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essay on law 3. Reatment o other in ections. Speci c in ections, when possible, are treated. Examples include hiv, ungal and bacterial abscesses, and whipple disease. 4. Surgical decompression. Because o the position o cerebellum, space-occupying lesions and in ammation can cause compression o brainstem in extreme cases. 5. Imunosuppression. Bikersta encephalitis, steroidresponsive encephalopathy associated with autoimmune thyroiditis, paraneoplastic, and anti-gad ataxia can be treated with immunosuppression. Corticosteroids and intravenous immunoglobulin g (ivig) are o en rst line. T e use o rituximab and cytotoxic agents should be done in conjunction with clinicians com ortable with the use o these 478 6. 7. 8. 9. 10. 11. 12. 13. Ch apt er 30 medications such as neuromuscular, neuroimmunology, or rheumatology physician. Gluten ataxia. T e patient may or may not have gi symptoms. Gluten- ree diet ameliorates the symptoms. T e best marker o strict adherence to a gluten- ree diet is serological evidence o elimination o circulating antibodies related to gluten sensitivity, although serum antibodies might be present or 6–12 months a er initiation o the diet. Friedreich’s ataxia. T ere is excess oxidative stress and one putative antioxidant medication that may be tried in fa is idebenone. Reatment with the drug is controversial and needs to be individualized. Patients with severe hypertrophic cardiomyopathy and early stages o the disease might bene t the most with treatment. Erythropoietin may also be tried with uncertain bene ts. Finally, the patient’s nonneurologic, cardiac, musculoskeletal, and diabetic complications should be closely watched.

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http://projects.csail.mit.edu/courseware/?term=essay-writing-course-london essay writing course london If there is extensive involvement, a "second look" operation may be done within 24 to 48 hours to determine whether any areas that appeared necrotic are actually viable. The length and areas of removed bowd are recorded. If large areas are resected, the length and position of the remaining bowd are noted, as this will affect the long-term outcome. In approximately 14% of infants with this condition, nec totalis (bowel necrosis from duodenum to rectum) is found. In these cases, mortality is almost certain. 5. In elbw infants (<1,000 g) and extremely unstable infants, peritoneal drainage under local anesthesia may be a management option. In many cases, this temporizes laparotomy until the infant is more stable, and in some cases, no further operative procedure is required. A recent multicenter cohort study comparing laparotomy versus peritoneal drainage in nec with perforation showed no significant differences in survival or need for long-term total pn between the two procedures. However, some studies have suggested worse long-term neurodevdopmental outcome in infants with nec treated with peritoneal drains alone, perhaps representing the infants who were too sick to undergo laparotomy. Optimal surgical therapy still remains controversial. C. Long-term management. Once the infant has been stabilized and effectively treated, feedings can be reintroduced. We generally begin this process after 2 weeks of treatment by stopping gastric decompression. If infants can tolerate their own secretions, feedings are begun very slowly while parenteral alimentation is gradually tapered. No conclusive data are available on the best method or type of feeding, but breast milk may be better tolerated and is preferred. The occurrence of strictures may complicate feeding plans. The incidence of recurrent nec is 4% and appears to be independent of type of management. Recurrent disease should be treated as before and will generally respond similarly.

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http://projects.csail.mit.edu/courseware/?term=nicolaus-copernicus-essay nicolaus copernicus essay A randomized trial of protocol-based care for early septic shock. N engl j med. 2014;370:1683–1693. 26. Peake s, delaney a, bailey m, et al. Goal-directed resuscitation for patients with early septic shock. N engl j med. 2014;371. 1496–1506. 27. Mouncey p, osborn t, power s, et al. Trial of early, goal-directed resuscitation for septic shock. N engl j med. 2015;372:1301–1311. 28. Finfer s, bellomo r, boyce n, et al. A comparison of albumin and saline for fluid resuscitation in the intensive care unit. N engl j med. 2004;350:2247–2256. 29. Ferrada p, anand r, whelan j, et al. Qualitative assessment of the inferior vena cava. Useful tool for the evaluation of fluid status in critically ill patients.

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