By Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi
Global specialists in ailments of the adrenal glands current new medical facts and functional guidance for surgeons, citizens, endocrinologists and working towards physicians. The booklet covers all features of adrenal gland illnesses in nice aspect. comprises approx. 2 hundred illustrations comparable to radiographs, CTMRI photos, graphs and microscopic pathological slides, and so on. a number of tables and colour illustrations of surgical innovations with emphasis at the laparoscopic strategy are integrated.
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Benign tumours rarely haemorrhage. Most lesions that bleed are malignant primary (glioblatoma multiforme) or metastatic tumours. Metastases from bronchogenic carcinoma, choriocarcinoma and renal cell carcinoma have a higher propensity to bleed. Management Paradigms for Intracerebral Haemorrhage Acute medical management This involves stabilising the cardiorespiratory system (intubation if necessary), controlling elevated intra-cranial pressure (head elevation, mild to moderate hyperventilation, intravenous mannitol), preventing and treating seizures (for lobar haemorrhages only) and controlling significantly raised blood pressure.
Lobar haemorrhages are more likely to be associated with structural abnormalities than deep haemorrhages. With large haemorrhages it may be difficult to make the distinction between lobar/deep ICH. The distribution of ICH is summarised in Table 3. With reference to Table 3, the main difference in the distribution of haematomas in the general population as compared to hypertensive patients is the higher incidence of deep haematomas (putamen, Intra-cerebral Haemorrhage in Adults Table 3 29 Common Sites for Intracerebral Haemorrhage Location Hypertensive Patients (%) General Population (%) Lobar Putamen Thalamus Cerebellum Brainstem 18 61 12 8 1 20–50 40–50 5–20 5–10 1–5 thalamus and brainstem) in hypertensive patients.
2 Intra-cerebral Haemorrhage in Adults John Thomas Introduction Intracerebral haemorrhages (ICH) are catastrophic events that often present as the sudden onset of neurologic deficit in previously well patients. The overall incidence is about 12–15 cases per 100,000/year. Under the age of 45, ICH is rare — less than 2 per 100,000/year. The Table 1 Causes of Intracerebral Haematomas I. g. peri-operative) II. Spontaneous (non-traumatic) Hypertension Vascular anomaly — cerebral aneurysm, AVM, cavernous malformation Haemorrhagic conversion of cerebral infarction Cerebral amyloid angiopathy Coagulopathy — constitutional, drug related Tumour — primary or metastatic or leukaemia Drug abuse 24 Intra-cerebral Haemorrhage in Adults 25 incidence of ICH increases significantly after age 55 years, and doubles with each decade of age until age of more than 80 where the incidence is 25 times that for the total population (350 per 100,000/ year).
Acute Surgical Management by Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi