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Congenital Heart Disease Imaging in Adults

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3761. Recommended procedure for the Caloric test

months) or is undergoing cardiac investigations 2 ? Psychotic/neurotic disorders (acute or de-compensated phase) ? Epilepsy (acute or de-compensated phase) ? Eye surgery (within the previous 3 months) ? Ear surgery (within the previous 6 months) The next list shows the second level of contraindications / special precautions, which should be checked for compliance at the time of the appointment by the testier as well as by the referring physician and which also may contraindicate performance (...) . Calibration 13 5.2.3. Recording Conditions 13 5.2.4. Problem with making recordings with eyes closed 14 6. Caloric irrigation, measurement and analysis of responses 14 6.1. Caloric irrigation 14 6.2. Measurement of the caloric response 15 6.3. Analysis of results 16 6.4. Normal Limits 17 6.5. Reporting of Results 17 6.6. Test modifications 18 7. References 18 Appendix A. Committee members and advisors 21 Appendix B. Common test modifications 23 B.01 Motion sickness 23 B.02 ‘Ice water’ caloric test 23

2010 British Society of Audiology

3762. Primary pulmonary hypertension, cerebrovascular malformation, and lymphoedema feet in a family. Full Text available with Trip Pro

Primary pulmonary hypertension, cerebrovascular malformation, and lymphoedema feet in a family. 5718986 1969 05 22 2018 11 13 0007-0769 30 6 1968 Nov British heart journal Br Heart J Primary pulmonary hypertension, cerebrovascular malformation, and lymphoedema feet in a family. 769-75 Avasthey P P Roy S B SB eng Journal Article England Br Heart J 0370634 0007-0769 AIM IM Adolescent Adult Arteriovenous Fistula congenital Arteriovenous Malformations Carotid Arteries abnormalities diagnostic (...) imaging Cerebral Arteries abnormalities Electrocardiography Female Foot Diseases genetics Heart Auscultation Humans Hypertension, Pulmonary genetics Lymphedema genetics Male Pedigree Radiography Respiratory System diagnostic imaging 1968 11 1 1968 11 1 0 1 1968 11 1 0 0 ppublish 5718986 PMC487800 Arch Intern Med. 1966 Nov;118(5):422-6 5922239 Br Heart J. 1966 Mar;28(2):193-8 4283636 Bull N Y Acad Med. 1954 Mar;30(3):195-207 13141055 Bull Johns Hopkins Hosp. 1955 Aug;97(2):69-111 13250284 Br Heart J

1968 British Heart Journal

3763. Pneumonectomy-CXR

esophageal recess on right. Space in pneumonectomy on right is mostly filled by heart 3. Anterior herniation is more common because heart rotates and occupied the posterolateral space on left in case of ipsilateral pneumonectomy. Rarely posterior herniation can occur above or below the azygos arch (azygoesophageal recesses ) 4. Congenital absence makes the chest much smaller with crowded ribs more accentuated Pneumonectomy-CXR Reviewed by Sumer Sethi on Thursday, April 30, 2015 Rating: 5 Tags : Sumer (...) a... But test results provide little insight into how he died King Tut wasn't murdered by a blow to the head, nor was his chest crushed i... Maffucci syndrome is characterized by benign enlargements of cartilage (enchondromas); bone deformities; and dark, irregularly shaped... WHO brain tumour classification has been updated in 2016. The 2016 World Health Organization Classification of Tumors of the Central Nervo... NBE has introduced FNB for Interventional Radiology, Breast imaging and Body Imaging. Tissue

2015 Sumer's Radiology Blog

3764. Liver Biopsy

autoimmune hepatitis (AIH) and nonalcoholic fatty liver disease (NAFLD) in an obese patient with elevated levels of ala- nine aminotransferase (ALT), raised immunoglobulin G concentration (IgG), and/or a positive antinuclear anti- body(ANA)titer.Liverhistologymayalsobeveryhelpful in patients with coexisting disorders such as steatosis and HCV or hemochromatosis 10,11 or an “overlap” syndrome of PBC with AIH. 12 Itislikelythatliverbiopsywillalwaysplayaroleinthe management of the patient with a diagnostic (...) training so as to ensure appropriate-sizedspecimenretrievalandthelowestrateof complications. Although liver biopsy is often essential in the management of patients with liver disease, physicians and patients may ?nd it to be a dif?cult undertaking because of the associated risks. The purpose of this prac- tice guideline is to summarize the current practice of liver biopsy and make recommendations about its perfor- mance. This guideline deals exclusively with liver biopsy as it relates to adult liver

