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621. Sedation (Overview)

at risk for hemodynamic compromise. The recommended dose for intubation is 0.3 mg/kg in adults and children, although the dose may be reduced to 0.15 mg/kg in critically ill patients. It can be also be used in procedures as a one-time dose. Etomidate has been shown to depress adrenal cortical function in critically ill patients, [ , ] but this may not be clinically significant in short-term administration. [ ] Because of this effect and because the drug is mixed in propylene glycol, neither titration (...) . Previous Next: Pediatric Considerations Essentially all the sedatives and analgesics listed above can be used in children. However, the clinician should recognize the differences between children and adults and how that relates to the type of sedation chosen. Differences exist in cognitive abilities and developmental status, respiratory mechanics, airway anatomy, drug metabolism, and toxic dosages. Presedation assessment of a child is very different than that of adults and must adapt to the limited

2014 eMedicine Emergency Medicine

622. Pneumonia, Aspiration (Overview)

aspiration pneumonia have one or more of the predisposing conditions listed below. Although all the listed conditions predispose the patient to chemical pneumonitis, conditions that alter consciousness and periodontal disease specifically predispose the patient to bacterial pneumonia. The basic pathogenesis of any aspiration event involves impaired swallowing, whether related to medications, anatomy, or neurologic dysfunction. A group that warrants special mention is head and neck cancer patients (...) in the treatment of aspiration pneumonitis, but randomized control studies have been unable to demonstrate a benefit to using high-dose corticosteroids. The role of supplementing corticosteroids in patients with hypotension from septic shock remains controversial. Previously, it was recommended that septic patients who were hypotensive despite fluid resuscitation and vasopressor support be screened for occult adrenal insufficiency. However, current guidelines recommend empiric therapy with stress-dose steroids

2014 eMedicine Emergency Medicine

623. Leptospirosis in Humans (Overview)

, India in 2005, involvement of the cardiovascular system was found in 41 of 44 cases. Interstitial myocarditis was the predominant feature on histopathological examination. These authors suggested that leptospirosis be viewed as an infective systemic vasculitis. [ ] Hemorrhage, focal necrosis, and inflammatory infiltration have been documented within the adrenal gland. Although these complications do not appear clinically, some researchers speculate that adrenal insufficiency may mediate, in part (...) . Cochrane Database Syst Rev . 2000. CD001305. . CDC. Adventure Racing and Leptospirosis. Centers for Disease Control and Prevention. Available at . April 17, 2015; Accessed: June 13, 2018. Agampodi SB, Matthias MA, Moreno AC, Vinetz JM. Utility of quantitative polymerase chain reaction in leptospirosis diagnosis: association of level of leptospiremia and clinical manifestations in Sri Lanka. Clin Infect Dis . 2012 May. 54(9):1249-55. . . AREAN VM. The pathologic anatomy and pathogenesis of fatal human

2014 eMedicine Emergency Medicine

624. Meningitis (Overview)

middle membrane Subarachnoid space - A delicate, fibrous inner layer that contains many of the blood vessels that feed the brain and spinal cord Risk factors for meningitis include the following: Extremes of age (< 5 or >60 years) Diabetes mellitus, chronic kidney failure, adrenal insufficiency, hypoparathyroidism, or cystic fibrosis Immunosuppression, which increases the risk of opportunistic infections and acute bacterial meningitis HIV infection, which predisposes to bacterial meningitis caused (...) . (See Etiology and Presentation.) Anatomically, meningitis can be divided into inflammation of the dura (sometimes referred to as pachymeningitis), which is less common, and leptomeningitis, which is more common and is defined as inflammation of the arachnoid tissue and subarachnoid space. (See Anatomy.) Meningitis can also be divided into the following 3 general categories: Bacterial (pyogenic) Granulomatous Aseptic The most common cause of meningeal inflammation is bacterial or viral infection

