Opening Of Duct Research Articles

Simpler and safer anastomosis by pancreaticogastrostomy using a linear stapler after pancreaticoduodenectomy.

Postoperative pancreatic fistula (POPF) remains a major and serious problem after pancreaticoduodenectomy (PD). In its presence, pancreatic juice may leak from the main duct or branches of the pancreatic stump. To prevent this, we have applied a newly modified anastomosis of pancreaticogastrostomy (PG) using a linear stapler (stapled PG). Clinical records of 30 consecutive patients who underwent PD were reviewed between 2013 and 2023 at our community hospital. Regarding procedures, 12 stapled PGs and eighteen pancreaticojejunostomies (PJs) were performed after PD, from 2018 to 2023 and from 2013 to 2017, respectively. The pancreas was transected for long compression by a linear stapler, involving: pre-compression for 5 min, stapling for 5 min, and dissection for 5 min. After removal of the staples at the main duct opening of the pancreatic stump, PG anastomosis was performed. The outer layer was anastomosed by a straight single row pancreas-transfixing suture with the posterior gastric wall, and inner layer duct-to-mucosa anastomosis was also performed in a radial axis manner. Anastomosis of PJ was conducted without using a linear stapler. POPF was defined as a clinical manifestation of POPF (grade B/C) based on the ISGPF (International Study Group of Pancreatic Fistula) criteria. None of the 12 patients who had undergone stapled PG developed clinically relevant POPF, whereas 5 (27%) patients who had received PJ developed POPF. Three patients showed POPF grade B and 2 patients exhibited POPF grade C. Stapled PG after PD may reduce clinically relevant POPF. Because our sample size was small, the further accumulation of cases is required to validate this method.

Prevalence, Clinical Characteristics, and Relative Factors of Acquired Punctal Stenosis in Adult Allergic Conjunctivitis Patients

Plain Language SummaryThis study aimed to examine the prevalence of acquired punctal stenosis (APS) among adults with allergic conjunctivitis (AC), describe its characteristics, and identify associated risk factors. We reviewed the medical data of 210 adult patients with AC at Zhongshan Ophthalmic Center. We gathered demographic data and evaluated ocular symptoms. Using slit-lamp microscopy, we assessed and graded the morphology of the lacrimal puncta (lacrimal duct openings) according to a modified grading system. The study results revealed that 69% of the adult patients with AC had APS. Stenotic lacrimal puncta were present in 49.3%, with grade IIa being the most common. The narrowing was most frequently observed in the upper lacrimal puncta compared to the lower ones. Older age and a higher tear meniscus height (TMH) were significantly associated with the presence of APS. Therefore, this study demonstrates that APS is commonly observed in adults with AC, which is associated with the increased age and widened TMH, indicating a possible link between chronic and recurrent AC and the development of APS.

Ectopic Opening of the Common Bile Duct Accompanied by Duodenal Ulcer

Ectopic Opening of the Common Bile Duct Accompanied by Duodenal Ulcer

Characteristics of wave loading and viscous energy loss of a bottom-sitting U-OWC wave energy device: A validated numerical perspective

This study involves numerical simulations of regular waves interacting with a bottom-sitting circular OWC wave energy converter with a U-shaped duct (circular U-OWC). A numerical wave tank is built based on the RANS equation and is validated against experiments. The effect of water depth and the height of the outer tube of the U-shaped duct on capture efficiency, wave loading, and viscous energy loss is investigated numerically. Results show that the height of the outer tube of the U-shaped duct has a significant effect on the capture efficiency of the device. Wave loading analysis reveals a critical mode of stability that may threaten the operation safety of the device. It is found that increasing the height of the U-shaped duct opening increases the viscous energy loss inside the U-shaped duct. A semi-theoretical model between work done by waves to the device and the viscous energy loss in the U-shaped duct is established, numerical data indicates that a significant amount of work done by waves to the device is lost in viscous effects. This suggests that certain optimization for reducing wave loading could possibly also reduce viscous energy loss, thus improving the overall efficiency of the device.

