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Adrenal Anatomy

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181. Guidelines for adult stroke rehabilitation and recovery

provide a complementary treat- ment for depression. Exercise may affect depressive symp- toms through a number of mechanisms. For example, the hypothalamic-pituitary-adrenal axis may be dysregulated in depression, resulting in elevated cortisol levels. Exercise can improve regulation of hypothalamic-pituitary-adrenal responses. 231 Depression also has direct and indirect con- sequences on immune function, 232 and regular exercise may serve as a nonpharmacological stimulus for enhanc- ing immune

2016 American Academy of Neurology

186. Paediatric Urology

]. This treatment has no side effects and the mean bloodspot cortisol levels are not significantly different from an untreated group of patients [10] (LE: 1b). The hypothalamic- pituitary-adrenal axis was not influenced by local corticoid treatment [11]. Agglutination of the foreskin does not respond to steroid treatment [7] (LE: 2). PAEDIATRIC UROLOGY - LIMITED UPDATE MARCH 2015 9 Operative treatment of phimosis in children is dependent on the parents’ preferences and can be plastic or radical circumcision

2015 European Association of Urology

188. Chronic Pelvic Pain

A in pelvic pain 41 5.4.3 Sacral neuromodulation and percutaneous tibial nerve stimulation in pelvic pain 41 5.4.4 Intermittent chronic anal pain syndrome 41 5.5 Summary 41 5.5.1 Conclusions and recommendations: anorectal pain syndrome 42 6. PERIPHERAL NERVE PAIN SYNDROMES 43 6.1 Neuropathic pain 43 6.2 Anatomy 44 6.2.1 The posterior subgluteal triangle nerves 44 6.2.2 Branches of the pudendal nerve 44 6.2.3 Anatomical relations of the pudendal nerve 44 6.2.4 Afferent nerves and the genitalia 45 6.2.5 (...) significant end-organ dysfunction. These functional abnormalities can have a significant effect on quality of life (QoL) and must be managed as appropriate. 2.2.8 Endocrine system The endocrine system is involved in visceral function. Significant life events, and in particular, early life events may alter the development of the hypothalamic-pituitary-adrenal axis and the chemicals released. Increased vulnerability to stress may occur following such events and is thought to be partly due to increased

2015 European Association of Urology

189. Task Force 5: Pediatric Cardiology Fellowship Training in Critical Care Cardiology

basic patient assessment and stabilization skills, command a clear understanding of complex cardiovascular anatomy and physi- ology, know the effects of pharmacological agents on cardiac physiology, and function as an effective communicator within a multidisciplinary team (MDT). The experience garnered by a pediatric cardiology trainee in the pediatric cardiac intensive care unit (CICU) concentrates the educational opportunity to refine these skill sets and is an important part of cardiology (...) ventricles stressed by abnormal preload or afterload • Cavopulmonary connection physiology 3.3.3. Pharmacology and Relationship to Cardiovascular Physiology The trainee should show competency in understanding the actions, mechanisms of action, side effects, and clinical use of these pharmacological agents: • Inotropic agents (eg, digoxin, adrenergic agonists, phos- phodiesterase inhibitors) • Vasodilators/antihypertensive agents (eg, alpha-adren- ergic antagonists, angiotensin-converting enzyme

2015 American Heart Association

190. Renal Cell Carcinoma Staging

/renal sinus fat or renal vein is staged as T3a; extension of tumor thrombus into the inferior vena cava (IVC) is staged T3b or T3c. Adjacent organ involvement, including extension beyond the Gerota fascia or involvement of the ipsilateral adrenal gland, is T4 disease. Perinephric tumor extension (T3a) is difficult to discriminate from nonspecific perinephric stranding due to edema, vascular engorgement, or fibrosis. High-resolution CT using thin sections appears to improve detection of perinephric (...) these structures. Some urologists rely on intraoperative frozen sections, when available, to make these determinations. [47]. Direct contiguous spread to the adrenal gland is classified as T4. CT has a high sensitivity and nearly a 100% negative predictive value in detecting direct contiguous spread to the ipsilateral adrenal gland [22,48]. However, the positive predictive value of CT is lower, as it may be difficult to distinguish abutment from direct invasion. The extent of venous invasion of tumor

2015 American College of Radiology

193. Interventional Spine and Pain Procedures in Patients on Antiplatelet and Anticoagulant Medications

. Moreover, patients after various spine surgeries may develop fibrous adhesions and scar tissue, thus further compromising the capacity of the epidural space and distorting the anatomy of the epidural vessels. The risk of bleeding is further increased in pain patients taking several concomitant medications with antiplatelet effects including NSAIDs, ASA, and SSRIs. | Anatomic Considerations for Hematoma Development in Spinal and Nonspinal Areas Although most cases of a spinal hematoma have (...) a multifactorial etiology, certain anatomic features may pose higher risks secondary to the anatomy and vascular supply of that specific spinal location. It is important for interventional pain physicians to apply knowledge of spinal and epidural anatomy during preprocedural planning. Contents of the epidural space include the epidural fat, dural sac, spinal nerves, extensive venous plexuses, lymphatics, and connective tissue (eg, plica mediana dorsalis and scar tissue after previous surgical intervention

2015 American Society of Regional Anesthesia and Pain Medicine

194. 2015 American Thyroid Association Management Guidelines for Adult Patients with Thyroid Nodules and Differentiated Thyroid Cancer

thyroid uptake (60–62). Focal thyroid uptake most often corresponds to a clinically relevant thyroid nodule, and US examination is thus rec- ommended to de?ne thyroid anatomy. Importantly, focal 18 FDG-PET uptake increases malignancy risk in an affected nodule, and therefore clinical evaluation and FNA of nodules ‡1 cm is recommended. 18 FDG-PET positive thyroid nodules 25%–50% cystic component) (64) or sampling error (dif?cult to palpate or posteriorly located nodules), US-guided FNA is preferred

2015 Pediatric Endocrine Society

196. Aortic Diseases

Diagnosis . . . . . . . . . . . . . . . . . . . . . . . . . . . .2902 7.1.2 Anatomy. . . . . . . . . . . . . . . . . . . . . . . . . . . . .2902 7.1.3 Evaluation . . . . . . . . . . . . . . . . . . . . . . . . . . . .2902 7.1.4 Naturalhistory . . . . . . . . . . . . . . . . . . . . . . . . .2903 7.1.4.1 Aorticgrowthinfamilialthoracicaorticaneurysms2903 7.1.4.2 Descendingaorticgrowth . . . . . . . . . . . . . . .2903 7.1.4.3 Riskofaorticdissection . . . . . . . . . . . . . . . . .2903 7.1.5 Interventions (...) )] and blood pressure. 21–26 In this regard, the rate of aortic expansion is about 0.9 mm in men and 0.7 mm in women for each decade of life. 26 This slow but progressive aortic A o r t i c a r c h Ascending aorta Descending aorta Thoracic aorta Abdominal aorta Infrarenal Diaphragm Aortic annulus Sinuses of valsalva Sinotubular junction Suprarenal Aortic root rPA Figure1 Segmentsoftheascendinganddescendingaorta.rPA=rightpulmonaryartery. ESCGuidelines 2879 Downloaded from https://academic.oup.com/eurheartj

2014 European Society of Cardiology

197. Evaluation of ambiguous genitalia. (Abstract)

Evaluation of ambiguous genitalia. To provide a framework for the evaluation of ambiguous genitalia.The most pressing evaluation of ambiguous genitalia is assessment for life-threatening causes such as salt-wasting congenital adrenal hyperplasia (CAH) or syndromes with underlying anomalies such as neurologic or cardiac malformations. A multidisciplinary team, including specialists in Gynecology, Endocrinology, Urology, Genetics, Clinical Psychology/Psychiatry, Radiology, Nursing, Neonatology (...) , and Pediatric Surgery, should be involved. Each patient should be approached in an individualized manner to assign sex of rearing in the most expeditious yet thoughtful means possible.As knowledge on the natural history of sex preference and fertility of individuals with ambiguous genitalia increases, controversy regarding the indication for and timing of genital surgery continues. Considerations include gender identity, future fertility, malignancy risk, infection prevention, and functional anatomy

2019 Current Opinion in Obstetrics and Gynecology

198. Itching for an Answer: A Review of Potential Mechanisms of Scalp Itch in Psoriasis. Full Text available with Trip Pro

Itching for an Answer: A Review of Potential Mechanisms of Scalp Itch in Psoriasis. Scalp psoriatic itch is a common complaint and often poses a therapeutic challenge. The pathophysiology of this phenomenon is unclear. The unique anatomy of the scalp contains richly innervated hair follicles, abundant vasculature and perifollicular inflammatory cytokines which may all contribute to this common sensory complaint. The mast cell, in particular, is portrayed as one of the main itch conductors (...) for its ability to trigger neurogenic inflammation, activate the peripheral hypothalamic pituitary adrenal (HPA)-axis, process and integrate itch signaling through its interactions with the scalp hair follicles. Herein we explain and speculate upon potential mechanisms underlying itchy scalp psoriasis, involving interconnections between the neuroimmune, neurovascular, and neuroendocrine systems. Many factors may play roles in itchy scalp psoriasis including the scalp hair structure, immune system

2019 Experimental Dermatology

200. Breastfeeding problems

and facial features. Oral anatomy (ankyloglossia, palate, jaw, and lips) or oral Candida infection that may affect sucking and swallowing. Any nasal congestion. Muscle tone, neurological maturity, behaviour. Consider use of the UNICEF UK Baby Friendly Initiative which may indicate when there is a breastfeeding problem requiring further assessment and observation of a full breastfeed. Ensure that a person with appropriate training and expertise (such as a health visitor or breastfeeding specialist

2017 NICE Clinical Knowledge Summaries

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