Der Energieumsatz beim Bergsteigen in großen Höhen

Zusammenfassung Bergsteigen in großen Höhen führt nur zu einer relativ geringen Energieumsatzsteigerung gegenüber dem Grundumsatzsollwert verglichen mit anderen Sportarten. Die Ursache dafür liegt anscheinend in der geringen Aufstiegsgeschwindigkeit, die einerseits durch die Ökonomie des Bergsteigens, andererseits durch die natürliche Begrenzung der Sauerstoffversorgung bedingt ist.

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Summary Climbing in high altitude leads to little increase of energy expenditure in relation with basic metabolism compared with other types of sport. Perhaps that is caused by the relatively slow speed of climbing limited on the one side by the economy of climbing (housekeeping) on the other one by the natural limitation of oxygen supply.

     

Acute upper airway obstruction caused by cervical hematoma as a complication of an internal jugular vein catheter

4 cases of inadvertent puncture of the common carotid artery following unsuccessful puncture of the internal jugular vein leading to a massive cervical hematoma are described. In all cases, acute upper airway obstruction required immediate intubation.     

Growth retardation in Turner syndrome: aneuploidy, rather than specific gene loss, may explain growth failure

The etiology of short stature (SST) in Turner syndrome (TS) is still a subject of speculation. A variety of hypotheses have been put forward, from SST as a result of increased intrauterine tissue pressure after fetal lymphedema to haploinsufficiency of a specific growth gene(s). These hypotheses have various statistical-auxological implications on the growth distribution in TS. Empirical research has provided no clear evidence for any of these theories, but the well known correlation between patients' and midparental height (MPH) could be established. The influence of undetected mosaic status has often been cited as a major problem in the investigation of growth in TS. However, an assessment of mosaic status (simultaneous analysis of karyotype and phenotype) and its effect on growth with inclusion of MPH has been not yet carried out for a large sample. The aim of this study was to evaluate growth and its complex relationship to mosaic status and MPH in TS. In a mixed cross-sectional and longitudinal study we retrospectively analyzed the auxological and clinical data of 447 patients with a pure loss of X-chromosomal material (n = 381 with 45,X0; n = 66 mosaics). The 447 patients were selected from a series of 609 consecutive patients with TS. To assess the effect of mosaic status on growth, we computed a bifactorial analysis of variance (phenotype, karyotype), including MPH as a covariate. In line with the mosaic hypothesis, we found a correlation between individual loss of X-chromosomal material and phenotypical expressivity. In contrast, no correlation was found with respect to growth. With respect to MPH, we found growth retardation (GR) even in those patients with "normal" height above the third percentile (-2 or more SD score). The interindividual variance of GR in TS (comparable to growth variance in the normal population) seems to be unrelated to other TS-specific factors (e.g. mosaic status or single gene loss). Instead, both interindividual variance and the global growth shift distribution are best explained by the presence of an unspecific aneuploidic effect. Furthermore, consideration of patient height in relation to MPH should lead to a better understanding of the nature of GR in TS than the commonly used, strictly qualitative definition of SST.     

Ernährung bei operativen Maßnahmen

Background

The special metabolic risk for complications must be taken into account in cancer patients undergoing extensive operations.

Method

This selective review of the literature refers to recent German S3 guideline recommendations.

Results

Early detection and observation of patients with weight loss and diminished food intake before hospital admission remain an essential part of perioperative management. With the aim of enhanced recovery after surgery (ERAS) and the reduction of postoperative morbidity there is a need for appropriate perioperative nutritional and metabolic care.

Conclusion

Whenever possible artificial nutritional support should be avoided; however, if inadequate oral intake has to be anticipated (> 10 days) in patients at risk nutritional support should be started early via the enteral route, maybe in combination with parenteral nutrition. Long-term total parenteral nutrition is restricted to special indications.

     

Die „Fab15“ der NIS zum Polytrauma

Notfall + Rettungsmedizin -