Esophageal achalasia referred to as achalasia, is a failure of smooth muscle fibers to relax, which can cause the lower esophageal sphincter to remain closed. Without a modifier, "achalasia" refers to achalasia of the esophagus. Achalasia can happen at various points along the gastrointestinal tract. Esophageal achalasia is an esophageal motility disorder involving the smooth muscle layer of the esophagus and the lower esophageal sphincter, it is characterized by incomplete LES relaxation, increased LES tone, lack of peristalsis of the esophagus in the absence of other explanations like cancer or fibrosis. Achalasia is characterized by difficulty in swallowing and sometimes chest pain. Diagnosis is reached with esophageal barium swallow radiographic studies. Various treatments are although none cures the condition. Certain medications or Botox may be used in some cases, but more permanent relief is brought by esophageal dilatation and surgical cleaving of the muscle; the most common form is primary achalasia.
It is due to the failure of distal esophageal inhibitory neurons. However, a small proportion occurs secondary to other conditions, such as esophageal cancer, Chagas disease or Triple-A syndrome. Achalasia affects about one person in 100,000 per year. There is no gender predominance for the occurrence of disease; the term is from a- + -chalasia "no relaxation." Achalasia can manifest alongside other diseases as a rare syndrome such as achalasia microcephaly. The main symptoms of achalasia are dysphagia, regurgitation of undigested food, chest pain behind the sternum, weight loss. Dysphagia tends to involve both fluids and solids; some people may experience coughing when lying in a horizontal position. The chest pain experienced known as cardiospasm and non-cardiac chest pain can be mistaken for a heart attack, it can be painful in some sufferers. Food and liquid, including saliva, may be inhaled into the lungs; the cause of most cases of achalasia is unknown. LES pressure and relaxation are regulated by inhibitory neurotransmitters.
People with achalasia lack noradrenergic, inhibitory ganglion cells, causing an imbalance in excitatory and inhibitory neurotransmission. The result is a hypertensive nonrelaxed esophageal sphincter. Autopsy and myotomy specimens have, on histological examination, shown an inflammatory response consisting of CD3/CD8-positive cytotoxic T lymphocytes, variable numbers of eosinophils and mast cells, loss of ganglion cells, neurofibrosis. Thus, it seems there is an autoimmune context to achalasia, most caused by viral triggers. Other studies suggest hereditary, neurodegenerative and infective contributions. Due to the similarity of symptoms, achalasia can be mistaken for more common disorders such as gastroesophageal reflux disease, hiatus hernia, psychosomatic disorders. Specific tests for achalasia are barium esophageal manometry. In addition, endoscopy of the esophagus and duodenum, with or without endoscopic ultrasound, is performed to rule out the possibility of cancer; the internal tissue of the esophagus appears normal in endoscopy, although a "pop" may be observed as the scope is passed through the non-relaxing lower esophageal sphincter with some difficulty, food debris may be found above the LES.
The patient swallows a barium solution, with continuous fluoroscopy to observe the flow of the fluid through the esophagus. Normal peristaltic movement of the esophagus is not seen. There is acute tapering at the lower esophageal sphincter and narrowing at the gastro-esophageal junction, producing a "bird's beak" or "rat's tail" appearance; the esophagus above the narrowing is dilated to varying degrees as the esophagus is stretched over time. An air-fluid margin is seen over the barium column due to the lack of peristalsis. A five-minutes timed barium swallow can provide a useful benchmark to measure the effectiveness of treatment; because of its sensitivity, manometry is considered the key test for establishing the diagnosis. A catheter is inserted through the nose, the patient is instructed to swallow several times; the probe measures muscle contractions in different parts of the esophagus during the act of swallowing. Manometry reveals failure of the LES to relax with swallowing and lack of functional peristalsis in the smooth muscle esophagus.
Characteristic manometric findings are: Lower esophageal sphincter fails to relax upon wet swallow Pressure of LES <26 mm Hg is normal,>100 is considered achalasia, > 200 is nutcracker achalasia. Aperistalsis in esophageal body Relative increase in intra-esophageal pressure as compared with intra-gastric pressure Biopsy, the removal of a tissue sample during endoscopy, is not necessary in achalasia but if performed shows hypertrophied musculature and absence of certain nerve cells of the myenteric plexus, a network of nerve fibers that controls esophageal peristalsis, it is not possible to diagnose achalasia by means of biopsy alone. Sublingual nifedipine improves outcomes in 75% of people with mild or moderate disease, it was classica
So Outta Reach is an EP by American indie rock musician Kurt Vile, released on November 8, 2011 on Matador Records. Produced by both John Agnello and Kurt Vile & the Violators, the EP's tracks were recorded during sessions for Smoke Ring for My Halo and reworked in the summer of 2011. Upon release, So Outta Reach peaked at 28 on the US Billboard Heatseekers Album Chart; the EP was subsequently included on the deluxe version of Smoke Ring for My Halo. Regarding the songs included on So Outta Reach, Kurt Vile stated: "There are a lot of songs on there that I wanted to fit on, like "The Creature." I wanted to get that one on the record." The EP's cover art features a collage of photographs featuring Vile asleep at a party. Regarding the cover, Vile noted, "I went to a party with my wife, her friend Greg Chow—he's the Asian guy giving the devil horns—took the pictures. I drank too much tequila early on in the party, he took all these photos and posted them online. Truthfully, I was embarrassed by them at first because I'm self-conscious, but my manager found them and was like,'That's your cover.'
