Imaging.Acute.Abdomen.in.Children.[taliem.ir]

Imaging Acute Abdomen in Children

Abdominal pain or symptoms related to the gastrointestinal, urinary or genital tract are common complaints and frequent reason for admission of children in the emergency department (ED) . Despite the relatively benign nature of the most common diseases treated in the paediatric ED, there are some clinical entities that can have adverse outcomes. How high is the index of suspicion among clinicians for such serious pathologies and how well aware are they of recent advances in their diagnosis and treatment? What are the clinical pitfalls to be avoided? One issue is to detect the child with a rare and potentially severe condition among all children with more common diagnoses in the ED. A second issue is the management of abdominal diseases in very young children, who often present with less specifc signs. A third issue is more and more often the admission of children soon after the onset of the frst symptoms. In this situation, the repetition of initially normal examinations could be necessary. The mechanisms of intra-abdominal diseases can be of vascular, obstructive or infectious origin. The causes vary with the age of the child, although almost all causes can be seen at any age. For example, intussusception usually occurs in children 2 months to 2 years of age. When it is described (rarely) in older children, an underlying disease has to be searched.
Geriatric.Anesthesiology.Third.Edition.[taliem.ir]

Geriatric Anesthesiology

The subject of anesthesiology spans the science and art of an entire clinical discipline. This includes material of basic and clinical sciences as well as particular pharmacology that encompass drugs to render man insensitive to pain, induce loss of consciousness, and paralyze muscles . Geriatric anesthesiology is an emerging, important area more narrowly focused on the art, science, pharmacology, and physiology pertaining to the elderly surgical population. Age is an imperfect descriptor of geriatric anesthesia because age alone does not defne the important changes that make older patients more challenging and different than normal adults. Nevertheless, age ≥65 years old is used arbitrarily to defne the geriatric population. Geriatric medical care has evolved from an empiric discipline in the 1950s and 1960s to a largely evidence-based practice today . An excellent short reference guide called Geriatrics at Your Fingertips is available in a small pocket edition as well as on the Internet . Perioperative geriatric anesthesia is very much at the frontlines of developing suffcient primary data on which to base practice guidelines. However, there are still only a few randomized controlled trials that provide class I evidence regarding perioperative care of the elderly, leaving the practitioner to extrapolate fndings from literature that has accumulated on geriatric care in other contexts that pertain to the perioperative setting.
Endocrine.and.Neuroendocrine.Surgery.[taliem.ir]

Endocrine and Neuroendocrine Surgery

Surgery is the only curative treatment for primary hyperparathyroidism. Several intraoperative adjuncts have been developed to facilitate parathyroidectomy to achieve a successful outcome. These include sestamibi-SPECT scanning, cervical ultrasound, 4D-CT scans, and intraoperative parathyroid hormone monitoring. One technology often overlooked is radioguided parathyroidectomy. Radioguided parathyroidectomy is closely related to other radioguided techniques already in use for breast cancer, malignant melanoma, thyroid cancer, and colon cancer. A radiotracer is administered, which accumulates preferentially in the targeted tissue. Radioguided techniques localize specifc tissue through the use of radioactivity, theoretically minimizing dissection and decreasing overall operative time. The radiotracer utilized for radioguided parathyroidectomy is technetium 99mTc–sestamibi, which is the same compound used for preoperative parathyroid imaging. Its use is based upon the principle that enlarged, hypercellular parathyroid glands contain an increased number of mitochondria, and these mitochondria take up and retain 99mTc– sestamibi longer than surrounding tissues. Thus, the abnormal parathyroid becomes “hot” relative to surrounding structures. A hand-held gamma probe can then be utilized to detect the enlarged parathyroid gland. Once resected, the parathyroid gland can be assessed ex vivo for its radioguided counts. The counts are then used to determine if the gland is abnormal.
Common.Problems.in.Acute.Care.[taliem.ir]

Common Problems in Acute Care Surgery

In 1946 hemorrhagic shock was induced in animal models and a stratification system emerged: simple hypotension, which was noted to always be reversible if identified and treated; impending shock, which was reversible if treated ggressively; and irreversible shock state, where hypotension, sustained by high-volume blood loss, correlated to notable metabolic derangement . The authors concluded that hemorrhagic shock did not occur at a specific volume loss or blood pressure, but was rather a fluid state that required early recognition by the treating physician and immediate intervention during the reversible period. Hemorrhagic shock is defined as a mismatch between cellular perfusion and metabolism. Strict adherence to the definition results in difficulty identifying compensated shock states, however, since compensated shock does not always have a straightforward clinical picture. Compensated and severe hemorrhagic shock occur on a spectrum of metabolic acidosis, blood loss, poor tissue perfusion, tissue injury, and ineffective oxygen extraction (Table 1.1 and Fig. 1.1) . Hemorrhage is commonly categorized by volume and percent blood loss with specific findings at defined losses . Interestingly these categories are largely based on opinion rather than objective clinical data. Clinical parameters are not markedly different from baseline in phases one and two of shock, contributing to the difficulty in recognizing shock in its early stages.
Color.Atlas.of.Pediatric.Anatomy.Laparoscopy.[taliem.ir]