The application of real-time indocyanine green fluorescence cholangiography in laparoscopic living donor left lateral sectionectomy.

The judgment of the division point of the bile duct has always been one of the difficulties of laparoscopic left lateral sectionectomy (LLLS). The purpose of this study was to assess the effects of indocyanine green (ICG) fluorescence cholangiography during LLLS on the occurrence of biliary complications in both donors and recipients. The optimal dose and injection time of ICG were also investigated. This is a retrospective cohort study. From October 2016 to December 2022, the clinical data of 103 donors who underwent LLLS and relevant recipients were retrospectively analyzed. According to whether ICG fluorescence cholangiography was used, they were divided into a non-ICG group (n=46) and an ICG group (n=57). Biliary complications were observed and the optimal dose and injection time of ICG were explored. Three donors in the non-ICG group suffered from bile leakage. Four grafts had multiple bile duct openings and biliary complications were observed in the relevant recipients who received these grafts in the non-ICG group. Two recipients had bile leakage, and the other two had biliary stenosis. There was no biliary complications both in donors and recipients in the ICG group. The fluorescence intensity of the liver was 108.1±17.6 at a dose of 0.004 mg/kg 90 minutes after injection, significantly weaker than that at 0.05 mg/kg 30 minutes (200.3±17.6, P=0.001) and 90 minutes after injection (140.2±15.4, P=0.001). The fluorescence intensity contrast value at a dose of 0.004 mg/kg was stronger than that at 0.05 mg/kg, both measured 90 minutes after injection (0.098±0.032 vs. 0.078±0.022, P=0.021). ICG fluorescence cholangiography is safe and feasible in LLLS. It reduces biliary complications in both donors and recipients. The optimal ICG dose was 0.004 mg/kg, and 90 minutes after injection was the best observation time. ICG fluorescence cholangiography is recommended for routine use in LLLS.

A case with an ectopic ejaculatory duct opening into the bladder trigone in Zinner syndrome, congenital unilateral renal agenesis, and an ipsilateral seminal vesicle cyst

IntroductionThis report describes a case with an ectopic ejaculatory duct opening into the bladder trigone in Zinner syndrome, congenital unilateral renal agenesis, and an ipsilateral seminal vesicle cyst.Case presentationThe patient was identified when no left kidney was detected in the fetal period. Abdominal ultrasonography and pelvic plain MRI at 6 months old revealed a 10‐mm cystic lesion on the dorsal aspect of the bladder. Cysto‐urethroscopy at 1 year old revealed a rather short posterior urethra and right and left inferior crests extending from the posterior urethra beyond the bladder neck. The ejaculatory duct opening was identified on the bladder trigone.ConclusionAnatomical abnormality of the ejaculatory duct may represent a cause of infertility and ejaculatory dysfunction in Zinner syndrome. Endoscopic evaluation should be performed for this rare anomaly, even in children.

An Experimental Study for Air Temperature Distribution in a Conditioned Room Using Various Vertical Locations of Conditioned Air Ducts

The Air distribution phenomenon is most useful in thermal environment study and its effectiveness. The main aim of this investigation is to examine and discover the thermal properties of the inside area and its thermal environment. The experimental work for research was studied at the first-floor lab of the government women’s polytechnic, Bhopal. The experiment was conducted in the summer and winter seasons in a closed-conditioned room with the arrangement of a conditioned air discharge duct. The conditioned air was discharged through the circular pipe duct which was set vertically. The duct has arrangements to discharge the air through various vertical positions as the lower duct (L), middle duct (M), and upper duct (U). This experimental work investigates supply air velocity and vertical temperature variation effectiveness inside said test room. The experiment results were collected with lower, middle, and vertical duct opening conditions respectively. The vertical temperature variation and air velocity at the outlet of the duct were noted with considerable points at 1 m from each inside the test room space. The outcome of the results shows the indoor thermal environment and vertical temperature distribution were affected by the discharge air duct position and supply air velocity. The temperature profile vertically impacted when the measuring test point position was near the discharge air duct and it became quite consistent in respective measurements from a large distance.

