By Senior Registrar Department of Anaesthesia Nian Chih Hwang, Peng Jin London Lucien Ooi

Global specialists in ailments of the adrenal glands current new clinical facts and useful directions for surgeons, citizens, endocrinologists and practicing physicians. The booklet covers all points of adrenal gland ailments in nice aspect. comprises approx. 2 hundred illustrations resembling radiographs, CTMRI photographs, graphs and microscopic pathological slides, and so on. a number of tables and colour illustrations of surgical strategies with emphasis at the laparoscopic strategy are integrated.

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These would include Full Blood Count, serum Urea/Electrolytes, Prothrombin Time/Partial Thromboplastin Time, Blood Group and Crossmatch. The next important assessment that should be made in the intubated patient is whether the comatose state is due to raised intracranial pressure. Brainstem infarcts and haemorrhages can result in coma without raising intra-cranial pressure (ICP) due to disruption of the reticular activating system (RAS). The finding of asymmetry in the pupils or limb movements or response especially in the presence of a raised blood pressure (systolic pressure greater than 180 mmHg) is very suggestive of a mass lesion (for example, dilated left pupil with right hemiplegia).

4) Previous CSF shunt which has malfunctioned The child who is used to normal ICP’s from being shunted, tends to become rapidly obtunded when the shunt malfunctions. This has been postulated as due to changes in the pressure-volume compliance of the shunted brain, but is generally not well understood. Congenital hydrocephalus seldom requires emergency surgical intervention because the fontanelle is still open and the skull sutures have not closed yet. Based on the patient history, clinical examination and CT scan, diagnosis is usually easily made.

Pp. 477–496. 2. Nehls DG, Mendelow AD, Graham DI, Teasdale GM (1990). Experimental intracerebral haemorrhage: early removal of spontaneous mass lesion improves late outcome. Neurosurgery 27, 674. 3 Paediatric Neurosurgical Emergencies: A Problem-Based Approach Keith YC Goh Introduction The doctor who practises in a large general hospital does not frequently encounter neurosurgical emergencies in children. In most countries, these cases are usually diverted to the nearest children’s hospital, where trained paediatric doctors are available to deal with the special problems which this patient group presents.

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