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4921. Immune Thrombocytopenic Purpura (Follow-up)

, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Ronald A Sacher, MBBCh, FRCPC, DTM&H Professor of Internal Medicine and Pathology, Director, Hoxworth Blood Center, University of Cincinnati Academic Health Center Ronald A Sacher, MBBCh, FRCPC, DTM&H is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose. Chief Editor Srikanth Nagalla, MBBS, MS, FACP Associate Professor of Medicine, Division of Hematology (...) to rule out leukemia?. Arch Pediatr Adolesc Med . 1998 Apr. 152(4):345-7. . . Sandler SG, Tutuncuoglu SO. Immune thrombocytopenic purpura - current management practices. Expert Opin Pharmacother . 2004 Dec. 5(12):2515-27. . Tarantino MD, Buchanan GR. The pros and cons of drug therapy for immune thrombocytopenic purpura in children. Hematol Oncol Clin North Am . 2004 Dec. 18(6):1301-14, viii. . [Guideline] Neunert C, Lim W, Crowther M, Cohen A, Solberg L Jr, Crowther MA. The American Society

2014 eMedicine.com

4922. Reflux Laryngitis

. Reza Shaker, MD Reza Shaker, MD is a member of the following medical societies: , , , , , , Disclosure: Nothing to disclose. Ramin Soraya, MD Chair, Department of Science, West Coast University, Dallas Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Robert M (...) Kellman, MD Professor and Chair, Department of Otolaryngology and Communication Sciences, State University of New York Upstate Medical University Robert M Kellman, MD is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose. Chief Editor Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine Arlen D Meyers, MD, MBA is a member of the following medical societies: , , Disclosure: Serve(d

2014 eMedicine Surgery

4923. Bronchiectasis

of that cause. Pathophysiology Bronchiectasis is not caused by a single factor, but is a complex interplay between repeated inflammation and a defective immune response to inflammation. [ ] Many congenital or acquired abnormalities can prevent normal airway defense and repair, resulting in infection. If the initial reaction to infection is ineffective, the immune response is increased and prolonged, potentially causing a vicious circle of bronchial injury and increased inflammation that leads (...) infections, and hemoptysis. V/Q scanning can be useful in determining whether surgical resection is appropriate therapy, especially for hemoptysis. In one series, 23 of 66 patients treated surgically had hemoptysis as a symptom. V/Q scanning demonstrated undiminished perfusion in cylindrical bronchiectasis, but areas of cystic or mixed cystic and cylindrical bronchiectasis showed perfusion defects. If a patient has a scan showing less than 10% perfusion of a bronchiectatic region, those patients can

2014 eMedicine Radiology

4924. Gastroesophageal Reflux

Dachman, MD, FACR Professor, Department of Radiology, University of Chicago Division of the Biological Sciences, The Pritzker School of Medicine; Director of CT, Department of Radiology, The University of Chicago Hospitals Abraham H Dachman, MD, FACR is a member of the following medical societies: Disclosure: Nothing to disclose. Chief Editor Eugene C Lin, MD Attending Radiologist, Teaching Coordinator for Cardiac Imaging, Radiology Residency Program, Virginia Mason Medical Center; Clinical Assistant (...) Professor of Radiology, University of Washington School of Medicine Eugene C Lin, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Acknowledgements The authors and editors of eMedicine gratefully acknowledge the contributions of previous author Thomas F Murphy, MD, to the development and writing of this article. What would you like to print? What would you like to print? Sections Gastroesophageal Reflux Imaging Find Us On About Membership WebMD Network Editions

2014 eMedicine Radiology

4925. Hyperbaric Oxygen

, absolute and relative contraindications exist with the use of hyperbaric oxygen therapy (HBOT). [ ] Table 2. Absolute Contraindications to Hyperbaric Oxygen Therapy Absolute Contraindications Reason Contraindicated Necessary Conditions Prior to HBOT Untreated pneumothorax Gas emboli Tension pneumothorax Pneumomediastinum Thoracostomy Bleomycin Interstitial pneumonitis No treatment for extended time from use of medication Cisplatin Impaired wound healing No treatment for extended time from use (...) of medication Disulfiram Blocks superoxide dismutase, which is protective against oxygen toxicity Discontinue medication Doxorubicin Cardiotoxicity Discontinue medication Sulfamylon Impaired wound healing Discontinue and remove medication Table 3. Relative Contraindications to Hyperbaric Oxygen Therapy Relative Contraindications Reason Contraindicated Necessary Conditions Prior to HBOT Air trapping upon ascent leading to Must be well controlled with medications Claustrophobia Treatment with benzodiazepines

2014 eMedicine Surgery

4926. Histology of Bone (Diagnosis)

, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Sean P Scully, MD Sean P Scully, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Chief Editor Harris Gellman, MD Consulting Surgeon, Broward Hand Center; Voluntary Clinical Professor of Orthopedic Surgery and Plastic Surgery, Departments of Orthopedic Surgery and Surgery, University of Miami (...) , Leonard M Miller School of Medicine; Clinical Professor of Surgery, Nova Southeastern School of Medicine Harris Gellman, MD is a member of the following medical societies: , , , , , , Disclosure: Nothing to disclose. Additional Contributors Timothy A Damron, MD David G Murray Endowed Professor, Department of Orthopedic Surgery, Professor, Orthopedic Oncology and Adult Reconstruction, Vice Chair, Department of Orthopedics, State University of New York Upstate Medical University at Syracuse Timothy