Experimental and numerical study on flow mixing and combustion characteristics of a novel multibypass integrated combustor

The integrated design of multibypass augmented/ramjet combustors can reduce the weight of turbine-based combined cycle (TBCC) engines and improve the thrust-to-weight ratio, but low-resistance mixing and efficient stable combustion of multiple airflows over short distances are necessary prerequisites. In this study, a novel structure for a TBCC multibypass integrated augmented/ramjet combustor is proposed. The influence of the inlet aerodynamic parameters on the flow field, mixing efficiency, flow loss, and combustion performance of the combustor under different working modes was obtained via experimental and numerical methods. The experimental results show that the outlet mixing efficiency is greater than 86% in the double-bypass mode (DB-mode). While the triple-bypass mode (TB-mode) has a larger decrease, the total pressure loss is slightly reduced (by approximately 0.5%). The opening of the ram duct has a significant impact on the flow field, resulting in different rules for the influence of the inlet temperature on the outlet mixing efficiency: in the DB-mode, the mixing efficiency decreases with increasing inlet temperature, while the rule is completely opposite after entering the TB-mode. Because the dominant role of the two mixing zones in the flow field changes with the velocity, the inlet velocity has a significant impact on the mixing efficiency in the flow direction. The combustion simulation results show that the combustion efficiency in the DB-mode is almost always above 90% and the high-temperature zone is mainly concentrated downstream of the integrated strut. The radial temperature gradient increases and the combustion efficiency decreases in the TB-mode.

Ectopic bile duct concomitant with gastric ulcer hemorrhage: report of a case

BackgroundAn ectopic bile duct opening into the stomach is a rare congenital anomaly of the biliary system, and thus, there are few case reports with gastric ulcer hemorrhage. Herein, we presented a case of ectopic bile duct concomitant with gastric ulcer hemorrhage.Case presentationA 75-year-old woman was referred to our hospital because she repeatedly vomited blood and had melena. Endoscopic hemostasis was attempted for hemorrhage from a gastric ulcer located on the anterior wall of the antrum. However, the bleeding was difficult to stop, and a laparoscopic distal gastrectomy was performed. Her postoperative course was uneventful. Pathological examination revealed that the bleeding point was an ectopic bile duct. In retrospect, an annual endoscopy performed at her family clinic had revealed a bulge in the same portion of the stomach. Exposure to bile acids from an ectopic bile duct opening can cause gastric mucosal damage and ulceration.ConclusionsEctopic bile ducts opening into the stomach can cause gastric ulcer and hemorrhage. Hemorrhage from a submucosal ridge with ulcer in the stomach may be rarely related to the presence of ectopic bile ducts.

Criteria for selecting living liver donors to optimize recipient outcomes in pure laparoscopic donor right hepatectomy: a cohort study.

Although the adoption of pure laparoscopic donor hepatectomy has expanded driven by considerations of donor cosmesis and function, the criteria for selecting candidates for pure laparoscopic donor right hepatectomy (PLDRH) continue to be debated. This study aimed to delineate the distinctive characteristics of donors and recipients who underwent conventional open-donor right hepatectomy (CDRH) during the era of PLDRH. We conducted a retrospective review of a prospectively collected single-center database encompassing all right hepatectomies at OOOO from April 2016 to December 2021, a period during which there were no absolute contraindications for PLDRH. During the exclusive PLDRH period, there were still 63 cases of CDRH alongside 362 cases of PLDRH. The CDRH donors were older, had a lower estimated remnant liver volume, and a higher incidence of expected multiple openings in the portal vein and bile duct based on preoperative imaging compared with PLDRH donors. In the subgroup analysis, including only donors meeting two or more criteria (age ≥40y, estimated remnant liver volume ≥35%, or multiple anticipated vessel openings), recipients in the PLDRH group exhibited significantly more early major complications (P=0.029) compared with those in the CDRH group. As PLDRH gains traction in practice, it is essential to acknowledge that specific donor conditions, such as advanced age, limited remnant liver volume, and anticipation of multiple portal or bile duct openings, may merit contemplating CDRH as a means of optimizing recipient outcomes.

