2 pathophysiology of ballistic trauma and the gravid uterus

... reservoir of master war and trauma surgeons and a ready supply of materials – patients on which to practice In the period of unrest in Northern Ireland 1969–2002 and at the time of the Falklands War of ... science The US editor is professor and chairman of the Department of Surgery at the Uniformed Services University of the health Sciences and has extensive experience in the management of ballistic trauma ... understanding of the xiii xiv Preface to the First Edition fundamentals of ballistic trauma, the mechanisms and some insight into the significance of new weapons, as well as the variations on the...

Ngày tải lên: 29/06/2014, 09:20

... Prognosis and Followup The prognosis for the patient with a retinal break and the need for followup by the optometrist depend on the type and severity of the break The frequency and composition of evaluation ... inflammation of blood vessels Visual acuity The clearness of vision that depends upon the sharpness of focus of the retinal image and the integrity of the retina and visual pathway Visual field The area ... time The further into the vitreous cavity the retina floats, the more elevated it appears during ophthalmoscopy and the greater the number and size of retinal folds in the detachment In longstanding...

Ngày tải lên: 22/03/2014, 09:20

... conceived the study, contributed to the collection of data, performed analysis and interpretation of data, and drafted the manuscript EV-P conceived the study, performed the collection of data, and ... to the analysis and interpretation of data and to the drafting of the manuscript XM and EV-P contributed equally to this study DO contributed to the collection, analysis, and interpretation of ... our study First, it reflects the experience of a single center Second, the study is retrospective and neither the choice of the ventilation support nor the modalities of this support were chosen...

Ngày tải lên: 13/08/2014, 10:20

Ngày tải lên: 13/08/2014, 16:20

... the availability of caregivers On the one hand, divorces may estrange families and deter caregiving On the other hand, the new configurations of families may expand the pool of caregivers in the ... limitation of this demonstration program and of the development of the private long-term insurance market as a whole—is the time lag between the purchase of a policy and the filing of a claim ... Fund THE FUTURE OF LONG-TERM CARE DEMAND In the future, a number of factors will converge to shape the magnitude, scope, and nature of the demand for long-term care: changing demographics and the...

Ngày tải lên: 28/03/2014, 17:20

... or she may incorrectly assume that the erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation would be that the patient has a pruritic eczematous ... raised above the surface of the surrounding skin and hence palpable (e.g., a closed comedone, or whitehead, in acne) Nodule: A larger (0.5–5.0 cm), firm lesion raised above the surface of the surrounding ... Note: The presence of pustules does not necessarily signify the existence of an infection Bulla: A fluid-filled, raised, often translucent lesion >0.5 cm in diameter Wheal: A raised, erythematous,...

Ngày tải lên: 06/07/2014, 20:20

... of epidermis without an associated loss of dermis Ulcer: Loss of epidermis and at least a portion of the underlying dermis Excoriation: Linear, angular erosions that may be covered by crust and ... configuration of skin lesions formed from coalescing rings or incomplete rings Pruritus: A sensation that elicits the desire to scratch Pruritus is often the predominant symptom of inflammatory ... epidermal atrophy) Scar: A change in the skin secondary to trauma or inflammation Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character Sites on hair-bearing...

Ngày tải lên: 06/07/2014, 20:20

... during a physical examination: the distribution of the eruption, the types of primary and secondary lesions, the shape of individual lesions, and the arrangement of the lesions An ideal skin examination ... evaluation of the skin, hair, and nails as well as the mucous membranes of the mouth, eyes, nose, nasopharynx, and anogenital region In the initial examination it is important that the patient ... distance of about 1.5–2 m (4–6 ft) so that the general character of the skin and the distribution of lesions can be evaluated Indeed, distribution of lesions often correlates highly with diagnosis...

Ngày tải lên: 06/07/2014, 20:20

... A–D The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules and plaques...

Ngày tải lên: 06/07/2014, 20:20

... with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption is characterized by multiple erythematous plaques with a target or iris morphology ... hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure 52-10 ...

Ngày tải lên: 06/07/2014, 20:20

... biopsy In the latter technique, a punch is pressed against the surface of the skin and rotated with downward pressure until it penetrates to the subcutaneous tissue The circular biopsy is then lifted ... dissolves keratin and allows easier visualization of fungal elements Brief heating of the slide accelerates dissolution of keratin When the preparation is viewed under the microscope, the refractile ... suspected The edge of such a lesion is scraped gently with a no 15 scalpel blade, and the removed scale is collected on a glass microscope slide then treated with to drops of a solution of 10–20%...