2009 American Association for the Study of Liver Diseases

3765. Non-emergency telecardiology consultation services: rapid review of clinical and cost outcomes

13 (cardiology or cardiologist or cardiologists).ti,ab. 14 (heart disease* or heart failure or cardiac disease* or coronary disease* or heart valve disease*).ti,ab. 15 or/4-14 16 exp Telemedicine/ use prmz 17 Telemetry/ use prmz 18 exp *Telehealth/ use emef 19 (videoconferencing or videoconference or videoconferences or telecommunication or teletransmission or transtelephonic or trans telephonic or telehealth or tele-health or telecare or telemedic* or tele-medic* or telemonitor* or tele-monitor (...) remote compared with hands-on echocardiograms, and cost savings in the avoidance of patient transfers from regional to tertiary care hospitals. Three reports of a second UK study concluded that the telecardiology program that was used to detect congenital heart defects in fetuses, newborns, infants, and children was reliable with similar costs to those of usual care. A cost-minimization study from Sweden reported that the remote diagnosis of heart failure in adults reduced travel time for patients

2011 EvidenceUpdates

3766. EANM guidelines for ventilation / perfusion scintigraphy - Part 1

rules. PE should be reported when mismatch of more than one subsegment is found.ForthediagnosisofchronicPE,V/P SCAN isofvalue. The additional diagnostic yield from V/P SCAN includes chronic obstructive lung disease (COPD), heart failure and pneumonia. Pitfalls in V/P SCAN interpretation are consid- ered. V/P SPECT is strongly preferred to V/P PLANAR as the former permits the accurate diagnosis of PE even in the presence of comorbid diseases such as COPD and pneumo- nia. Technegas is preferred (...) to DTPA in patients withCOPD. Keywords Pulmonaryembolism . Radioncuclideimaging . Ventilationperfusionscintigraphy . Singlephotonemission tomography . MultidetectorCTscan’ Abbreviations COPD Chronic obstructive pulmonary disease DTPA Diethylene triamine pentaacetic acid DVT Deep venous thrombosis MAA Macroaggregated human albumin MDCT Multidetector computed tomography of the pulmonary arteries PA Contrast-enhanced pulmonary angiography Eur J Nucl Med Mol Imaging (2009) 36:1356–1370 DOI 10.1007/s00259

2009 European Association of Nuclear Medicine

3767. Painless Scrotal Mass

Necrosis Which of the following is a more common cause of acute tubular necrosis (ATN)? Ethylene glycol poisoning Burns Renal hypoperfusion Rhabdomyolysis NEWS & VIDEOS Endogenous Testosterone Linked to Cardiovascular Disease THURSDAY, March 7, 2019 (HealthDay News) -- In men, endogenous testosterone may have a causal role in thromboembolism, heart failure, and myocardial infarction, according to a study published... 3D Model Male Reproductive System Video How to do Urethral Catheterization in Males (...) in the inguinal canal Clinical evaluation Varicocele Palpable when standing (enhanced with Valsalva), feeling like a bag of worms Usually on left side Possibly pain and fullness when standing Possibly testicular atrophy Clinical evaluation Hematocele Tender swelling Risk factors (eg, trauma, surgery, bleeding disorder or use of anticoagulants) Usually ultrasonography Fluid overload Diffuse, bilateral enlargement of scrotal sac Often pitting Often causative disorder evident (eg, heart failure, ascites