2014 eMedicine Emergency Medicine

625. Aneurysm, Abdominal (Overview)

Aneurysm, Abdominal (Overview) Abdominal Aortic Aneurysm: Practice Essentials, Background, Anatomy Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTk3OTUwMS1vdmVydmlldw== processing > Abdominal Aortic Aneurysm (...) angiography (CTA) - This form of imaging is the main modality for defining and planning open or endovascular AAA repair; CT offers certain advantages over ultrasonography in defining aortic size, rostral-caudal extent, involvement of visceral arteries, and extension into the suprarenal aorta Magnetic resonance imaging - This permits imaging of the aorta comparable to that obtained with CT and ultrasonography, without subjecting the patient to dye load or ionizing radiation Angiography - With the fine

2014 eMedicine Emergency Medicine

626. Aneurysm, Abdominal (Follow-up)

. [ ] Table 1. Operative Mortality Risk With Open Repair of Abdominal Aortic Aneurysm Lowest Risk Moderate Risk High Risk Age < 70 y Age 70-80 y Age 80 y Physically active Active Inactive, poor stamina No clinically overt cardiac disease Stable coronary disease; remote MI; LVEF >35% Significant coronary disease; recent MI; frequent angina; CHF; LVEF < 25% No significant comorbidities Mild COPD Limiting COPD; dyspnea at rest; O 2 dependency; FEV 1 < 1 L/sec ... Creatinine 2.0-3.0 mg/dL ... Normal anatomy (...) Adverse anatomy or AAA characteristics Creatinine >3 mg/dL No adverse AAA characteristics ... Liver disease (↑PT; albumin < 2 g/dL) Anticipated operative mortality, 1-3% Anticipated operative mortality, 3-7% Anticipated operative mortality, at least 5-10%; each comorbid condition adds ~3-5% mortality risk AAA = abdominal aortic aneurysm; CHF = chronic heart failure; COPD = chronic obstructive pulmonary disease; FEV 1 = forced expiratory volume in 1 second; LVEF = left ventricular ejection fraction; MI

2014 eMedicine Emergency Medicine

627. Aneurysm, Abdominal (Treatment)

. [ ] Table 1. Operative Mortality Risk With Open Repair of Abdominal Aortic Aneurysm Lowest Risk Moderate Risk High Risk Age < 70 y Age 70-80 y Age 80 y Physically active Active Inactive, poor stamina No clinically overt cardiac disease Stable coronary disease; remote MI; LVEF >35% Significant coronary disease; recent MI; frequent angina; CHF; LVEF < 25% No significant comorbidities Mild COPD Limiting COPD; dyspnea at rest; O 2 dependency; FEV 1 < 1 L/sec ... Creatinine 2.0-3.0 mg/dL ... Normal anatomy (...) Adverse anatomy or AAA characteristics Creatinine >3 mg/dL No adverse AAA characteristics ... Liver disease (↑PT; albumin < 2 g/dL) Anticipated operative mortality, 1-3% Anticipated operative mortality, 3-7% Anticipated operative mortality, at least 5-10%; each comorbid condition adds ~3-5% mortality risk AAA = abdominal aortic aneurysm; CHF = chronic heart failure; COPD = chronic obstructive pulmonary disease; FEV 1 = forced expiratory volume in 1 second; LVEF = left ventricular ejection fraction; MI

2014 eMedicine Emergency Medicine

628. Neoplasms, Lung (Overview)

, such as , , and have all been shown to be associated with increased lung cancer rates. The current multiple hit theory suggests that a series of toxic cellular insults disrupts orderly genetic reproduction. Symptoms ultimately develop from the uncontrolled disorganized growth that interferes with local or distant anatomy or physiologic processes. [ ] A study by Ito et al assessed the shift in histologic types of lung cancer in Japan and the United States in relation to the shift from nonfiltered to filtered