A rare cause of recurrent acute pancreatitis: ectopic opening of the pancreatic duct (with videos)

A rare cause of recurrent acute pancreatitis: ectopic opening of the pancreatic duct (with videos)

Treatment of Ejaculatory Duct Obstruction by Seminal Vesiculoscopy Assisted Flow Modification.

Transurethral resection of ejaculatory duct (TURED) is a primary surgical approach to treat ejaculatory duct obstruction (EDO) caused by the ejaculatory duct cyst. Intraoperative excision of the verumontanum is usually required to expose the ejaculatory ducts. However, preserving the verumontanum structure allows for a better simulation of normal physiological anatomy. Maintaining the verumontanum may increase the risk of postoperative distal ejaculatory duct scarring, leading to recurrent obstruction or reduced semen volume. Therefore, we attempted a novel technique that preserves the verumontanum, which is relatively easier and safer compared to TURED. The following were the procedural steps: 1. A 6F seminal vesiculoscope was introduced through the external urethral orifice to the vicinity of the verumontanum, locating the opening of the affected-side ejaculatory duct and introducing a guidewire into the cyst. This successful step preserved the verumontanum, maximizing the retention of the anti-reflux mechanism in the distal ejaculatory duct. 2. The holmium laser enlarged the affected-side ejaculatory duct opening to 5 mm, decreasing the likelihood of postoperative closure of the ejaculatory duct opening and simplifying the procedure. 3. A window was created within the cyst to access the contralateral seminal vesicle, and then a holmium laser was used to burn and dilate the opening to 5 mm, redirecting the contralateral ejaculatory duct into the cystic cavity. This modification preserved the opening of the healthy-side ejaculatory duct and provided a new outflow passage for semen, reducing the risk of decreased semen volume postoperatively. The patients experienced no complications postoperatively, had shorter hospital stays, and showed improvement in semen volume. Hence, this surgical approach is simple yet effective.

Assessment of Salivary Glands as Reservoirs of SARS-CoV-2 and the Contagiousness of Saliva in Asymptomatic COVID-19 Patients: Is Delta Variant More Contagious?

Background: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection transmits when aerosols or droplets containing the virus are inhaled or come directly into contact, mainly in close contact with an infected person. Objectives: This study aimed to evaluate the role of the salivary glands in the secretion of SARS-CoV-2-infected saliva and determine the contagiousness of saliva in asymptomatic coronavirus disease 2019 (COVID-19) patients. Methods: In this cross-sectional analytical study between March 2021 and March 2022, 85 asymptomatic COVID-19 individuals with positive nasopharyngeal/oropharyngeal swabs were recruited. The SARS-CoV-2 cycle threshold (Ct) value was investigated in concomitant nasopharyngeal swabs (NPS), saliva, and pure saliva (collected directly from the salivary duct opening) using Real Time-PCR assay. Statistical analysis was performed using SPSS software (version 23), and a p-value of < 0.05 was considered significant. Results: The saliva Ct-value was the lowest (the highest viral load) for Delta (29.82 ± 4.66), Omicron (32.75 ± 4.82), and Alpha (36.83 ± 4.8) variants, respectively. Delta-infected saliva and pure saliva revealed the strongest correlation (correlation coefficient = 0.971, P < 0.001). Saliva Ct-value was significantly lower in Delta- (P < 0.001) and Omicron- (P = 0.012) infected patients than in Alpha-infected patients. The pure saliva Ct-value was significantly lower (P = 0.014) in Delta samples (30.13 ± 4.51). Asymptomatic Alpha- and Omicron-infected patients revealed significantly lower NPS Ct-value (30.52 ± 4.02 and 29.44 ± 3.34) than the saliva (36.83 ± 4.8 and 32.75 ± 4.82). Conclusions: The major salivary glands secrete SARS-CoV-2-infected saliva in nearly all Delta-infected and most Omicron-infected asymptomatic individuals. Although the transmission process is complex, saliva droplets and aerosols seem to have a higher contagiousness potential in individuals infected with the Delta variant.

