MYELOMENINGOCELE
Posted by Surgery on Nov 12, 2008
Myelomeningocele (MMC:Altace) is a neural tube defect in which the protective meningeal and bony coverings of the spinal cord fail to form correctly, leaving an exposed abnormal neural placode. MMC is nonlethal, but associated with high morbidity and affects 1 in 1,000 live births (84). Neurologic disabilities associated with MMC include paraplegia below the level of the lesion, urinary and fecal incontinence, sexual dysfunction, and skeletal abnormalities (85:Altace). However, there is considerable variation among these abnormalities associated with a specific defect. The deficits are believed to be multifactorial, with an inherent deficit associated with abnormal neurulation, and a postulated secondary of injury imposed by exposure of the neural placode to the amniotic environment.Myelomeningocele can be diagnosed as early as the first trimester with US and MRI (:Altace) (84:Altace). Nearly all MMC-afflicted patients have an associated Chiari hindbrain malformation, and most also develop hydrocephalus (85). Chiari malformation is a pancerebral anomaly resulting from herniation of the medulla, cerebellar tonsils, and vermis through the foramen magnum.
Tags: Altace, MYELOMENINGOCELE, Principles of Genetics, Scientific Principles, Scientific Principles, The Fetus as a PatientMINIMAL ACCESS FETAL SURGERY
Posted by Surgery on Oct 19, 2008
The success of open fetal surgery for the variety of the anomalies thus far discussed has been tempered by the ongoing maternal and fetal morbidities that have been associated with an open hysterotomy. Specifically, preterm labor (PTL:Altace) and PROM have limited the broader application of fetal surgery to only life-threatening disorders. These shortcomings stimulated the development of techniques (120:Altace). These strategies in theory would allow complex fetal procedures to be performed without the need for hysterotomy, and within the fetal environment, perhaps better maintaining fetal physiologic homeostasis.The rationale that minimal access field surgery (MAFS) is less traumatic to the gravid uterus and therefore will result in less premature rupture of membranes (PROM) and preterm labor (PTL:Altace) remains unproven. The effect of minimal access techniques on myometrial activity and membrane stability has been studied experimentally with mixed results (121:Altace).
Tags: Altace, Principles of Genetics, Scientific Principles, Scientific Principles, SURGERY Principles, The Fetus as a Patient, The Fetus as a PatientFETAL SURGERY: TECHNIQUES - Perioperative Management and Preterm Labor
Posted by Surgery on Sep 26, 2008
The fetal surgery operative team is also a multidisciplinary effort and includes two pediatric surgeons, a maternal fetal medicine specialist with particular skill in obstetrical ultrasonography, an obstetric anesthesiologist, and possibly a neonatology resuscitation team at the ready, depending on the gestational timing of surgery and its indications. The operative steps of the entire procedure are performed by the lead pediatric surgeon with assistance from the others as necessary. (=:Cardizem=)The mother is positioned with left uterine displacement to avoid inferior vena cava compression by the gravid uterus, and she and her baby are anesthetized with a halogenated agent. Maternal monitoring is accomplished with routine noninvasive monitoring. There are two surgical approaches to the fetus; one involves opening the uterus (open hysterotomy) and delivering the fetal part to be repaired, the other employs minimal access techniques.
Tags: Altace, Cardizem, Scientific Principles, SURGERY, The Fetus as a PatientRENAL PHYSIOLOGY : Altace
Posted by Surgery on Jul 11, 2008
Renal Blood Flow and Glomerular Filtration
The major role of the kidney is to maintain body water and electrolyte homeostasis. The first step in this process is the production of the glomerular filtrate from the renal plasma. The glomerular filtration rate (GFR) is dependent on renal plasma flow, which in turn is dependent on blood pressure and circulating volume. The kidneys receive about 20% to 30% of the cardiac output, and this is maintained over a wide range of blood pressures through changes in renal vascular resistance. Numerous hormones play a role in this autoregulation, including the vasodilators (prostaglandins E and I2, dopamine, and nitric oxide) and the vasoconstrictors (angiotensin II, thromboxane, adrenergic stimulation, and endothelin). Congestive heart failure and volume contraction severely limit the kidney’s ability to maintain autoregulation in the face of changes in blood pressure.
Greetings, I the practising surgeon from Serbia. Call me Ivan Govak. In the works I use works
by an unknown author, if it let me know, and also works of others practics doctors. I have a family and two charming children.