2013 Merck Manual (19th Edition)

3768. Late Preterm Infant

dysfunction. Cardiac The overall incidence of structural congenital heart defects among premature infants is low. The most common cardiac complication is (PDA) The ductus arteriosus is more likely to fail to close after birth in premature infants. The incidence of PDA increases with increasing prematurity; PDA occurs in almost half of infants < 1750 g birth weight and in about 80% of those < 1000 g. About one third to one half of infants with PDA have some degree of heart failure. Premature infants ≤ 29 (...) and ], ). There are many risk factors: Past obstetric history (biggest risk factor) Prior multiple and/or Current pregnancy-related factors Pregnancy achieved by Little or no prenatal care Poor nutrition during gestation (and perhaps before) Younger or older (eg, < 16, > 35) Untreated infections (eg, , [formerly chorioamnionitis]) (eg, twins, triplets) (formerly cervical incompetence) Certain congenital defects (fetuses with structural congenital heart defects are nearly twice as likely to be delivered prematurely

2013 Merck Manual (19th Edition)

3769. Hypothyroidism

manifestations: Slow heart rate (a decrease in both thyroid hormone and adrenergic stimulation causes bradycardia), enlarged heart on examination and imaging (partly because of dilation but chiefly because of pericardial effusion; pericardial effusions develop slowly and only rarely cause hemodynamic distress) Other manifestations: Pleural or abdominal effusions (pleural effusions develop slowly and only rarely cause respiratory or hemodynamic distress), hoarse voice, and slow speech Pretibial Myxedema (Mild (...) to 150 mcg po once/day, depending on age, body mass index, and absorption (for pediatric doses, see ). The starting dose in young or middle-aged patients who are otherwise healthy can be 100 mcg or 1.7 mcg/kg po once/day. However, in patients with heart disease, therapy is begun with low doses, usually 25 mcg once/day. The dose is adjusted every 6 wk until maintenance dose is achieved. The maintenance dose may need to be increased in pregnant women. Dose may also need to be increased if drugs

2013 Merck Manual (19th Edition)

3770. Leishmaniasis

fly bite in the skin to regional lymph nodes, the spleen, the liver, and bone marrow and cause symptoms. Subclinical infections are common; only a minority of infected patients develop progressive visceral disease. Symptomatic infection with L. infantum is more common among children than adults. Visceral leishmaniasis is an opportunistic infection in patients with AIDS or other immunocompromising conditions. Symptoms and Signs In cutaneous leishmaniasis, a well-demarcated skin lesion develops (...) are phagocytized by host macrophages; inside these cells, they transform into amastigotes. Leishmania life cycle. Leishmania life cycle."> Image from the Centers for Disease Control and Prevention Image Library. The parasites may remain localized in the skin or spread to the mucosa of the nasopharynx or disseminate to bone marrow, the spleen, the liver, and occasionally other organs, resulting in 3 major clinical forms of leishmaniasis: Cutaneous Mucosal Visceral Cutaneous leishmaniasis is also known

2013 Merck Manual (19th Edition)

3771. Hepatic Fibrosis

abnormalities (eg, Gaucher disease) Peroxisomal disorders (eg, Zellweger syndrome) Tyrosinemia Congenital hepatic fibrosis Infections Bacterial (eg, brucellosis) Parasitic (eg, echinococcosis) Viral (eg, chronic hepatitis B or C*) Disorders affecting hepatic blood flow Heart failure † Drugs and chemicals Alcohol* Amiodarone Chlorpromazine Isoniazid Methotrexate Methyldopa Oxyphenisatin Tolbutamide Mechanical obstruction Scarring due to prior liver surgery Bile duct strictures due to impacted *Most common (...) ). After months or years of chronic or repeated injury, fibrosis becomes permanent. Fibrosis develops even more rapidly in mechanical biliary obstruction. Table Disorders and Drugs That Can Cause Hepatic Fibrosis Disorders with direct hepatic effects Autoimmune hepatitis Certain storage diseases and inborn errors of metabolism Copper storage diseases (eg, ) Fructosemia Galactosemia Glycogen storage diseases (especially types III, IV, VI, IX, and X) Iron-overload syndromes (hemochromatosis) Lipid

