Postoperative Energy Intake in Patients after Colorectal Cancer Surgery

In a prospective noninterventional study of 75 consecutive patients (mean age 71 ± 12 years) undergoing surgery for colorectal cancer, standard postoperative energy intake was evaluated. Seventeen patients expended 40%–60% of estimated basal energy during hospitalization, 33 patients 60%–80%, 22 patients 80%–100% and three patients 100%–125%. Weight loss was observed in 67 patients (mean loss 4.7 ± 4.4%) during hospitalization. Men had a significantly higher mean total calorie deficit (p < 0.001), and mean weight loss percentage (p < 0.01), compared to women. Preoperative nutritional status, nutrition-associated complications and length of hospital stay did not change the nutritional support and intake. Correlation analyses resulted in significant associations between gender and total calorie deficit (r_s = 0.41, p < 0.01), postoperative weight loss and total calorie deficit (r_s = ?0.32, p<0.01), and between postoperative weight loss and length of stay (r_s = 0.27, p < 0.05). We concluded that the patients' energy intake was insufficient compared to estimated basal energy expenditure. These results suggest a need for individualized nutritional care, based on each patient's energy needs and on registration of daily calorie intake, all with the aim of increasing energy intake postoperatively in standard hospital care.     

THE INFLUENCE OF FOOD ON SIDE EFFECTS AND ABSORPTION OF LITHIUM

In a cross-over study, 24 mmol of lithium sulphate was given as a single dose in slow release tablets to 30 healthy volunteers fasting and after a standardised meal. Comparisons were also made with lithium citrate in slow release tablets and placebo. Postprandial administration of lithium gave practically no side effects, while lithium on an empty stomach gave diarrhoea in about 20 % of the subjects. The absorption was measured by determination of the amount of lithium excreted in the urine in a group of ten subjects. Lithium was completely absorbed when given after food, but when given on an empty stomach the absorption was lower in some subjects, apparently due to rapid gastrointestinal passage in connection with diarrhoea. Lithium should therefore preferably be administered after meals.     

Stereotactic neurosurgery planning on a personal-computer-based work station

Stereotactic surgery requires knowledge of cerebral structures derived from more than one image source. We have developed a PC-AT-based workstation that accepts patient images, made with the stereotactic frame in place, from CT, MRI, and DSA modalities. Reference markers on the frame are identified in the images to establish the coordinate geometry for each modality. Target points may be identified on each image type and trajectories of probe paths to these points defined. Targets identified on one set of images may be transferred automatically to other images of the same patient in order to guarantee a vessel-free path of approach to a target point deep within the brain. To date several hundred patients have had stereotactic surgery performed on the basis of plans using this system. Procedures included biopsy and aspiration of lesions, implantation of electrodes for the recording of deep EEG signals, and radiosurgical techniques. We present clinical examples of the use of this system in typical stereotactic neurosurgery procedures, address stereoscopic applications, and discuss the results of intermodality tests to establish the accuracy of the technique.     

Clinical and cerebrospinal fluid findings in lymphocytic meningo-radiculitis (Bannwarth's syndrome)

11 patients with lymphocytic meningo-radiculitis (Bannwarths syndrome) are described. The disease is characterized by intensive pain, often radiating and migrating, and neurological deficits, i.e. peripheral facial palsies, as well as disseminated radiculopathies. In 4 patients the onset was preceeded by an arthropode bite, close to which 3 patients exhibited an erythema chronicum migrans.
In the cerebrospinal fluid there was a mononuclear pleocytosis, predominately by lymphocytes. In the early stages, a plasma cell reaction was frequently encountered. Protein analysis indicated a defect in the blood brain barrier and an intrathecal synthesis of IgG.
All patients recovered almost completely from their neurological symptoms within 1–2 months, irrespective of treatment.