A 58-year-old female with a recurrent history of upper abdominal pain and intermittent dysphagia underwent endoscopic evaluation that demonstrated an irregular and nodular esophago-gastric （EG） junction and grade I ...A 58-year-old female with a recurrent history of upper abdominal pain and intermittent dysphagia underwent endoscopic evaluation that demonstrated an irregular and nodular esophago-gastric （EG） junction and grade I erosive esophagitis. Biopsies showed prominent intestinal metaplasia of Barrett＇s type without dysplasia, chronic inflammation and multiple aggregates of large cells within the mucosal lamina propria, some with spindle shaped nuclei. Immunohistochemistry stains for keratins AE-1/ AE-3 were negative, while S-100 and NSE were positive. This, together with routine stains, was diagnostic for mucosal ganglioneuromatosis. The background of chronic inflammation with intestinal type metaplasia was consistent with long-term reflux esophagitis. No evidence of achalasia was seen. Biopsies of gastric antrum and fundus were unremarkable, without ganglioneural proliferation. Colonoscopy was unremarkable. No genetic syndromes were identified in the patient including familial adenomatous polyposis and multiple endocrine neoplasia type Ⅱ b （MEN Ⅱ b）. Iansoprazole （Prevacid） was started by oral administration each day with partial relief of symptoms. Subsequent esophagogastroscopy repeated at 4 mo showed normal appearing EG junction. Esophageal manometry revealed a mild nonspecific lower esophageal motility disorder. Mild motor dysfunction is seen with gastro-esophageal reflux disease （GERD） and we feel that the demonstration of localized ganglioneuromatosis was not likely related etiologically. In the absence of findings that might suggest neural hypertrophy, such as achalasia, the nodular mucosal irregularity seen with this instance of ganglioneuromatosis may, however, have exacerbated the patient＇s reflux.展开更多
We describe the design, modeling and production of a 3D printed manifold for attaching multiple respiration masks to a single ventilator machine. During a disaster surge this would allow up to four masks to be connect...We describe the design, modeling and production of a 3D printed manifold for attaching multiple respiration masks to a single ventilator machine. During a disaster surge this would allow up to four masks to be connected to a single ventilator source. In a disaster which involves high numbers of patients with lung damage, simultaneous respirator support may be required;however, the number of patients may quickly outnumber the available respirator machines. We explore the use of a rapid and low cost 3D printing method referred to as Fused Filament Deposition (FFD) for creation of a four-port ventilator manifold. This 3D printing method deposits layers of melted ABS plastic filament in a fine “stream” onto successive layers in order to form a three dimensional object. The standard file format for this object (manifold attachment) can be made globally available through the internet. It can be “printed” anywhere and anytime it is needed as a three dimensional object at extremely low cost (under two dollars per unit) and since the digital file that represents the object is modifiable, “derivative” versions can be redesigned to suit a broad range of potential applications, especially in areas with limited healthcare resources.展开更多
文摘A 58-year-old female with a recurrent history of upper abdominal pain and intermittent dysphagia underwent endoscopic evaluation that demonstrated an irregular and nodular esophago-gastric （EG） junction and grade I erosive esophagitis. Biopsies showed prominent intestinal metaplasia of Barrett＇s type without dysplasia, chronic inflammation and multiple aggregates of large cells within the mucosal lamina propria, some with spindle shaped nuclei. Immunohistochemistry stains for keratins AE-1/ AE-3 were negative, while S-100 and NSE were positive. This, together with routine stains, was diagnostic for mucosal ganglioneuromatosis. The background of chronic inflammation with intestinal type metaplasia was consistent with long-term reflux esophagitis. No evidence of achalasia was seen. Biopsies of gastric antrum and fundus were unremarkable, without ganglioneural proliferation. Colonoscopy was unremarkable. No genetic syndromes were identified in the patient including familial adenomatous polyposis and multiple endocrine neoplasia type Ⅱ b （MEN Ⅱ b）. Iansoprazole （Prevacid） was started by oral administration each day with partial relief of symptoms. Subsequent esophagogastroscopy repeated at 4 mo showed normal appearing EG junction. Esophageal manometry revealed a mild nonspecific lower esophageal motility disorder. Mild motor dysfunction is seen with gastro-esophageal reflux disease （GERD） and we feel that the demonstration of localized ganglioneuromatosis was not likely related etiologically. In the absence of findings that might suggest neural hypertrophy, such as achalasia, the nodular mucosal irregularity seen with this instance of ganglioneuromatosis may, however, have exacerbated the patient＇s reflux.
文摘We describe the design, modeling and production of a 3D printed manifold for attaching multiple respiration masks to a single ventilator machine. During a disaster surge this would allow up to four masks to be connected to a single ventilator source. In a disaster which involves high numbers of patients with lung damage, simultaneous respirator support may be required;however, the number of patients may quickly outnumber the available respirator machines. We explore the use of a rapid and low cost 3D printing method referred to as Fused Filament Deposition (FFD) for creation of a four-port ventilator manifold. This 3D printing method deposits layers of melted ABS plastic filament in a fine “stream” onto successive layers in order to form a three dimensional object. The standard file format for this object (manifold attachment) can be made globally available through the internet. It can be “printed” anywhere and anytime it is needed as a three dimensional object at extremely low cost (under two dollars per unit) and since the digital file that represents the object is modifiable, “derivative” versions can be redesigned to suit a broad range of potential applications, especially in areas with limited healthcare resources.
