ballistic trauma in pregnancy

... who, increasingly are trained within narrow specialty and sub-speciality fields This is leading to what an eminent colleague of this author calls “… deployed surgeons hunting in teams.” Working in ... Ballistic Trauma in Children 529 Graeme Pitcher xx Contents 36 Ballistic Trauma in Pregnancy 549 Michael J Socher and Peter E Nielsen 37 Managing Ballistic Injury in the NGO Environment ... coalition, the invasion of Iraq by a US led coalition in 2003, terrorist bombings in Madrid in 2004, terrorist bombings in London in July 2005, and countless other terrorist and insurgency events...

Ngày tải lên: 29/06/2014, 09:20

... pre-existing retinal holes, the increase in retinal detachment following cataract extraction is substantial.104 Prevalence and Incidence The incidence of phakic nontraumatic retinal detachment in the ... fluorescein dye is injected intravenously into the vascular circulation and observed as it transits the retina and choroid Pneumatic retinopexy The injection of air or expanding gases into the eye in ... resulting in what is called a "retinal tear." Traction at the site of a tear can initiate retinal detachment surrounding the tear by pulling on the surface of the adjacent retina The break in the...

Ngày tải lên: 22/03/2014, 09:20

... NIMV failed in HIV-negative cases and in HIV-positive case and after first-line endotracheal intubation in HIV-negative case and in HIV-positive cases Mortality Mortality was higher in HIV-negative ... more severe in HIV-negative subjects Even though we could not assess whether baseline differences in age and chronic lung condition influenced this finding, it suggested that the lung injury was ... in nonAIDS patients, which is well known [18,28,29] Interestingly, the standard staining methods failed to detect P jiroveci in a large proportion of HIV-negative patients As an important clinical...

Ngày tải lên: 13/08/2014, 10:20

Ngày tải lên: 13/08/2014, 16:20

... services are integrated with housing needs In defining long-term care, then, several points are worth emphasizing: • • Long-term care is primarily concerned with maintaining or improving the ability ... systems with a single point of accountability; and flexible funding with incentives to integrate funding streams and minimize cost shifting (Booth et al., 1997) Despite the rhetoric of integration, ... of integrated administration, information, financing, and care management arrangements to help providers work together in minimizing costs while maximizing the long-term health and well-being...

Ngày tải lên: 28/03/2014, 17:20

... differential diagnosis (Table 52-4) For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in a different diagnostic category than ... different from the surrounding skin This differs from a macule only in size Papule: A small, solid lesion, 5 cm in diameter Plaque: A large (>1 cm), flat-topped, raised lesion; edges may either be distinct (e.g., in psoriasis) or gradually blend with surrounding skin (e.g., in eczematous...

Ngày tải lên: 06/07/2014, 20:20

... with intact epidermis (i.e., loss of dermal or subcutaneous tissue) or as sites of shiny, delicate, wrinkled lesions (i.e., epidermal atrophy) Scar: A change in the skin secondary to trauma or inflammation ... Poikiloderma: Skin that displays variegated pigmentation, atrophy, and telangiectases Polycyclic: A configuration of skin lesions formed from coalescing rings or incomplete rings Pruritus: A ... portion of the underlying dermis Excoriation: Linear, angular erosions that may be covered by crust and are caused by scratching Atrophy: An acquired loss of substance In the skin, this may appear...

Ngày tải lên: 06/07/2014, 20:20

... are seen in this patient with cutaneous small vessel vasculitis (Courtesy of Robert Swerlick, MD; with permission.)[newpage] APPROACH TO THE PATIENT: SKIN DISORDER In examining the skin it is ... ideal skin examination includes 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 ... taking an extensive history This way, the entire cutaneous surface is sure to be evaluated, and objective findings can be integrated with relevant historic data Four basic features of a skin...

Ngày tải lên: 06/07/2014, 20:20

... lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with overlying adherent silvery scale Figure 52-8 ...

Ngày tải lên: 06/07/2014, 20:20

... contact (Fig 52-10) or primary irritant dermatitis In contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure ... morphology It usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure...