2014 eMedicine Emergency Medicine

629. The Effects of an Intensive Lifestyle Intervention on Reproductive Outcomes

conception) Ovulatory dysfunction (amenorrhea, irregular cycles, or progesterone level less than 10 ng/mL in the luteal phase) Partner with semen analysis demonstrating at least 20 million sperm/mL, 50% motility, and normal morphology by Kruger criteria of 8% Evidence of normal uterine anatomy and at least on patent tube documented by hysterosalpingogram or saline infusion sonogram. Women with polycystic ovary syndrome Exclusion Criteria: Significant heart disease (coronary artery disease, Class II-VI (...) Heart Failure, arrythmia) Chronic Kidney Disease, Stage IV or greater Significant gastrointestinal tract diseases (e.g. IBD) Autoimmune disorders (e.g. systemic lupus erythematosus) Neurological (e.g. Multiple Sclerosis) Psychiatric disorders (Bipolar, Major Depression) History of or current eating disorders or substance abuse Endocrine disorders (Type 1 diabetes, adrenal, pituitary or uncontrolled thyroid disease) HIV/AIDS Significant anemia History of or current clotting disorder Cancer other than

2013 Clinical Trials

630. A Study of Renal Denervation in Patients With Treatment Resistant Hypertension

and at randomization, one of which must be a diuretic (a medication can be counted more than once if it acts on different receptors) Suitable renal artery anatomy based on CT/MRI/renal angiography imaging: both renal arteries > 20 mm in length and > 4 mm in diameter without significant fibromuscular disease or renal artery stenosis (>50%) Exclusion Criteria: Secondary causes of hypertension: Primary aldosteronism (secondary to adrenal adenoma) Chronic kidney disease: creatinine clearance or eGFR < 45 ml/min/1.73m

2013 Clinical Trials

631. Study of Renal Denervation in Patients With Heart Failure

renal artery anatomy for Renal Sympathetic Denervation (RSD) procedure. All of the following criteria must be met, based on the screening renal Doppler ultrasound: ≥ 20mm treatable length in each renal artery, Diameter in treatable segments must be ≥4mm, Lone main renal vessel feeding each kidney. Exclusion Criteria: Unable to comply with protocol or procedures. Evidence of orthostatic hypotension or known dysautonomia. Orthostatic hypotension is defined by ≥1 of the following feature(s) within 2-5 (...) in another clinical trial within the next 12 months. History of urinary outflow tract obstruction, bladder retention and/ or moderate to severe prostate hypertrophy. History of adrenal insufficiency History of untreated hypothyroidism Patients with non-cardiac dyspnea or fatigue due to frailty, motivational factors, pulmonary disease or orthopedic problems that precludes them from performing 6MWT (Six-Minute WalkTest). Contacts and Locations Go to Information from the National Library of Medicine

2013 Clinical Trials

632. Fenestrated endografting of juxtarenal aneurysms after open aortic surgery. Full Text available with Trip Pro

Fenestrated endografting of juxtarenal aneurysms after open aortic surgery. Juxtarenal aneurysms after previous surgical aortic reconstruction constitute a complex clinical scenario. Open redo surgery is technically demanding and usually requires suprarenal or supraceliac clamping. Standard endovascular repair is prohibited due to the lack of a proximal landing zone. We present our experience with fenestrated endovascular aneurysm repair (F-EVAR) in the treatment of juxtarenal aneurysms after (...) patients (33 male; mean age, 71.5 ± 6.2 years) were treated. Median interval from the primary surgical reconstruction was 126 months (range, 48-223 months). All patients had proximal anatomies precluding standard endovascular techniques and were considered high risk for open repair due to their comorbidities and redo nature of the operation. In total, 111 vessels were targeted: 77 with small fenestrations, 33 with scallops, and 1 vessel with a downward branch. The operation was completed by totally

2013 Journal of Vascular Surgery

633. When the chimney is blocked: malignant renovascular hypertension after endovascular repair of abdominal aortic aneurysm. Full Text available with Trip Pro

When the chimney is blocked: malignant renovascular hypertension after endovascular repair of abdominal aortic aneurysm. The Chimney graft (CG) procedure is one of the novel modification techniques of the endovascular aneurysm repair (EVAR) surgery to treat suprarenal and juxtarenal abdominal aortic aneurysms. Other indications for the use of CG placement include thoracic and thoracoabdominal aneurysms with supraortic branches orifice involvement and cases of common iliac artery aneurysms (...) and conservative treatment was chosen. Seven months after presentation, blood pressure was within normal ranges with little need for antihypertensive therapy.Physicians should be aware that the novel emerging techniques of EVAR to overcome the limitations of the aortic-neck anatomy may still adversely influence the renal outcome with potential development of new-onset hypertension.

2013 BMC Nephrology

634. The shocking confessions of a naturopathic doctor

, hydrotherapy, craniosacral therapy, chiropractic manipulation, and naturopathic philosophy. Some classes are taught with the same titles as courses in medical programs, but the content is indeed inferior. NDs take gross anatomy, histology, pharmacology, and other basics, but they are not all taught by faculty members with academic expertise. For example, a person who is a “doctor of naprapathy” taught me embryology, and other courses were taught by NDs, often using naturopathic textbooks. Naturopathic (...) not seen. All of this happens under the supervision of instructors, who were educated and trained under this system or one with weaker requirements before the 1990s. Naturopathic students are not trained in medical standards of care, let alone reality. Instructors would commonly discuss a patient’s “vital force” as if this could magically be detected. Frequently, patients presenting with nonspecific symptoms were diagnosed with dubious food allergies, chronic Lyme disease, adrenal fatigue, or yeast

2016 KevinMD blog

635. Sympathetic Nervous System

(ionotropic), Increases and bronchodilation Increases pupil size or (contrast with and accommodation by the ) Stimulates ry VISCOUS secretion (contrast with watery secretion by ) Stimulates sweat secretion (via postganglionic fibers) Decreases gastrointestinal activity and secretion, and contracts gastrointestinal sphincters Stimulates liver gluconeogenesis and glycogenesis and fat lipolysis Stimulates renin release and adrenal medulla release ( postganglionic fibers) Mediates ejaculation (contrast (...) with mediated by ) Shunts blood flow to critical organs Cardiac muscle and skeletal muscle vasodilation (beta-2 receptor) Skin and gastrointestinal striction (alpha-1 receptor) IV. Anatomy Thoracolumbar division of the Signals originate in the spinal cord intermediolateral column (T1 to L2) Transmit to target organs via paravertebral or prevertebral ganglia V. Pathophysiology See VI. References Goldberg (2014) Clinical , Medmaster, p. 54-60 Netter (1997) Atlas Human Anatomy, ICON Learning, p. 152-4 Images

2015 FP Notebook

636. Vascutek Anacondaâ„¢ Abdominal Aortic Aneurysm (AAA) Post-Market Surveillance Registry

thus preventing graft migration. The iliac limbs are fully supported with Nitinol and the bifurcate bodies feature a distal contra-lateral lumen Nitinol support, which in conjunction with a unique intrinsic magnet guidewire system facilitates cannulation of the bifurcate section. The system is available in a wide range of sizes thus making it a flexible and adaptable stent graft system with the potential to repair diverse patient anatomy. Study Design Go to Layout table for study information Study (...) and older (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Sampling Method: Non-Probability Sample Study Population Patients implanted with a CE-Marked Vascutek Anaconda™ Stent Graft System for Infra-Renal Abdominal Aortic Aneurysm Repair Criteria Inclusion Criteria: Patient is implanted with Anaconda™ Stent Graft System Exclusion Criteria: Ruptured or symptomatic aneurysm Juxta or Suprarenal extension of aneurysm Clinically serious concomitant medical disease

2012 Clinical Trials

637. Neonatal Midaortic Syndrome and Renal Artery Atresia Presenting as Malignant Hypertension. (Abstract)

Neonatal Midaortic Syndrome and Renal Artery Atresia Presenting as Malignant Hypertension. We report a case of congenital midaortic syndrome with bilateral renal artery atresia in a premature female neonate born by way of caesarean section secondary to acute onset of decreased fetal movement and polyhydramnios. The infant required cardiopulmonary resuscitation at birth, and initial echocardiogram exhibited normal intracardiac anatomy and mildly depressed left-ventricular systolic function (...) . Within 24 h, the neonate developed severe systemic arterial hypertension and acute renal failure. Ultrasound demonstrated hyperechoic kidneys and a hypoplastic abdominal aorta. Angiography revealed severe suprarenal hypoplasia of the abdominal aorta with bilateral renal artery atresia. Medical support was withdrawn, and the patient died shortly thereafter.

