Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal...Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal pain and dyspepsia to acute intestinal obstruction. We report a case of hepato-diaphragmatic migration of the hepatic flexure of the colon associated to an unusual, heretofore unreported, angina-like pain exclusively evoked by the left lateral decubitus. To maximize the chance of observing anatomical changes in different postures, computed tomography of the chest and abdomen was performed after air insufflation into the colon. While frank herniation into the chest was excluded, the scan showed that the hepatic flexure-with the interposition of the diaphragm-came in contact with the right side of the heart in the left lateral, but not in the supine, decubitus. This finding was reproduced by echocardiography which also showed virtually unaltered hemodynamics after the change of posture. ECG, left and right ventricular global and regional function as well as cardiac injury markers also remained unchanged during the maneuver, indicating that the pain evoked by the latter was unlikely due to myocardial ischemia. This case suggests that Chilaiditi's syndrome should be included among the possible, although rare,causes of unexplained angina-like symptoms.展开更多
Using physical model and numerical simulation techniques, some technical problems were studied systemati- cally, including layout of power station, measures of sediment and floating debris discharging, types of intake...Using physical model and numerical simulation techniques, some technical problems were studied systemati- cally, including layout of power station, measures of sediment and floating debris discharging, types of intake, embed- ded types of spiral ease, layout of underground powerhouse tunnel group and block reinforcement. It was optimal in technique and economy with the arrangement of powerhouse at the dam-toe of both banks ＋ underground powerhouse in the right bank, as well as the intake with a single and small orifice. The sediment and debris problems could be solved with disperse sediment ejection and floating debris discharging holes. With the adoption of techniques for spiral cases such as heat and pressure preservation, cushion layer and combined embedding, the stable operation of generating units can be guaranteed. The arrangement of tailrace tunnel with sloping ceiling was better than that of tailrace surge tank. The technical requirements related to the embedding type of spiral case were proposed. The reinforcement of huge unfavorable blocks was discussed and the new idea for block reinforcement using anti-sliding piles and normal compressive stress of structural plane was put forward.展开更多
文摘Symptomatic hepato-diaphragmatic interposition of a bowel loop or Chilaiditi's syndrome is a peculiar anatomical condition most often found by chance. Its described symptoms range from intermittent, mild abdominal pain and dyspepsia to acute intestinal obstruction. We report a case of hepato-diaphragmatic migration of the hepatic flexure of the colon associated to an unusual, heretofore unreported, angina-like pain exclusively evoked by the left lateral decubitus. To maximize the chance of observing anatomical changes in different postures, computed tomography of the chest and abdomen was performed after air insufflation into the colon. While frank herniation into the chest was excluded, the scan showed that the hepatic flexure-with the interposition of the diaphragm-came in contact with the right side of the heart in the left lateral, but not in the supine, decubitus. This finding was reproduced by echocardiography which also showed virtually unaltered hemodynamics after the change of posture. ECG, left and right ventricular global and regional function as well as cardiac injury markers also remained unchanged during the maneuver, indicating that the pain evoked by the latter was unlikely due to myocardial ischemia. This case suggests that Chilaiditi's syndrome should be included among the possible, although rare,causes of unexplained angina-like symptoms.
文摘Using physical model and numerical simulation techniques, some technical problems were studied systemati- cally, including layout of power station, measures of sediment and floating debris discharging, types of intake, embed- ded types of spiral ease, layout of underground powerhouse tunnel group and block reinforcement. It was optimal in technique and economy with the arrangement of powerhouse at the dam-toe of both banks ＋ underground powerhouse in the right bank, as well as the intake with a single and small orifice. The sediment and debris problems could be solved with disperse sediment ejection and floating debris discharging holes. With the adoption of techniques for spiral cases such as heat and pressure preservation, cushion layer and combined embedding, the stable operation of generating units can be guaranteed. The arrangement of tailrace tunnel with sloping ceiling was better than that of tailrace surge tank. The technical requirements related to the embedding type of spiral case were proposed. The reinforcement of huge unfavorable blocks was discussed and the new idea for block reinforcement using anti-sliding piles and normal compressive stress of structural plane was put forward.
