BACKGROUND: Recently, investigators have reported the use of endoscopic myotomy in the treatment of esophageal achalasia. As with the open operation, considerable disagreement exists regarding the appropriate length of the myotomy and the need for a concomitant antireflux procedure. METHODS: Patients presenting with symptomatic achalasia between 1993 and 1997 were included in this prospective study. Preoperative studies included barium upper gastrointestinal study, endoscopy, and esophageal manometry. Laparoscopic myotomy was completed in all 20 patients; 18 had concomitant Toupet fundoplication. RESULTS: Operative times ranged from 95 to 345 minutes (mean 216). Blood loss ranged from 50 to 300 cc (mean 100 cc). There were 7 minor complications (5 mucosal injuries repaired laparoscopically, 1 bile leak and 1 splenic capsular tear). Nine patients began a liquid diet on the first day postoperatively; 19 were tolerating liquids by postoperative day 3. Hospital stay ranged from 2 to 20 days (mean 5). Eighteen patients had complete relief of dysphagia, with less than one reflux episode per month. One individual continues to have mild persistent solid food dysphagia. Another patient initially did well but subsequently developed mild recurrent dysphagia and reflux. One patient required laparoscopic take-down of the wrap because of recurrent dysphagia and now has no problems swallowing, but does complain of mild reflux. Two other patients also have mild reflux, 1 of whom did not undergo fundoplication. CONCLUSIONS: Laparoscopic Heller myotomy can be performed safely with excellent results in patients with achalasia. Adding a partial fundoplication appears to help control postoperative symptoms of reflux. This procedure should be considered the procedure of choice in patients with symptomatic esophageal achalasia. 相似文献
Attachment between parent and child plays a crucial role in the healthy development of the child. Accordingly disturbances in parental bonding will be linked with the development of mental disorders later in life. The present study examines the relationship between parental bonding and mental health in healthy adolescents. Participants were 847 Israeli high school students who completed the Parental Bonding Instrument (PBI), the Brief Symptom Inventory (BSI), the General Well-Being (GWB), the Perceived Social Support (PSS), and the Social Desirability scale (SDS). In general, Israeli adolescents reported more parental care and less control than did Australian adolescents and adults. Female subjects reported more maternal care than did males. Subjects who reported high care and low control (optimal bonding) reported less distress, better general well-being and better social support that did all other groups. In contrast, those who reported low care and high control (affectionless control bonding) had the highest BSI scores and the lowest GWB and PSS scores. These results are in line with Bowlby's theory of attachment. They also show that specific configuration of parental bonding are linked with distress and isolation in adolescents. 相似文献
Liquid crystal polymer (LCP) has potentially a very wide application as substrate material in electronic packaging applications because of its unique advantages. The work in this paper was performed to realize the metallization of LCP for the purpose of board fabrication, and to study the adhesion between deposited copper and LCP. A homogenous electroless plated copper layer on LCP with 4 to 5 /spl mu/m thickness was achieved, while it increased up to 40 /spl mu/m with the subsequent electroplating. The timescale of etching, deposit ion rate, and pH value were gradually changing during the plating process and the influences on copper layer quality were investigated. The adhesion force of the copper-LCP layer system was measured by a shear-off-method. Scanning electron microscopy (SEM) was used to check the surface morphology after etching and the interface after shearing on both the backside of the copper layer and the LCP side. The relationship between the shear-off adhesion of copper and the time of chemical etching before plating was examined, and the optimal etching time is discussed. Heat treatment after plating was used, and it was shown that this significantly improved the adhesion strength. 相似文献
It is well known that angles in composite parts contract as they are cooled down from the curing temperature, this is often referred to as spring-in. It is caused mainly by the significantly different thermal contractions and cure shrinkage's experienced between the fibre direction and the through-thickness direction during the manufacturing process. A number of works have reported on the spring-in of straight angle composite parts. However, little has been done to investigate the distortion of curved flanged composite parts, which will distort differently owing to the introduction of the additional curvature, thus constraint.
In the present work, the distortion of the circularly curved flanged laminates is studied numerically. The finite element method is used to predict the processing-induced distortion of the part with two different approaches. In the first approach, the shear angles of the composite plies are predicted by a draping analysis. The effect of the fibre shearing on the mechanical properties of the laminates is considered in the model used to predict the distortion. The second simplified approach assumes that the in-plane properties of the laminates are isotropic. The results obtained by these two approaches are compared with those obtained experimentally. 相似文献
Single=walled carbon nanotubes(SWNTs) were synthesized by a hydrogen arc discharge method.A high yield of gram quantity of SWNTs per hour was achieved.Tow kinds of SWNT products:web-like substancea and thin films in large slices were obtained. Results of resonant Raman scattering measurements indicate that the SWNTs prepared have a wider diameter distribution and a larger mean diameter.Hydrogen uptake measurements of the two kinds of SWNT samples(both as prepared and pretreated) were carried out using a high pressure volumetric method,respectively.And a hydrogen storage capacity of 4 wt pct could be repeatedly achieved for the suitably pretreated SWMNTs,whicb indicates that SWNTs may be a promising hydrogen storge material. 相似文献