Buch Kondrup (wavelegal14)

g., hypotension; these were evident during clonidine infusion. Epidurally, the antinociceptive potency of fadolmidine was weaker (ED50 128 μg) than when intrathecally administered and weaker than that of epidural clonidine (ED50 51 μg). At analgesic doses, fadolmidine injection induced moderate initial hypertension concomitantly with a decrease in heart rate whereas clonidine evoked hypotension and bradycardia. These results suggest that especially when non-opioid long-term pain relief is needed, an intrathecal infusion of fadolmidine can provide long-term antinociception with less of the known use-limiting adverse effects associated with clonidine.INTRODUCTION Esophagectomy for oncological reasons is associated with high morbidity, which was intended to be reduced by a minimally invasive approach. Main problem of the minimally invasive approach is the challenge of a safe intrathoracic anastomosis. To address this problem several methods such as a collar anastomosis instead of an intrathoracic anastomosis with poor functional outcome, hybrid techniques with an open approach to the demanding intrathoracic circular stapled anastomosis ore robotic assistance have been used. We demonstrate the minimally invasive linear stapler technique for the intrathoracic esophagogastrostomy, which can be applied quite easily even without robotic assistance. SURGICAL TECHNIQUE The abdominal part is performed with the patient in French position. After division of the greater omentum along the gastroepiploic arcade and the spleen as well as the perigastric incision of the lesser omentum 6cm from the pylorus a 4,5 cm gastric conduit is created in linear stapler technique. Next an intraabdominal and transhiatal systematic lymphadenectomy is performed. For the thoracic part the patient is repositioned in a left side position. The thoracic lymphadenectomy is completed, and the specimen removed via mini-thoracotomy. For the anastomosis the esophageal stump is incised, and the gastric conduit is opened 5 cm from the oral resection line. Once the stapler is fired and removed the remaining opening is hand-sewn in a modified double-layer technique. DISCUSSION The side-to-side esophagogastrostomy in linear stapler technique seems to be a quite easily feasible and safe alternative for the reconstruction after minimally invasive esophagectomy. To confirm this, the method is currently investigated in a randomized controlled trial.Hypernatremia is a common electrolyte disorder in daily clinical practice. In many cases hypernatremia is caused by a lack of free water or an increased salt load. Out-of-hospital acquired hypernatremia is often caused by an increased loss of water or a decreased water intake. By contrast, hospital-acquired, nosocomial hypernatremia is often induced by an inadequate fluid balance with saline infusions, saline overload, or due to osmotic diuresis. The consequences are structural changes in the cell morphology such as cell shrinkage. Chronic hypernatremia affects all cell functions predominantly with cerebral symptoms and coma; the main complication is a too-rapid compensation of an adapted electrolyte imbalance with development of cerebral edema. The overall osmolality should always be considered. Overall changes in osmolality correspond to the effect on the cellular stress situation and have to be taken into account and balanced slowly. In cases of unknown duration, a chronic disorder should be assumed.This study aimed to model the inactivation of Lactobacillus brevis DSM 6235 while retaining the viability of yeasts during washing brewer's yeast with phosphoric acid and chlorine dioxide. The independent variables in the acid washing were pH (1-3) and temperature (1-9 °C), whereas in the washing with chlorine dioxide, concentration (10-90 mg/L) and temperature (5-25 °C) were assessed. The predictive models obtained for the four response variables γLA, γCl (decimal reduction of L. bre