Splenic size after division of the short gastric vessels in Nissen fundoplication in children

Item does not contain fulltextPURPOSE: Nissen fundoplication is an effective treatment for gastro-esophageal reflux disease (GERD). Mobilization of the gastric fundus during fundoplication requires division of short gastric vessels of the spleen, which may cause splenic ischemia. The aim of this study was to determine if Nissen fundoplication results in hypotrophy of the spleen. METHODS: We performed pre-operative and post-operative ultrasound measurements of the spleen in children undergoing Nissen fundoplication. During operation, the surgeon estimated the compromised blood flow by assessment of the percentage of discoloration of the spleen. RESULTS: Twenty-four consecutive children were analyzed. Discoloration of the upper pole of the spleen was observed in 11 patients (48%) of a median estimated splenic surface of 20% (range 5-50%). The median ratio for pre-operative and post-operative length, width, and area of the spleen was 0.97, 1.03, and 0.96, respectively. The percentage of the estimated perfusion defect during surgery was not correlated with the ratios. In three patients, the area ratio was smaller than 0.8 (0.67-0.75), meaning that the area decreased with at least 20% after surgery. In none of these patients a discoloration was observed. CONCLUSION: Discoloration of the spleen after Nissen fundoplication is not associated with post-operative splenic atrophy.1 maart 201

Research On and Activities For Mathematically Gifted Students

This Topical Survey offers a brief overview of the current state of research on and activities for mathematically gifted students around the world. This is of interest to a broad readership, including educational researchers, research mathematicians, mathematics teachers, teacher educators, curriculum designers, doctoral students, and other stakeholders. It first discusses research concerning the nature of mathematical giftedness, including theoretical frameworks and methodologies that are helpful in identifying and/or creating mathematically gifted students, which is described in this section. It also focuses on research on and the development of mathematical talent and innovation in students, including connections between cognitive, social and affective aspects of mathematically gifted students. Exemplary teaching and learning practices, curricula and a variety of programs that contribute to the development of mathematical talent, gifts, and passion are described as well as the pedagogy and mathematics content suitable for educating pre-service and in-service teachers of mathematically gifted students. The final section provides a brief summary of the paper along with suggestions for the research, activities, and resources that should be available to support mathematically gifted students and their teachers, parents, and other stakeholders