2012 Pediatric Cardiology

638. Aortic banding and endovascular aneurysm repair in a case of juxtarenal aortic aneurysm with unsuitable infrarenal neck. Full Text available with Trip Pro

Aortic banding and endovascular aneurysm repair in a case of juxtarenal aortic aneurysm with unsuitable infrarenal neck. The proximal aortic neck is one of the limiting factors for endovascular aneurysm repair (EVAR) and represents a crucial factor for success or failure of the procedure. In contrast to open surgery, where a clamp can be placed suprarenally but the repair performed infrarenally, EVAR requires a good infrarenal neck for durable fixation and seal. In a high-risk surgical 79-year (...) -old patient with juxtarenal aortic aneurysm with unsuitable infrarenal neck, a hybrid procedure was chosen: juxtarenal aortic banding and EVAR. The banding allowed a successful EVAR by reshaping the juxtarenal aneurysmal aortic segment, hence converting a previously untreatable anatomy into a treatable one.Copyright © 2012 Society for Vascular Surgery. Published by Mosby, Inc. All rights reserved.

2012 Journal of Vascular Surgery

639. The in vitro enzymic hydroxylation of steroid hormones. 1. Factors influencing the enzymic 11β-hydroxylation of 11-deoxycorticosterone Full Text available with Trip Pro

Desoxycorticosterone OM Adrenal Cortex anatomy & histology Desoxycorticosterone Hydroxylation In Vitro Techniques Mitochondria Steroids 5426:35005:11:134:285 ADRENAL CORTEX/anatomy and histology DESOXYCORTICOSTERONE MITOCHONDRIA 1954 6 1 1954 6 1 0 1 1954 6 1 0 0 ppublish 13172177 PMC1269740 J Biol Chem. 1953 Mar;201(1):93-102 13044778 Biochem J. 1953 Jul 17;55(320th Meeting):xxii 13093706 Arch Biochem Biophys. 1952 May;37(1):140-6 14953424 Science. 1951 Jul 20;114(2951):61-2 14854902 J Biol Chem. 1950 Oct;186(2

1954 Biochemical Journal

640. A quantitative study of the effects of compound E, compound F, and compound A, upon the bone marrow of the guinea-pig Full Text available with Trip Pro

A quantitative study of the effects of compound E, compound F, and compound A, upon the bone marrow of the guinea-pig 13162928 2003 05 01 2018 12 01 0021-8782 88 2 1954 Apr Journal of anatomy J. Anat. A quantitative study of the effects of compound E, compound F, and compound A, upon the bone marrow of the guinea-pig. 115-31 YOFFEY J M JM ANCILL R J RJ HOLT J A JA OWEN-SMITH B B HERDAN G G eng Journal Article England J Anat 0137162 0021-8782 0 Adrenal Cortex Hormones V27W9254FZ Cortisone OM (...) Adrenal Cortex Adrenal Cortex Hormones Bone Marrow drug effects Cortisone pharmacology Guinea Pigs 5426:25628:12:78:121 ADRENAL CORTEX/hormones BONE MARROW/effect of drugs on CORTISONE/effects 1954 4 1 1954 4 1 0 1 1954 4 1 0 0 ppublish 13162928 PMC1244700 Blood. 1952 Nov;7(11):1125-7 12997527 Br Med J. 1951 Mar 31;1(4708):660-6 14821502 Blood. 1951 Jun;6(6):513-21 14838962 AMA Arch Intern Med. 1951 Sep;88(3):310-36 14856459 Endocrinology. 1951 Oct;49(4):497-511 14887664 Br Med J. 1952 May 10;1(4766

1954 Journal of anatomy

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