Research on a new method of “blocking-sealing” dust control and removal in fully mechanized heading face

The fully mechanized heading face has the disadvantages of a large open space, difficult to seal, and low dust reduction efficiency. To overcome these issues, a new “blocking-sealing” method for cutting the produced dust was proposed in this study. The impact mechanism of ventilation parameters on dust pollution was analyzed using the CFD-DPM method. The results show that in the original state, the transverse offset airflow generated by the roller of the heading machine carries high-concentration dust into the sidewalk space, the length of the high-concentration dust area of more than 570 mg/m3 in the sidewalk space is about 16 m. After using the new method, the distribution of airflow mechanical energy between the sidewalk space and the bracket-coal wall space was redistributed. When the air suction volume was 600 m3/min, the high-concentration dust area basically disappeared. By increasing the air volume ratio to 1:1.5, the dust concentration in the original high-concentration dust area of the sidewalk space was basically lower than 172 mg/m3. When the side opening of the dust exhaust duct for suction (SO), the dust removal efficiency in the local area of the sidewalk reached 80.7%, which provides a new method for clean coal production.

Ectopic Opening of Common Bile Duct to Duodenal Bulb: A Single Tertiary Center Experience.

The ectopic opening of the common bile duct(CBD) into the duodenal bulb is a rare biliary anomaly. The study aimed to reveal the experience with clinical and endoscopic outcomes in these patients. This study was conducted on 57 consecutive patients who underwent endoscopic retrograde cholangiopancreatography (ERCP) for ectopic opening of the CBD into the duodenal bulb at our institution between 2010 and 2020. The median age was 59 years (49 males). A total of 146 ERCP procedures were performed (once in 26 patients and 2 or more times in 31 patients). Ten patients had a history of unsuccessful ERCP in an external center. The median follow-up time was 14.6 months. All patients had a slit-like opening of the CBD into the duodenal bulb, apical stenosis, and hook-shaped distal CBD. ERCP findings were CBD stone or dilatation in 55 patients and post-cholecystectomy biliary leakage in 2 patients. Balloon dilatation was performed for apical stenosis in 7 patients and distal CBD stenosis in 26 patients. During the first ERCP session, biliary stent/nasobiliary drainage was placed in 37 patients, and CBD stones were extracted in 19 patients without stenting. Biliodigestive anastomosis was applied to 13 patients, 5 of whom had recurrent cholangitis, 7 required recurrent ERCP, and one was due to the technical difficulty of ERCP. Ectopic biliary opening should be remembered if the papilla cannot be seen in its usual place in a patient with apical stenosis. ERCP should be performed in experienced hands, and surgery should be considered in the need for recurrent ERCP.

Methodology to measure the energy flux captured by a submerged U-OWC by using temperature sensors