I just laughed. And he sent it to Matador, they loved it." All tracks written by Kurt Vile except. "The Creature" "It's Alright" "Life's a Beach" "Laughing Stock" "Downbound Train" "" Kurt Vile – vocals, banjo, optigan Adam Granduciel – guitar, sweet tones Jesse Trbovich – guitar, synth Mike Zanghi – drums, percussion Steve Shelley – drums Mike Polizze – bass Rob Laakso – bass John Agnello – producer Kurt Vile & the Violators – producers Greg Calbi – mastering Greg Chow – front cover photos and concept Shawn Brackbill – back cover photo Matt De Jong – design
Not to be confused with Mike Hank's 1960s Detroit, Michigan soul music D-Town label. Eieg/D-Town Music Group called DMG is an American independent record label established in 2004 and distributed through Universal Music Group Distribution and based out of Dallas, TX; the CEO Nate Edwards, a native of Cincinnati, OH, met with Funk legend Bootsy Collins, CEO Of Bootzilla Productions, in Cincinnati, OH, at the tribute concert to Bootsy's mentor, James Brown, on Saturday December 22, 2007, at which time a business relationship was formed. As of September, 2009, Eieg/D-Town Music Group has forged an exclusive U. S. and Worldwide distribution agreement with Bungalo Records and Universal Music Group Distribution. Bungalo Records and Universal Music Group Distribution will pursue synchronization and licensing deals for Eieg/D-Town Music Group releases, their hit song from The Deele "Two Occasions" was referenced by Mariah Carey in her 2005 megahit song "We Belong Together," rapper The Game on the song "One Night" in 2006, Plies 2009 hit song, "Want It, Need It" featuring Ashanti.
MF Doom samples the track "Shootem Up Movies" in his 1999 opus "Red & Gold." Eieg/D-Town Music Group has locations in Dallas, TX, Cincinnati, OH, Atlanta, GA, Tokyo, Japan. Industry: music and entertainment Products: music and entertainment Key people: Nathaniel G. Edwards:, Steven Franklin, Darryl Ethley Anthony Paul Distributing label: Bungalo and Universal Music Group Distribution DMG companies: D-Town Music Group Inc. aka EIEG Publishing EIEG, LLC DBA D-Town Records Nate"E" Entertainment Group D-town Record is allied with Cintrton Beverage company, Curtis James Jackson III and Marian Records. 3riple Threat Seven Second Chase from Ontario, Canada The Gang of Roses from Atlanta, Georgia Gerald Brown The Deele Keingz Ransom List of record labels Block Ent. Bad Boy South Chris Lighty Background Official website Official Myspace Bootzilla Productions
Heroes Die is a science fantasy novel by American writer Matthew Stover, the first of a series of novels featuring the protagonist Caine. The novels are set in a future dystopia Earth where a parallel world called Overworld reminiscent of the worlds featured in post-Tolkien secondary world fantasy has been discovered; the corporations that run Earth send actors into Overworld in order to provide the masses of an overcrowded world with virtual-reality entertainment. Hari Michaelson is a famous son of a now-mentally ill libertarian professor. On Overworld, he is the assassin Caine, while his estranged wife Shanna is another Actor playing the mage Pallas Ril. In this world Actors are people who travel to Overworld through advanced technology and assume an alternate persona which they use to carry out'adventures'. Pallas is captured by Ma'elKoth, the Emperor of Overworld's human kingdom of Ankhana on one of her adventures. Ma'elKoth's plan to rule Ankhana by wiping out a final resistance group, is blocked by a spell that causes others to forget the existence of the resistance group's members.
