility of the arytenoid cartilages was well preserved in the one patient with bilateral arytenoids, and in the other patient with only one arytenoid remaining. Two types of airway configuration were observed during phonation: one patient had a single stream airway, while the other had a combination of several streams.
In the patient with only one arytenoid remaining, the preserved arytenoid tended to be rotated excessively inward. Therefore, phonation may have also occurred in various airways followed by mucosal vibration, which may be a sound source.
This study aimed to analyse vocal performance and to investigate the nature of the neoglottal sound source in patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy, using a high-speed digital imaging system.
High-speed digital imaging analysis of neoglottal kinetics was performed in two patients who had undergone supracricoid laryngectomy with cricohyoidoepiglottopexy; laryngotopography, inverse filtering analysis and multiline kymography were also undertaken.
In case one, laryngotopography demonstrated two vibrating areas: one matched with the primary (i.e. fundamental) frequency (75 Hz) and the other with the secondary frequency (150 Hz) at the neoglottis. In case two, laryngotopography showed two vibrating areas matched with the fundamental frequency (172 Hz) at the neoglottis. The interaction between the two areas was considered to be the sound source in both patients. The waveform of the estimated volume flow at the neoglottis, obtained by inverse filtering analysis, corresponded well to the neoglottal vibration patterns derived by multiline kymography. These findings indicated that the specific sites identified at the neoglottis by the present method were likely to be the sound source in each patient.
High-speed digital imaging analysis is effective in locating the sites responsible for voice production in patients who have undergone supracricoid laryngectomy with cricohyoidoepiglottopexy. This is the first study to clearly identify the neoglottal sound source in such patients, using a high-speed digital imaging system.
The authors prepared a near-UV to red wavelength conversion thick film containing 38.8 wt% of YVO4:Bi3+,Eu3+ nanoparticles of 10.8 ± 1.6 nm in size. This nanoparticle film shows a high transparency in the visible region, e.g., the transmittance at 619 nm is ∼ 96% irrespective of the film thickness. The photoluminescence intensity at 619 nm corresponding to the f-f transition of Eu3+ for this nanoparticle film increases with increasing the film thickness up to 400 μm, whereas that of the film containing micron-sized particles reaches the maximum at the film thickness of ∼ 40 μm. On the other hand, YVO4:Bi3+,Eu3+ nanoparticles have a sufficient photostability for practical use over 15 years outside, as confirmed by the light fastness test. These results suggest that the transparent film of YVO4:Bi3+,Eu3+ nanoparticles are potentially applicable to the spectral convertor for photovoltaic cells from the aspects of low light-scattering loss and high photostability.
Mineralogical changes of cement and bentonite accompanied with their interaction wereexperimentally studied by mixing granulated hardened cement paste and bentonite, and aging the mixture for91 days at 50° C. Mineralogical changes of cement and bentonite were identified by XRD. Hydratedcalcium-silicate phases (C-S-H), Ca(OH)2, ettringite and monosulfate were identified in the unalteredhardened cement. While Ca(OH)2 and monosulfate decreased with aging and disappeared after 91 days,calcite and katoite (Ca3Al2(SiO4)(OH)8) were formed concurrently. Montmorillonite, quartz (and/orchalcedony), clinoptilolite, plagioclase, calcite, analcime and pyrite were identified in the unaltered bentonite.The XRD pattern showed that diffraction intensities of these minerals decreased with aging. It seems thatthese primary minerals dissolved in the course of the alteration. C-S-H appeared in bentonite during the agingas secondary phases, indicating the participation of silicon dissolved from the bentonite and calcium from thecement formed the C-S-H. The formation of C-S-H that had been predicted by previous modeling studieswas confirmed by the present experiments.
In addition, diffusivity of tritiated water in mixed specimen with granulated hardened cement andbentonite was determined by a through-diffusion method. The effective diffusivity of tritiated water decreasedwith aging. The result suggests that the mass diffusivity in the interface of cement-bentonite system willdecrease with their interactions. The results of the diffusion experiments are qualitatively consistent with thediffusivity change in cement-bentonite systems predicted by some computational studies.
We have performed supracricoid laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy for tumour (T) stage T2 and T3 laryngeal cancer cases and some T4 cases. We report the clinical symptoms and management, using this technique to avoid complications.
Among patients undergoing the procedure, two cases manifested laryngeal chondritis following laryngectomy with cricohyoidoepiglottopexy. This complication was caused by C3–4 cervical osteophytes physically contacting the cricoid cartilage. Laryngeal microlaryngoscopy was performed, which revealed white, necrotic tissue in the posterior wall of the pharynx and persistent oedema of the neoglottis.
When encountering a patient with an excessive osteophyte formation at the level of C3–4, one needs to take extra precautions when undertaking laryngectomy with cricohyoidoepiglottopexy or with cricohyoidopexy.