2013 Merck Manual (19th Edition)

3772. Adrenal Virilism

of the Endocrine System Which of the following hormones regulates gene function and interacts with receptors inside cells? Antidiuretic hormone Growth hormone Thyroid hormone Thyrotropin-releasing hormone NEWS & VIDEOS Endogenous Testosterone Linked to Cardiovascular Disease THURSDAY, March 7, 2019 (HealthDay News) -- In men, endogenous testosterone may have a causal role in thromboembolism, heart failure, and myocardial infarction, according to a study published... 3D Model Female Endocrine System Video (...) Overview of Buffering and the Henderson-Hasselbalch Equation SOCIAL MEDIA Add to Any Platform Loading , MD, University of Oxford; Fellow, Green-Templeton College Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Adrenal virilism is a syndrome in which excessive adrenal androgens cause virilization. Diagnosis is clinical and confirmed by elevated androgen levels with and without dexamethasone suppression; determining the cause may involve adrenal imaging

2013 Merck Manual (19th Edition)

3773. Bronchiectasis

for up to 20% of idiopathic cases. Even heterozygous patients, who typically have no clinical manifestations of CF, may have an increased risk of bronchiectasis. Immunodeficiencies such as (CVID) may also lead to diffuse disease, as may rare abnormalities in airway structure. Undernutrition and HIV infection also appear to increase risk. Congenital defects in mucociliary clearance such as primary ciliary dyskinesia (PCD) syndromes may also be a cause, explaining almost 3% of previously idiopathic (...) cases. Diffuse bronchiectasis sometimes complicates common autoimmune disorders, such as RA or Sjögren syndrome, and can occur in the setting of hematologic malignancy, organ transplant, or due to the immune compromise associated with treatment in these conditions. , a hypersensitivity reaction to Aspergillus spp that occurs most commonly in people with asthma, but sometimes in patients with CF, can cause or contribute to bronchiectasis. In developing countries, most cases are probably caused

2013 Merck Manual (19th Edition)

3774. Syrinx of the Spinal Cord or Brain Stem

Test your knowledge Other Neurologic Imaging Studies The use of cerebral catheter angiography has dramatically decreased with the advent of which of the following? CT angiography Duplex Doppler ultrasonography Echoencephalography Myelography NEWS & VIDEOS History of Cycling Weight May Up Risk for Heart Disease in Women FRIDAY, March 8, 2019 (HealthDay News) -- A history of weight cycling (HWC), or yo-yo dieting, is associated with poorer cardiovascular health in women, according to a study (...) abnormalities of the craniocervical junction (eg, herniation of cerebellar tissue into the spinal canal, called Chiari malformation), brain (eg, ), or spinal cord (eg, ). For unknown reasons, these congenital abnormalities often expand during the teen or young adult years. A syrinx can also develop in patients who have a spinal cord tumor, scarring due to previous spinal trauma, or no known predisposing factors. About 30% of people with a spinal cord tumor eventually develop a syrinx. Syringomyelia

2013 Merck Manual (19th Edition)

3775. Drug Treatment of Seizures

Neurologic Imaging Studies The use of cerebral catheter angiography has dramatically decreased with the advent of which of the following? CT angiography Duplex Doppler ultrasonography Echoencephalography Myelography NEWS & VIDEOS History of Cycling Weight May Up Risk for Heart Disease in Women FRIDAY, March 8, 2019 (HealthDay News) -- A history of weight cycling (HWC), or yo-yo dieting, is associated with poorer cardiovascular health in women, according to a study presented at the... 3D Model Herniated (...) are not recommended unless children have a subsequent seizure in the absence of febrile illness. Previously, many physicians gave phenobarbital or other antiseizure drugs to children with complicated febrile seizures to prevent nonfebrile seizures from developing, but this treatment does not appear effective, and long-term use of phenobarbital reduces learning capacity. For seizures due to alcohol withdrawal, drugs are not recommended. Instead, treating the withdrawal syndrome tends to prevent seizures. Treatment

2013 Merck Manual (19th Edition)

3776. Male Hypogonadism

to produce enough FSH and LH. In secondary hypogonadism, testosterone levels are low and levels of FSH and LH are low or borderline normal. Any acute systemic illness can cause temporary secondary hypogonadism. Some syndromes of hypogonadism have both primary and secondary causes (mixed hypogonadism). lists some common causes of hypogonadism by category. Some syndromes of hypogonadism (eg, cryptorchidism, some systemic disorders) affect spermatozoon production more than testosterone levels. Table Causes (...) preparations at adult dosages when their IM dosage has reached the equivalent of 100 to 200 mg q 2 wk. Adults with established testosterone deficiency may benefit from replacement therapy. Treatment slows the course of osteopenia, muscle loss, vasomotor instability, , , and occasionally . The effects of testosterone on are not well understood. TRT may improve coronary artery blood flow and may decrease the risk of coronary artery disease. Concerns that TRT increases risk of cardiovascular events have been

