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 attainable scope, Ashcraft's Pediatric surgical procedure provides authoritative, functional tips on treating the total diversity of surgical difficulties in babies, kids, and youngsters. the recent fifth version maintains this wonderful legacy with its completely up to date insurance of today's sizzling issues together with the elevated use of minimally invasive surgical procedure (MIS) for pediatric sufferers, urology, bariatric surgical procedure in teens, and evidence-based remedies and results in kids. specialist seek advice functionality-new to this edition-offers handy entry to the whole contents of the booklet, in addition to bonus surgical movies that show a few of the new concepts and methods from the textual content that will help you refine your talents.

* Covers the total diversity of surgical difficulties in babies, young ones, and teenagers, for entire tips in a single handy resource.

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

* Discusses well timed issues resembling bariatric surgical procedure in youth and evidence-based remedies and results in children.

* comprises surgical videos-many new to this edition-which reveal the best way to practice key techniques.

* Emphasizes a medical concentration for a vast spectrum of pediatric surgical problems, for insurance that ambitions the fabric most vital to you.

* incorporates a uncomplicated layout that makes assessment effortless for certification and recertification exams.

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

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

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

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

* offers 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 subsequent version is released, or till the present variation is not any longer provided on the market by means of Elsevier, whichever happens first. Elsevier reserves the suitable to provide an appropriate alternative product (such as a downloadable or CD-ROM-based digital model) should still entry to the website be discontinued.

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More recent studies examining the role of insulin for tight glycemic control in critically ill patients have been less encouraging and are discussed in the next section. A Review of Carbohydrate Metabolism and Requirement during Illness Glucose production and availability are a priority in the pediatric metabolic stress response. Glucose is the primary energy source for the brain, erythrocyte, and renal medulla and also is used extensively in the inflammatory response. 10 Moreover, glycogen stores provide only a limited endogenous supply of glucose in adults and an even smaller reserve in the neonate.

86 This approach will provide the child with full nutritional supplementation while alleviating an increased ventilatory burden and difficulties with hyperglycemia. Administration of high caloric (glucose load) diets in the early phase of critical illness may exacerbate hyperglycemia, increase CO2 generation with increased load on the respiratory system, promote hyperlipidemia resulting from increased lipogenesis, and result in a hyperosmolar state. 79 The precise mechanism(s) responsible for this beneficial effect of tight glycemic control with insulin protocol remains unanswered.

The direct calorimetric method measures the heat released by a subject at rest and is based on the principle that all energy is eventually converted to heat. 19 This method is the true gold standard for measured energy expenditure. Direct calorimetry is not practical for most hospitalized children, and REE is often estimated using standard equations. 19-21 REE estimation is difficult in critically ill or postoperative children. Their energy requirements show individual variation and are dependent on severity of injury.

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