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What are the most commonly encountered problemi con kamagra-cialis.biz tumors in the spinal column?. —metastatic spine tumors are much more common than primary spine tumors. Hey occur most commonly in patients with breast and lung cancer. Cancer spreads to the spine and epidural space hematogeneously (arterial spread through segmental branches o the aorta. Venous spread through batson’s perivertebral plexus) or per continuitatem. When the vertebral periost is in iltrated by cancer or nerve roots are compressed, pain dominates the clinical picture. Myelopathic symptoms are initially related to venous congestion. Once cord per usion is compromised, an irreversible myelopathy ensues.

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While technology such as the c scan and mri is tremendously help ul, its value is greatly diminished in problemi con kamagra-cialis.biz the absence o a clinical context. “shotgun” testing is just that. While it may cover a wide range (like shotgun pellets), it is just as widely inaccurate and ine ective. A well-done, e cient, and ocused neurologic examination can yield more in ormation than any ancillary diagnostic testing, in less time and at less cost. While other elds have allowed their examination skills to be replaced by technology (the echocardiogram, or example, exceeds the stethoscope), there is still no replacement or a well-struck re ex hammer. Brain death examination x t e american academy o neurology (aan) revised the evidence-based recommendation or brain death examination in 2010. T ey answered ve important questions regarding this sometimes-di cult area:10 1. Are there patients who ul ll the clinical criteria o brain death who recover brain unction?. T e answer to this is there are no reports o recovery o patients who have ul lled the brain death criteria who have recovered their neurological unction. 2. What is an adequate observation period to ensure that cessation o neurologic unction is permanent?. T ere is no evidence-based period one should watch a patient who ul lls brain death criteria. 3. Are complex motor movements that alsely suggest retained brain unction sometimes observed in brain death?. Movements (sometimes complex) may be caused on occasion by subcerebral structures in patients who ul ll brain death criteria. 4. What is the comparative sa ety o techniques or determining apnea?. Di erent methods o apnea testing all appear relatively sa e but there is no evidence to avor one over others. 5. Are there new ancillary tests that accurately identi y patients with brain death?. Mri/mra, c a, and quantitative eeg (bispectral index) may be used as adjuncts in determination o brain death but their role has not been well de ned. There are our stages in determining the presence o brain death in a patient. 1. Establish irreversible and proximate cause o coma that would explain brain death. 2.

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