Paediatric surgery workbook by Jan Hendrik Reynor Becker

By Jan Hendrik Reynor Becker

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This water and electrolyte shortage must be replaced in addition to the maintenance fluids that have already been calculated. Most patients will be isotonically dehydrated. The body therefore has a shortage of fluid that has the same composition as plasma and the fluid that is returned must be isotonic to plasma. The best fluid mixtures that fulfil these requirements are: • Plasmalyte® B or L • Ringer’s lactate® If the patient’s serum K is rather high due to dehydration, in other words there is pre-renal failure, then 0,45% of NaCl should preferably be administered until the patient excretes and the serum K returns to normal.

Distinction between the various vascular tumours, when in doubt, is made on biopsy. PAEDIATRIC BOOK 3/12/05 1:08 am Page 31 4 Vascular malformations (See Chapter 18) Vascular malformations, on the other hand, consist of mature endothelial cells and therefore do not involute and grow progressively with the child. They are classified by the predominant vessel type and subdivided into high-flow (arterial or arteriovenous) and low-flow (capillary, venous and lymphatic, or a mixture of the latter two) groups (Mulliken and Glowacki 1982).

G. in the identification of ultrastructures of small round cell tumours. This is an investigation that is not extensively carried out. Specific chromosomal abnormalities have now been identified in a whole range of paediatric tumours, but chromosomal studies cannot be performed on samples that have been contaminated or fixated. Precise anatomical and clinical staging of subgroup classification is an essential part of the planning of therapy and can only be done during primary surgery. For most paediatric cancers, the primary therapy is a very important and decisive factor which will determine the survival of the child.

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