We demonstrate that Franz-Keldysh oscillations (FKOs) observed by photoreflectance (PR) spectroscopy are highly sensitive to the surface morphology of AlxGa1−xN layers in AlxGa1−x N heterostructures. Three Al0.2Ga0.8N/GaN heterostructures with different surface-morphology profiles, which are confirmed with atomic force microscopy, have been investigated. The X-ray-diffraction patterns are hardly affected by the Al0.2Ga0.8N/GaN-layer morphology. In contrast, it is revealed that cracks and pits dominating the morphology remarkably reduce the amplitude of the FKOs from the Al0.2Ga0.8N/GaN layer, which is attributed to the following two mechanisms related to the cracks and pits. One is lifetime broadening due to carrier scattering, and the other is the suppression of the modulation magnitude for the built-in electric field, which is caused by the trapping and recombination of photogenerated carriers at the surface.
Two patients who received supracricoid laryngectomy with cricohyoidoepiglottopexy to treat laryngeal cancers, underwent intra-operative electromyography analysis. After the lesion was removed and the electrodes were inserted into the remaining intrinsic laryngeal muscles, the depth of anaesthesia was carefully reduced. Gentle tactile stimulations were applied to the pharynx to trigger the reflex movement of the remaining arytenoids. Recordings were made when reflex movement was achieved.
Case one: Electromyography (EMG) of the remaining arytenoid demonstrated clear phase differences indicating reciprocal activities between the adductor group (lateral cricoarytenoid muscle, interarytenoid muscle) and the abductor muscle (posterior cricoarytenoid muscle). Case two: EMG of the remaining arytenoid demonstrated reciprocal activities between the interarytenoid muscle and the posterior cricoarytenoid muscle. Activity of the lateral cricoarytenoid muscle was not evident because the muscle was excised during removal of the paraglottic space. Mobility of the arytenoid was attributed to interaction between the interarytenoid muscle and posterior cricoarytenoid muscle. Reciprocal interaction between the interarytenoid muscle and posterior cricoarytenoid muscle alone is also capable of maintaining post-operative laryngeal functions after supracricoid laryngectomy with cricohyoidoepiglottopexy.
Background and objective: Thiopental has been reported to reduce sympathetic tone, however, it is not clear whether change in heart rate variability is associated with depth of anaesthesia. The purpose of the present study was to evaluate changes in heart rate variability at different depths of hypnosis during induction of anaesthesia with thiopental. Methods: We studied 17 ASA I patients scheduled for minor surgery. The depth of hypnosis was monitored by the BIS. Spectral analysis of heart rate variability using a maximum entropy method resulted in a characteristic power spectrum with two main regions, a high frequency and a low frequency. Haemodynamics, entropy, low frequency, high frequency and low frequency/high frequency were monitored in an awake state and after the induction of anaesthesia. Results: Heart rate increased in a BIS-dependent manner, whereas blood pressure showed no significant changes during the study period. High frequency, entropy and low frequency decreased with a reduction in the BIS value. Low frequency/high frequency showed no significant change during the study period. Conclusions: Induction of anaesthesia with thiopental increased heart rate and decreased high frequency, entropy and low frequency in a BIS-dependent manner, indicating that thiopental reduces cardiac parasympathetic tone depending on the depth of hypnosis.
A new simple method for measuring a long-range electrostatic attractive force between metal and semiconductor substrate and charged polymer surfaces has been developed to make clear the effect of the electronic nature of substrate surfaces. Nickel, titanium, and silicon wafer substrates were subjected to various surface pretreatments. The surfaces of polystyrene and polytetrafluoroethylene sheets were positively and negatively charged by triboelectrification, respectively. A progressive increase in the attractive force was observed with a decrease in the distance between the substrate and polymer surfaces. The magnitude of the attractive force was greatly influenced by the substrate pretreatments and the polymers with the oppositely charged surface. The electronic nature of the substrate surfaces evaluated by temperature programmed photoelectron emission method was well correlated with the attractive force. The electrostatic induction generated at the substrate surface is considered to govern the attractive force.
In order to have a knowledge on electron emission from wearing metal surfaces under frictional heating, we investigated thermally stimulated electron emission (TSEE) phenomena together with thermoelectronic emission for 14 kinds of scratched metal surfaces, Al, Ti, V, Cr, Fe, Co, Ni, Cu, Mo, W, Pd, Pt, Ag and Au. The scratched metal surfaces in ambient air were thermally stimulated in a constant heating rate ranged from 1.3 to 4.4 °C/s from room temperature to 700 °C in a residual gas pressure of 10-4Pa in a vacuum chamber. During the stimulation, a channeling type secondary electron multiplier detected the electrons emitted from the scratched metal surfaces. The TSEE glow curves and the integrated electron emission intensities over tested temperature range for the metals are presented and the emission mechanisms are discussed.