2013 Merck Manual (19th Edition)

3777. Infective Endocarditis

with prosthetic cardiac valve or prosthetic material used for cardiac valve repair and for patients with unrepaired and palliated cyanotic congenital heart disease), and GI, GU, or musculoskeletal procedures that involve an area with an established infection (see Table: ). Guidelines for endocarditis prophylaxis vary geographically. Table Procedures Requiring Antimicrobial Endocarditis Prophylaxis in High-Risk Patients in the US Type Examples Oral-dental* Dental extraction Dental implant placement (...) , Bashore TM, et al: ACC/AHA 2008 Guidelines for the Management of Adults with Congenital Heart Disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation 2008;118(23):e714. Prophylactic antibiotic regimens For most patients and procedures, a single dose shortly before the procedure is effective. For oral-dental and respiratory procedures, a drug effective against viridans group streptococci is used (see Table: ). For vaginal

2013 Merck Manual (19th Edition)

3778. Pericarditis

output may be greatly reduced if cardiac tamponade or constrictive pericarditis develops. Diagnosis is based on symptoms, a friction rub, ECG changes, and evidence of pericardial fluid accumulation on x-ray or echocardiogram. Finding the cause requires further evaluation. Treatment depends on the cause, but general measures include analgesics, anti-inflammatory drugs, colchicine , and rarely surgery. Pericarditis is the most common pericardial disorder. Congenital pericardial disorders are rare (...) are probably viral. Acute MI causes 10 to 15% of cases of acute pericarditis. Post-MI syndrome (Dressler syndrome) is a less common cause now, occurring mainly when reperfusion with percutaneous transluminal coronary angioplasty (PTCA) or thrombolytic drugs is ineffective in patients with transmural infarction. Pericarditis occurs after pericardiotomy (called postpericardiotomy syndrome) in 5 to 30% of cardiac operations. Postpericardiotomy syndrome, post-MI syndrome, and traumatic pericarditis comprise

2013 Merck Manual (19th Edition)

3779. Overview of Hypertension

or by ambulatory BP monitoring. However, extreme BP elevation alternating with normal readings is unusual and possibly suggests , a sleep disorder such as , or unacknowledged drug use. History The history includes the known duration of hypertension and previously recorded BP levels; any history or symptoms of coronary artery disease, heart failure, sleep apnea or loud snoring; history or symptoms of other relevant coexisting disorders (eg, stroke, renal dysfunction, peripheral arterial disease, dyslipidemia (...) sodium intake is more likely to precipitate hypertension. Secondary hypertension Common causes include Renal parenchymal disease (eg, chronic glomerulonephritis or pyelonephritis, polycystic renal disease, connective tissue disorders, obstructive uropathy) Sleep apnea Other much rarer causes include , , , , (myxedema), primary hyperparathyroidism, , , and mineralocorticoid excess syndromes other than primary aldosteronism. Excessive alcohol intake and use of oral contraceptives are common causes

2013 Merck Manual (19th Edition)

3780. Cystic Fibrosis (CF)

with advanced pulmonary disease, as well as combined liver-lung transplantation for patients with end-stage liver and lung disease. Bilateral lung transplantation for severe lung disease is becoming more routine and more successful with experience and improved techniques. Among adults with CF, median survival posttransplant is about 9 yr. End-of-life care The patient and family deserve sensitive discussions of prognosis and preferences for care throughout the course of illness, especially as the patient's (...) with , , (ABPA), and right heart failure secondary to . GI Meconium ileus due to obstruction of the ileum by viscid meconium may be the earliest sign and is present in 13 to 18% of CF-affected neonates. It typically manifests with abdominal distention, vomiting, and failure to pass meconium. Some infants have intestinal perforation, with signs of peritonitis and shock. Infants with meconium plug syndrome have a delayed passage of meconium. They can have similar signs of obstruction or very mild and transient

2013 Merck Manual (19th Edition)

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