Präoperative Koloskopie vor Magenhochzug

ZusammenfassungEinleitung Die operative Standardtherapie des Ösophaguskarzinoms ist die Ösophagektomie und Rekonstruktion durch Magenhochzug. Im Rahmen der präoperativen Abklärung wird zum Ausschluss von pathologischen Befunden des Kolons endoskopiert, falls ein intraoperatives Umsteigen von Magen- zur Koloninterposition notwendig wird.Patienten und Methodik Bei 228 Patienten erfolgte die Ösophagektomie wegen eines Ösophaguskarzinoms. 219 Patienten erhielten eine Mageninterposition, während 9 Patienten primär durch ein Koloninterponat rekonstruiert wurden. 171 von 228 (75%) Patienten wurden präoperativ koloskopiert.Ergebnisse Bei keinem der Patienten mit geplantem Magenhochzug war ein intraoperatives Umsteigen auf eine Koloninterposition notwendig. Insgesamt wurden koloskopisch 2 pT1-Adenokarzinome entfernt und 62 Adenome abgetragen. Eine asymptomatische Divertikulose fand sich bei 53 Patienten (31%). Untersuchungsbedingte Komplikationen nach Koloskopie wurden nicht beobachtet.Schlussfolgerung Die präoperative Koloskopie vor geplantem Magenhochzug ist aus operationstechnischen Gründen nicht zwingend erforderlich, da ein intraoperatives Umsteigen auf eine Koloninterposition sehr selten notwendig ist. Die Rate von Adenomen oder Karzinomen des Kolons ist weder bei Patienten mit Adeno- noch mit Plattenepithelkarzinom des Ösophagus höher als in einem gleichaltrigem Normalkollektiv.     

ROENTGENOGRAPHIC CRANIAL-BASE AND CALVARIAL MEASUREMENTS OF JAMAICAN CHILDREN BETWEEN ONE MONTH AND FIVE YEARS

Three-hundred-and-thirty lateral skull-films obtained from apparently healthy normocephalic Jamaican children between the age of one month and five years were studied, using bony reference points nasion (N), tuberculum sellae (Ts), internal occipital prominence (IOP), inion (I), bregma (B) and lambda (L). Cranial-base length was measured between N-Ts, Ts-IOP and N-I. Calvarial height was measured between Ts-B (anterior calvarium) and Ts-L (posterior calvarium). All the measurements showed an increase with age and were higher in boys. Significant correlations were seen between N-Ts and Ts-IOP, N-Ts and N-I, N-Ts and Ts-B, N-Ts and Ts-L and N-I and Ts-L at all the ages and in both sexes. Ratios between lengths of anterior and posterior cranial-base, as well as between cranial-base lengths and anterior cranial heights, were nearly constant at all the ages and in both sexes. These observations support the view that there is definite proportionality between the growth of anterior and posterior cranial-base lengths, and between anterior calvarial height and cranial-base lengths. On the other hand, a significant increase with age was seen in the ratios N-Ts/Ts-L, N-I/Ts/L and Ts/B/Ts-L, suggesting a progressive decrease in growth of posterior calvarial height. A comparison of the data with previously published figures for Indian and Norwegian populations suggests a racial difference in the various cranial-base and calvarial ratios.     

Posterior spinal cord block: a dosimetric study

To determine the optimal width of a midline posterior spinal block (MPSB) (to avoid delivering too great a dose to the cord and too small a dose to adjacent tissue), the authors determined with magnetic resonance (MR) imaging normal ranges of cord depth and width and correlated them with film dosimetric data. In 59 randomly selected patients there was a wide range for both depth and width. The average depths of the anterior and posterior surfaces of the cord were 6.7 cm +/- 1.4 and 5.4 cm +/- 1.3, respectively. The average cord width was 1.6 cm +/- 0.4. Optimal cord block width as a function of cord width was determined for a 6-MV photon beam. The optimal cord block width at the surface (half-value layer [HVL] thickness = 6) varied from 1.5 to 3.0 cm for cord widths of 0.8-2.4 cm, which correspond to two standard deviations from the average. There was no significant dependence on depth of the cord. For optimal treatment outcome, the MPSB width may have to be determined for each patient individually.     

The Effect of Early Feeding on the Development of Obesity

Early influences associated with adult obesity include overfeeding leading to fat cell hyperplasia, inactivity, and faulty mechanisms of control of food intake. The first year of life is critical for the intiation of these influences; thus we need to reevaluate some of the approaches to infant feeding. Excessive weight gains in infants must be taken seriously. This article reviews related literature and makes recommendations for preventing early obesity.