Ashcraft's Pediatric Surgery by George W. Holcomb III, J. Patrick Murphy

By George W. Holcomb III, J. Patrick Murphy

Acclaimed for its unsurpassed clarity and achievable scope, Ashcraft's Pediatric surgical procedure provides authoritative, sensible assistance on treating the complete variety of surgical difficulties in babies, teenagers, and teenagers. the recent fifth variation maintains this wonderful legacy with its completely up-to-date insurance of today's scorching themes together with the elevated use of minimally invasive surgical procedure (MIS) for pediatric sufferers, urology, bariatric surgical procedure in youth, and evidence-based remedies and results in childrens. specialist seek advice functionality-new to this edition-offers handy entry to the full contents of the publication, in addition to bonus surgical video clips that exhibit some of the new suggestions and methods from the textual content that can assist you refine your abilities.

* Covers the total variety of surgical difficulties in babies, kids, and teenagers, for entire suggestions in a single handy resource.

* deals assurance of minimally invasive surgical procedure, together with laparoscopy and thoracoscopy, outlining the professionals and cons of every approach.

* Discusses well timed themes similar to bariatric surgical procedure in teenagers and evidence-based remedies and results in children.

* contains surgical videos-many new to this edition-which reveal how one can practice key techniques.

* Emphasizes a medical concentration for a extensive spectrum of pediatric surgical problems, for insurance that goals the cloth most vital to you.

* includes a simple layout that makes overview effortless for certification and recertification exams.

* locations an elevated emphasis on minimally invasive surgical procedure, reflecting the shift from open to closed strategies that permit for speedier restoration and higher outcomes.

* offers a brand new specialize in evidence-based remedies and results, equipping you with today's most sensible practices.

* deals the whole textual content on-line, totally searchable, in addition to all the illustrations downloadable in your own displays, and entry to surgical movies at expertconsult.com.

* contains over 900 illustrations-more than part new to this edition-that depict today's top surgical practice.

* presents on-line references associated with PubMed for simple entry to abstracts and whole textual content articles.

Your buy entitles you to entry the website till the following version is released, or till the present variation is not any longer provided on the market through Elsevier, whichever happens first. Elsevier reserves the suitable to supply an appropriate alternative product (such as a downloadable or CD-ROM-based digital model) may still entry to the website be discontinued.

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81 Therefore, a surplus of carbohydrate may increase the ventilatory burden on the critically ill patient. 83 In addition, excessive carbohydrate provision may play a role in the genesis of TPN-associated cholestatic liver injury. 84 When designing a nutritional regimen for the critically ill child, excessive carbohydrate calories should be avoided. A mixed fuel system, with both glucose and lipid substrates, should be used to meet the patient’s caloric requirements. 86 This approach will provide the child with full nutritional supplementation while alleviating an increased ventilatory burden and difficulties with hyperglycemia.

The process of lipid turnover involves the conversion of free fatty acids and their glycerol backbone into, and hydrolytic cleavage from, triglycerides. Thirty to 40 percent of free fatty acids are oxidized for energy. 94 This suggests that fatty acids are a prime source of energy in metabolically stressed pediatric patients. In addition to the rich energy supply from lipid substrate, the glycerol moiety released from triglycerides may be converted to pyruvate and used to manufacture glucose. As seen with the other catabolic changes associated with illness and trauma, the provision of dietary glucose does not decrease fatty acid turnover in times of illness.

82 These include more dramatic aberrations in blood pressure (more constant decline), heart rate (progressive, persistent tachycardia), blood sugar level (severe, progressive hypoglycemia), acid-base status (severe acidosis), and oxygenation (severe hypoxemia). 5 vs. 1 hours) compared with the premature animal. The neonate’s host defense can usually respond successfully to ordinary microbial challenge. However, defense against major challenges appears limited and provides an explanation for the high mortality rate with major neonatal sepsis.

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