The estimation of the power captured by a wave energy converters (WEC) device, needs to calculate the plant efficiency. In general, it is necessary to measure both the pressure and the discharge fluctuations of the fluid motion inside the plant. Unfortunately, gauges for the direct measurement of the velocity are bulky and provide punctual measures and, especially on converters having a U-duct, the presence of the velocity sensor produces a relevant disturbance on the motion field. To overcome this issue, an alternative method to evaluate the captured energy flux, using the pressure fluctuation and the air temperature inside the plenum, was proposed by [1] and [2]. However, no information about the accuracy of the temperature sensors and consequently about the errors in estimation of the energy flux were provided.
 In this work, following the procedure described by [1] and [2], we have analysed the influence of the time response of the temperature sensor in evaluating the variation of the air volume inside the chamber and, consequently the energy captured by the plant. To this aim, the submerged U-OWC, tested directly at sea in [1], has been simulated numerically. The aim of the numerical experiment is having the actual estimation of the air temperature inside the plenum and trough it, the captured energy flux. The computational domain is constituted by a wave-flume, with a piston-type wavemaker, placed at the left extremity and a submerged breakwater embedded a U-OWC plant, in the middle. The numerical 2D unsteady simulation is based on the Eulerian approach, using the commercial code Ansys Fluent v17.0, Academic Version.
 Starting from the knowledge of the pressure fluctuation at the upper opening of the vertical duct and, of both pressure and temperature variations of the air in the plenum, we have evaluated the energy flux absorbed by the plant and we have calibrated the mathematical model used in [1] and [2], using as input the time series of the pressure fluctuations at the upper opening of the vertical duct, and the variation of both temperature and pressure of the air inside the chamber. Then, using the time series of the actual air temperature, we have simulated the input of several first order temperature sensors characterized by different time constant t, and we have analysed the percentage differences in term of energy flux as a function of t.
 We have observed that the measurements of the temperature inside the plenum are strongly affected by time constant of the sensor, which produce large errors in the evaluation of the captured energy flux.
 Finally, we have proposed a method for conditioning the measure of the air temperature, obtaining an excellent estimation of the energy flux.
 
 Boccotti, P. (2003) "On a new wave energy absorber"Ocean Engineering 30(9), pp. 1191-1200.
 Arena, F., Filianoti, P. (2007),"Small-scale field experiment on a submerged breakwater for absorbing wave energy", Journal of Waterway, Port, Coastal and Ocean Engineering, 2007, 133(2), pp. 161–167.

Multiple Graft Bile Ducts Do Not Affect the Postoperative Outcomes of Right Lobe Living Donor Liver Transplantation

Multiple graft duct openings are associated with a high incidence of biliary complications (BCs), and biliary reconstruction for multiple graft bile ducts (BDs) remains a surgical challenge during living donor liver transplantation (LDLT). In particular, biliary reconstruction using "high biliary radicals (HBR)" of recipients for multiple graft BDs has a high probability of BCs. Herein, we analyzed outcomes by retrospectively reviewing 283 patients who underwent right lobe LDLT from January 2013 to September 2019. In total, 112 LDLT procedures using grafts with multiple BDs have been performed under our policies. In recent cases with 2 orifices located on the same hilar plate, we did dunking with a mucosal eversion technique instead of ductoplasty. When 2 orifices are located far apart on different hilar plates, we attempted to perform separate duct-to-duct anastomosis (DDA) using HBR of the recipient instead of hepaticojejunostomy. Among patients with multiple graft BDs, 20 underwent ductoplasty, 50 were treated using dunking with mucosal eversion technique, and 40 underwent separate DDA using HBR (HBR group). The incidence rates of biliary leakage and stricture were 8.9% and 10.7% in the multiple BD group, respectively, congruent with the outcomes of the single BD group. In subgroup analysis, we compared clinical outcomes between the HBR and single BD groups; the incidence of BCs in the HBR group was 15.0%, comparable to that of the single BD group. In conclusion, multiple graft BDs do not negatively impact the BC rate compared with single-graft BD when applying our technique to prevent BCs.

