Allied Health Services

Senior Registrar Department of Anaesthesia Nian Chih Hwang,'s Acute Surgical Management PDF

By Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi

ISBN-10: 9812386815

ISBN-13: 9789812386816

ISBN-10: 9812563032

ISBN-13: 9789812563033

International specialists in ailments of the adrenal glands current new medical info and sensible directions for surgeons, citizens, endocrinologists and working towards physicians. The e-book covers all facets of adrenal gland ailments in nice aspect. comprises approx. two hundred illustrations similar to radiographs, CTMRI pictures, graphs and microscopic pathological slides, and so on. a number of tables and colour illustrations of surgical thoughts with emphasis at the laparoscopic strategy are incorporated.

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Initial conservative management with further investigation The investigations are cerebral angiography and MRI brain scan. These are reserved for patients with atypical clinical or radiological features. The atypical features may suggest the possibility of recurrent haemorrhage or an underlying lesion or tumour. The common clinical feature that deserves investigation is a haemorrhage (in any location) in a young patient (under 45 years). In these patients the possibility that a brain vascular malformation may underlie the haemorrhage needs to be excluded by cerebral angiography.

Haematomas greater than 60– 70 ml are usually associated with coma and poorer outcome despite aggressive treatment. Haematoma volume is usually approximated by a modified ellipsoid volume equation: Modified ellipsoid volume ≈ ½ (A × B × C) where A, B and C are the maximum length, breadth and height of the clot measured off the CT scan. The CT scan also allows a useful classification of ICH into lobar and deep haemorrhages. Lobar haemorrhage (Fig. 1) is seen in the cortex and subcortical white matter of the cerebral or cerebellar hemispheres.

Elderly (> 65 years) Hypertension Tumours Amyloid angiopathy Coagulopathy Aneurysm or arteriovascular malformation (AVM) 28 J Thomas These drugs can predispose them to both ischaemic or haemorrhagic events. Imaging A CT brain scan is the best tool to ascertain the presence of ICH. MRI is not the ideal initial investigation to evaluate cerebral haemorrhage. ICH is seen as a high density area within the brain substance. The high density on CT is due to the high haematocrit of formed haematoma (60– 90%) and the consequent high iron concentration.

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Acute Surgical Management by Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi

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