Color Atlas of Pediatric Anatomy, Laparoscopy, and Thoracoscopy

Minimally invasive surgery (MIS) has become relatively commonplace in paediatric surgery, and is becoming more popular. Paediatric surgeons perform laparoscopic and thoracoscopic surgery with the commonly held belief that MIS is associated with a dampened stress response, more rapid postoperative recovery, and early discharge from hospital. There are also long-term cosmetic advantages. Depending on the operation in question, some of the potential advantages hold, but others do not, and we need to be conscious of potential disadvantages and difficulties when embarking on MIS.
Basic.Practical.Skills.in.Obstetrics.[taliem.ir]

Basic Practical Skills in Obstetrics and Gynaecology

This handbook has been prepared for participants on the Royal College of Obstetricians and Gynaecologists’ Basic Practical Skills in Obstetrics and Gynaecology course. The course has been designed to introduce trainees to safe surgical techniques and obstetric clinical skills in a structured workshop environment. It is a requirement that this course is completed during ST1/ 2 before trainees move to ST3. The course consists of three modules and covers basic surgical skills and basic skills in obstetrics. In each module, the importance of sound knowledge of anatomy, the correct development of tissue planes, the appropriate use of traction and counter- traction, the need to obtain meticulous haemostasis and the importance of gentle tissue handling will be emphasised. In addition, the trainees will be taken through basic obstetrics skills and will have the opportunity to practise these skills under direct supervision. The course runs from a number of approved regional centres and is standardised to ensure that common objectives, content structure and assessment methods are followed. The contents of the course do not represent the only safe way to perform a procedure, but endeavour to give trainees one safe approach to common obstetric and gynaecological procedures. There is an emphasis on acquiring practical skills .Each course will include: ■ considerable hands- on practical experience ■ high tutor to participant ratio ■ course manual ■ performance assessment with feedback to identify strengths and weaknesses.
Autonomic.Nervous.System.[taliem.ir]

Autonomic Nervous System

The traditional view of the autonomic nervous system (ANS) considers only its peripheral part, the sympathetic and parasympathetic systems, to which sometimes the enteric ANS is added as an independent entity. However, this view is insuffcient to understand the most important function of the ANS: the maintenance of homeostasis. This Chapter describes the hierarchical organization of the autonomic motor pathways and their similarities with the somatic motor organization. It analyzes the types of neurons, neuronal circuits, and electric potentials identifed in autonomic neurons.
Textbook.of.Hernia.[taliem.ir]

Textbook of Hernia

ABSTRACT Hernia formation is a multifactorial process involving endogenous factors including age, gender, anatomic variations, and inheritance and exogenous factors such as smoking, comorbidity, and surgical factors (Fig.  1.1) . However, …
Acute.Pancreatitis.An.A-Z.[taliem.ir]

Acute Pancreatitis

Most patients with acute pancreatitis will present to the Accident and Emergency (A&E) Unit with sudden onset abdomen pain and will therefore be frst seen by the emergency physician and the resident doctor on call. Tose working in A&E should therefore be familiar with clinical presentation, diagnosis, and initial management of acute pancreatitis.
Surgical.Patient.Care.Improving.Safety.Quality.and.Value.[taliem.ir]

Surgical Patient Care

The ability of healthcare to save and extend life and improve the quality of life for the ill is a testament to the success of human competencies, technology and scientifc inquiry. Perhaps as a result, most healthcare systems are challenged by issues of access, quality, and cost. Although most institutions and systems provide safe and effective care for the vast majority of patients most of the time, unwanted variation in quality and safety is common . The causes for this are many and not always well understood but, in general ,they result from an increasingly complex healthcare environment, rapidly exploding medical knowledge; poor evidence for the treatments available; and an overreliance on subjective judgment . A RAND Corporation analysis highlights opportunities to improve the healthcare system in which some people receive more care than they need and others receive less, and yet others get little access to care. In this study, approximately 50% of those seeking healthcare received the recommended preventive care. For acute care, 70% received the recommended treatment and 30% of patients received contraindicated care. For chronic diseases, 60% of patients received the recommended care and 20% received contraindicated care. These studies strongly suggest that, too frequently, care delivered in developed countries does not meet professional standards or best practices. In fact, the US healthcare system gets it .“right” only 55% of the time.