The remainder of the book plays out the conflict between Ma'elKoth and the resistance. Hari finds himself manipulated by both the powers on Overworld and the Studio on Earth, must defeat them both in order to save himself and Pallas Ril from death. Heroes Die contains moral questions the author does not believe arise in fantasy. In a 1999 interview regarding the novel, Stover describes it as follows: "It's a piece of violent entertainment that's a meditation on violent entertainment- as a concept in itself, as a cultural obsession. It's a love story: romantic love, paternal love, repressed homoerotic love, love of money, of power, of country, love betrayed and employed as both carrot and stick. It's about all different kinds of heroes and all the different ways they die." Earth is oppressed, with a caste-based dystopian government. The violence within the Acts of Caine is portrayed in graphic detail because, what the viewers on Earth are seeking. Michaelson, in the character of Caine, exhibits willingness to sacrifice the citizens of Ankhana and his friend Majesty in order to save his wife.
Hari's father is a former libertarian academic who provides a counterpoint to the violence and despair of Earth. As with its sequel, Heroes Die utilizes multiple point of view. However, for the scenes from Hari's perspective when he is on Overworld as Caine, the sections are portrayed from a first-person viewpoint and are meant to be Caine's interior soliloquies he runs for the benefit of the audiences on Earth; these segments tend to be more in plain speech, more peppered with profanity, shorter paragraphs, tangents that follow Caine's train of thought. Caine mentions the book The Moon is a Harsh Mistress as the source of Pallas Rill's pseudonym, Simon Jester. Excerpt
Fort George was the name of five forts in what is now the state of New York. The first Fort George was built in 1626 in the Dutch colony of New Amsterdam and named Fort Amsterdam; the British Army renamed it Fort James in 1664. It was re-occupied by the Dutch from 1673 to 1674 as Fort Willem Hendrick; the British named the fort Fort William Henry in 1691, Fort Anne or Queen's Fort in 1703, Fort George in 1714. The north side bastions and ramparts were destroyed in the American Revolutionary War in 1776 by the Americans, demolished in 1790; the site is now the location of the Alexander Hamilton U. S. Custom House in Lower Manhattan. A second Fort George was built by the British in 1755 at Oswego, New York, but it was destroyed by the French commander Louis-Joseph de Montcalm in 1756; the site is now Montcalm Park, bordered by West Schulyer Street, Montcalm Street and West 6th Street. A third Fort George was built in Lake George, New York, in 1755, it was destroyed in 1777 and abandoned in 1780. It was located south east of Fort William Henry facing Lake George, in the wooded area within Lake George Battlefield Park).
A fourth Fort George was an encampment built on Staten Island around 1777 in the area of St. George, Staten Island Fort Hill; the last Fort George was built in 1776 in New York City on Fort George Hill, near the current intersection of Audubon Avenue and West 192nd Street in Upper Manhattan. Named Fort Clinton and Fort George, from 1895 to 1914 it was the site of the Fort George Amusement Park, is now the location of George Washington Educational Campus and part of Highbridge Park. Fort George Hill is the name of a present-day street in the area; the neighborhood surrounding the hill is called Fort George, is considered a sub-neighborhood of Washington Heights. It is agreed to run from West 181st Street to Dyckman Street east of Broadway to the Harlem River
Pethapur State was a small princely state belonging to the Mahi Kantha Agency of the Bombay Presidency during the era of the British Raj. It was centered on Pethapur village, in present-day Gandhinagar district of Gujarat State, a place renowned for block-making. In the 13th century, King Pethasinh of Pethapur ruled over Shertha town. After the death of parmar Pethasinh, the Gujarat Sultanate of Patan used this land as battle ground. Sultan Ahmed Shah decided to move his capital from Patan to a new city, built Ahmedabad. In 1960, Bombay state was split in two different states and Maharashtra. Ahmedabad became capital of Gujarat, a new capital city was to be built on land, once part of Pethapur state; the state was ruled by the Baghela dynasty of Rajputs. Rawal Virajmal, son of Rao Kiratsinghji of Idar State, was succeeded on 12 April 1882 by his son Rawal Dipsinhji Sheosinhji, born in 1863. On 1 February 1940 Pethapur State became the first petty princely state to be subject to the Attachment Scheme, being integrated with Baroda State.
The last ruler was Fateh Singh, born 3 October 1895 who nominally ruled till Indian independence while the process for joining India was active. Baroda State acceded to the Indian Union on 1 May 1949; the rulers of Pethapur State bore the title Thakur. C. 1650 –.... Punj Singh c. 1700 –.... Ranchhod Singh 1700 – 1800 after 1800–.... Ade Singh.... – 1861 Bhawan Singh 1861 – 1879 Himat Singh 1879 – 1896 Gambhir Singh 1896 – 1948 Shri Fateh Singh List of Rajput dynasties and states Baroda and Gujarat States Agency Political integration of India