Ngày tải lên: 06/07/2014, 20:20

... expertise in skin diseases and knowledge of superficial anatomic structures in selected areas of the body In this procedure, a small area of skin is anesthetized with 1% lidocaine with or without epinephrine ... with a minimum of equipment Skin Biopsy A skin biopsy is a straightforward minor surgical procedure; however, it is important to biopsy a lesion that is most likely to yield diagnostic findings ... epinephrine The skin lesion in question can be excised or saucerized with a scalpel or removed by punch biopsy In the latter technique, a punch is pressed against the surface of the skin and rotated...

Ngày tải lên: 06/07/2014, 20:20

... certain skin disorders For example, a Wood's lamp will cause erythrasma (a superficial, intertriginous infection caused by Corynebacterium minutissimum) to show a characteristic coral pink color, ... caused by necrotizing vasculitis (Fig 52-4) will not Diascopy is performed by pressing a microscope slide or magnifying lens against a lesion and noting the amount of blanching that occurs Granulomas ... 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...

Ngày tải lên: 06/07/2014, 20:20

... began to decline in 1997 (Fig 77-2) The five leading causes of cancer deaths are shown for various populations in Table 77-2 Along with the decrease in incidence has come an increase in survival ... cases were in those over age 65 Cancer incidence 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 ... or she is being attacked and invaded by a disease that could be anywhere in the body Every ache or pain takes on desperate significance Cancer is an exception to the coordinated interaction among...

Ngày tải lên: 07/07/2014, 01:20

... made without obtaining tissue; no noninvasive diagnostic test is sufficient to define a disease process as cancer Although in rare clinical settings (e.g., thyroid nodules) fine-needle aspiration ... pollution, indoor smoke from household fuels, and contaminated injections Figure 77-3 Patient Management Important information is obtained from every portion of the routine history and physical examination ... markers or intracellular proteins that typify a particular cancer, or the presence of a molecular marker, such as the t(8;14) translocation of Burkitt's lymphoma Increasing evidence links the expression...

Ngày tải lên: 07/07/2014, 01:20

... lower growth fractions Information obtained from studying the tumor itself will increasingly be used to influence treatment decisions Host genes involved in drug metabolism can influence the safety ... isotopic scans, CT scans, and other imaging procedures; pathologic staging takes into account information obtained during a surgical procedure, which might include intraoperative palpation, resection ... adjacent to the tumor, and inspection and biopsy of organs commonly involved in disease spread Pathologic staging includes histologic examination of all tissues removed during the surgical procedure...

Ngày tải lên: 07/07/2014, 01:20

... http://www.cancer.gov/cancertopics/pdq Information can be obtained through a facsimile machine using CancerFax by dialing 301-402-5874 Patient information is also provided by the National Cancer Institute in at least three ... forces In addition to the medicines administered to alleviate symptoms (see below), it is important to remember the comfort that is provided by holding the patient's hand, continuing regular examinations, ... tumor could result in a patient dying from a reversible intercurrent cholecystitis Intestinal obstruction may be due to reversible adhesions rather than progressive tumor Systemic infections, sometimes...

Ngày tải lên: 07/07/2014, 01:20

... gonadotropin Gestational trophoblastic Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular ... Hepatocellular carcinoma, gonadal germ Cirrhosis, cell tumor Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, hepatitis, lung, breast, ovary inflammatory bowel ... Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific Prostate cancer Prostatitis, antigen prostatic hypertrophy Monoclonal Myeloma Infection,...

Ngày tải lên: 07/07/2014, 01:20

... doing The appearance of unexpected toxicity may be an indication that a supplemental therapy is being taken.3 Information about unsound methods may be obtained from the National Council Against ... treatment, sites originally involved with tumor are reassessed, usually by radiography or imaging techniques, and any persistent abnormality is biopsied If disease persists, the multidisciplinary team ... relapses In view of the enormous cost of a full battery of diagnostic tests and their manifest lack of impact on survival, new guidelines are emerging for less frequent follow-up visits, during which...

Ngày tải lên: 07/07/2014, 01:20

... coordinating the secretory and muscle contraction activity that leads to emesis Diverse receptor types participate in the process, including dopamine, serotonin, histamine, opioid, and acetylcholine ... of prochlorperazine For highly emetogenic agents such as cisplatin, mechlorethamine, dacarbazine, and streptozocin, combinations of agents work best and administration should begin 6–24 h before ... that activate 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...

Ngày tải lên: 07/07/2014, 01:20