Ngày tải lên: 06/07/2014, 20:20

... under a Wood's lamp, and previously unsuspected areas of involvement often become apparent A Wood's lamp may also aid in the demonstration of tinea versicolor and in recognition of ash leaf spots ... is applied to the patient's back under occlusive dressings and allowed to remain in contact with the skin for 48 h The dressings are removed, and the area is examined for evidence of delayed hypersensitivity ... a lesion and noting the amount of blanching that occurs Granulomas often have an opaque to transparent, brown-pink "apple jelly" appearance on diascopy Figure 52-11 Urticaria Discrete and confluent,...

Ngày tải lên: 06/07/2014, 20:20

... or her body The cancer patient feels that he or she, and not just a body part, is diseased The Magnitude of the Problem No nationwide cancer registry exists; therefore, the incidence of cancer ... increases as the third, fourth, or fifth power of age in different sites For the interval between birth and age 39, in 72 men and in 51 women will develop cancer; for the interval between ages 40 and ... natural mutability and natural selection to seek advantage over normal cells in a recapitulation of evolution One consequence of the traitorous behavior of cancer cells is that the patient feels...

Ngày tải lên: 07/07/2014, 01:20

... portion of the routine history and physical examination The duration of symptoms may reveal the chronicity of disease The past medical history may alert the physician to the presence of underlying ... influence the course of disease and its treatment The family history may suggest an underlying familial cancer predisposition and point out the need to begin surveillance or other preventive therapy ... procedure, the diagnosis generally depends on obtaining adequate tissue to permit careful evaluation of the histology of the tumor, its grade, and its invasiveness and to yield further molecular...

Ngày tải lên: 07/07/2014, 01:20

... categorizes the tumor on the basis of the size of the primary tumor lesion (T1–4, where a higher number indicates a tumor of larger size), the presence of nodal involvement (usually N0 and N1 for the ... absence and presence, respectively, of involved nodes, although some tumors have more elaborate systems of nodal grading), and the presence of metastatic disease (M0 and M1 for the absence and presence, ... be done at the time of definitive surgical resection of the primary tumor Knowledge of the predilection of particular tumors for spread to adjacent or distant organs helps direct the staging...

Ngày tải lên: 07/07/2014, 01:20

... disappearance of all evidence of disease, and a partial response as >50% reduction in the sum of the products of the perpendicular diameters of all measurable lesions The determination of partial ... any new lesion or an increase of >25% in the sum of the products of the perpendicular diameters of all measurable lesions (or an increase of 20% in the sums of the longest diameters by RECIST) ... much to offer the patient for whom curative therapy is no longer an option Often a combination of guilt and frustration over the inability to cure the patient and the pressure of a busy schedule...

Ngày tải lên: 07/07/2014, 01:20

... Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma, gonadal germ ... Neuron-specific enolase Lactate dehydrogenase Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific ... gonadal germ Cirrhosis, cell tumor Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, hepatitis, lung, breast, ovary inflammatory bowel disease, smoking Enzymes...

Ngày tải lên: 07/07/2014, 01:20

... treated for cancer and must be examined (Chap e13) Some problems emerge as a consequence of the disease and some as a consequence of the treatment An understanding of these disease- and treatment-related ... alternatives are often well educated and may be early in the course of their disease Unsound approaches are usually hawked on the basis of unsubstantiated anecdotes and not only cannot help the patient ... success of the supportive care Failure to control the symptoms of cancer and its treatment may lead patients to abandon curative therapy Of equal importance, supportive care is a major determinant of...

Ngày tải lên: 07/07/2014, 01:20

... aseptic necrosis of the femoral head) In 10% of cases, pain is unrelated to cancer or its treatment Assessment of pain requires the methodical investigation of the history of the pain, its location, ... indicate the severity of the pain The clinical condition is often dynamic, making it necessary to reassess the patient frequently Pain therapy should not be withheld while the cause of pain is ... signals in the chemoreceptor trigger zone in the medulla, the cerebral cortex, and peripherally in the intestinal tract lead to stimulation of the vomiting center in the medulla, the motor center...

Ngày tải lên: 07/07/2014, 01:20