Clinicopathological Profile of Ampulla of Vater and Pancreas Malignancies at Cipto Mangunkusumo Hospital in 2015-2019

Background
 Malignancies of ampulla of vater and pancreas are often difficult to distinguish. Malignancies in ampulla of vater include malignancies in major duodenal papilla, distal common bile duct and pancreatic duct opening (Wirsung). The origin of the primary tumor, histopathological diagnosis and staging play a role in therapy and prognosis. WHO Classification of tumors of the digestive system, 2019 made changes in tumor staging following the system of the American Joint Committee on Cancer (AJCC), 8th edition. This study was conducted to determine types of pancreatic and ampullary malignancies, demographic distribution, location, profile, histomorphology and tumor staging changes in the 7th edition of the AJCC to 8th edition of the AJCC in the WHO Classification of tumors of the digestive system, 2019. The aim to determine clinicopathological profile of malignancies of ampulla of vater and pancreas as well as tumor staging changes based on AJCC edition 8.
 Methods
 Observational descriptive study on pancreatic and ampulla vater malignancy resection preparations at Department of Anatomic Pathology FKUI/RSCM, period January 2015 to December 2019 that met the inclusion criteria. Demographic evaluation, tumor location, histopathological profile and patient staging changes were carried out based on the 8th edition of AJCC.
 Results
 There were 27 cases of adenocarcinoma in ampulla of vater, 10 cases of pancreatic ductal adenocarcinoma, 1 case of mucinous cystic neoplasm with adenocarcinoma focus, 1 case of serous cystadenocarcinoma, 7 cases of PanNET, 2 cases of PanNEC, 3 cases of SPN, 1 case of MiNEN. Changes in pT were present in 29 cases. Changes in pN were present in 6 cases.
 Conclusion
 The diagnosis and pathological staging are in accordance with the 2019 WHO digestive system tumor classification. Tumor differentiation, presence or absence of lymphovascular invasion, perineural invasion and lymph node metastases and incision margin status are important histopathological parameters.

Pancreaticoduodenectomy for severe duodenal stenosis and biliary-duodenal fistula induced by groove pancreatitis due to repetitive duodenal ulcers: A pediatric case report

Groove pancreatitis (GP), an uncommon form of recurrent or chronic focal pancreatitis, is exceedingly rare in children. This report describes a case of pancreaticoduodenectomy performed for severe duodenal stenosis and biliary-duodenal fistula induced by GP in a child. A 14-year-old boy presented to a gastroenterologist due to repeated abdominal pain for 5 years. Esophagogastroduodenoscopy, computed tomography, and magnetic resonance cholangiopancreatography suggested a duodenal ulcer that was possibly associated with GP. The patient was referred to our hospital for further examination. Endoscopic retrograde cholangiopancreatography revealed stenosis of the main pancreatic duct and ectopic opening of the common bile duct into the duodenum (biliary-duodenal fistula). An internal pancreatic stent was placed via the papilla of Vater to treat obstructive pancreatitis, while an internal biliary stent was placed through the fistula to prevent cholangitis. Replacement of the pancreatic stent was deemed impossible due to exacerbation of the duodenal stenosis. Considering the limitations of repeated endoscopic treatment, radical surgical intervention and subtotal stomach-preserving pancreaticoduodenectomy were performed. Relapse of previous abdominal symptoms and surgery-associated long-term complications did not occur postoperatively. In pediatric GP cases without any contributing factors of chronic pancreatitis, such as pancreas divisum, GP is often attributable to repetitive duodenal ulcers.

Analytical investigation and experimental validation of anchorage zone to improve bursting force equation for post-tensioned concrete members

The anchorage zone is a critical component of post-tensioned concrete members, and its effect on transverse tensile stress and bursting force is of utmost importance. In the study undertaken, analytical investigation and experimental validation of the anchorage zone has been carried out in order to improve the bursting force equation presented in IS 1343 for post-tensioned concrete members. To determine the relative contribution of anchorage ratio (k), pre-stressing force, and duct opening in the modeling of the plate on bursting tensile stress and bursting force, 3D Finite Element Analysis (FEA) was conducted. The results indicate that the equation recommended by IS 1343 underestimates the bursting force. To address this, an updated design equation is proposed in the same form as presented by IS 1343.