2014 eMedicine Surgery

4927. Hidradenitis Suppurativa (Diagnosis)

hygiene Weight reduction in patients who are obese Use of ordinary soaps and antiseptic and antiperspirant agents (eg, 6.25% aluminum chloride hexahydrate in absolute ethanol) Application of warm compresses with sodium chloride solution or Burow solution Wearing of loose-fitting clothing Laser hair removal Discontinuation of cigarette smoking Medical anti-inflammatory or antiandrogen therapy (eg, oral or topical antibiotics, intralesional triamcinolone, spironolactone, finasteride) Biological therapy (...) patients may reveal abnormalities in the deep part of the follicle. See for more detail. Management Medical management is recommended in early stages, whereas surgery should be performed after the formation of abscesses, fistulas, scars, and sinus tracts. [ ] Systemic treatment does not restore the skin’s original architecture; therefore, once the inflammation has been treated, epithelialized cysts and sinus tracts remain in the affected skin. [ ] Conservative treatment may include the following: Local

2014 eMedicine Surgery

4928. Frostbite (Diagnosis)

of Indianapolis and University of Indiana Amit Tevar, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Nothing to disclose. Wayne Wolfram, MD, MPH Associate Professor, Department of Emergency Medicine, Mercy St Vincent Medical Center Wayne Wolfram, MD, MPH is a member of the following medical societies (...) , MD, Department of Emergency Medicine, Regions Hospital. Frostbite of the ear. Photo courtesy of Kevin P. Kilgore, MD, Department of Emergency Medicine, Regions Hospital. Frostbite of the hand. of 3 Tables Contributor Information and Disclosures Author Bobak Zonnoor , MD Resident Physician, Department of Emergency Medicine, SUNY Downstate Medical Center, Kings County Hospital Bobak Zonnoor , MD is a member of the following medical societies: Disclosure: Nothing to disclose. Chief Editor Dirk M

2014 eMedicine Surgery

4929. Eustachian Tube Function

and Neck Surgeon, Australia Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Gerard J Gianoli, MD Clinical Associate Professor, Departments of Otolaryngology-Head and Neck Surgery and Pediatrics, Tulane University School of Medicine; President, The Ear and Balance (...) Gallery Anatomy of the ear. of 1 Tables Contributor Information and Disclosures Author Ted L Tewfik, MD Professor of Otolaryngology-Head and Neck Surgery, Professor of Pediatric Surgery, McGill University Faculty of Medicine; Senior Staff, Montreal Children's Hospital, Montreal General Hospital, and Royal Victoria Hospital Ted L Tewfik, MD is a member of the following medical societies: , Disclosure: Nothing to disclose. Coauthor(s) Harpreet Singh, MBBS, MS, FRACGP General Physician (ENT), Head

2014 eMedicine Surgery

4930. General Approach to the Trauma Patient

, Department of Otolaryngology, Manhattan Eye, Ear, and Throat Hospital Yael Halaas, MD is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Stephen G Batuello, MD Consulting Staff, Colorado ENT Specialists Stephen G (...) Batuello, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Chief Editor Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine Arlen D Meyers, MD, MBA is a member of the following medical societies: , , Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Cerescan;RxRevu;Cliexa;The Physicians Edge;Sync-n-Scale;mCharts
Received income

2014 eMedicine Surgery

4931. Foot Infections (Diagnosis)

structures, joints, deep structures, or tissue planes. Initial treatment for cellulitis as a result of an abrasion in a host who is not immunocompromised includes oral antibiotic therapy using first-generation cephalosporins, aminopenicillins, or quinolones. Knowledge of local community and hospital antibiograms helps guide empiric therapy. [ , ] Group A streptococci are the most common pathogens and are usually susceptible to penicillin V and cephalexin. In more severe cases, oxacillin (2 g IV q4hr (...) below). It can be initiated by a traumatic event such as dropping objects on the toes, having them stepped on, or improper fitting of shoes. Paronychia more frequently results from an ingrown toenail (onychocryptosis). Underlying onychomycosis also can be a predisposing factor, which results in paronychia. [ ] Onychocryptosis with paronychia of medial and lateral nail folds. Treatment consists of oral antibiotic therapy and removal of involved nail borders. Nail borders puncture skin and act

2014 eMedicine Surgery

4932. Cervical Spine Injuries in Sports (Diagnosis)

ownership interest from Alphatec Spine, Inc., BI Members, LLC, Centinal Spine, Inc., Dis. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons William O Shaffer, MD is a member of the following medical (...) University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center Jeffrey A Goldstein, MD is a member of the following medical societies: , , , , , , , Lumbar Spine Research Society, , , Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic, Nuvasive, NLT Spine, RTI, Magellan Health
Received consulting fee from Medtronic

2014 eMedicine Surgery

4933. Lymphedema (Diagnosis)

. Pharmacotherapy The following medications are used in to manage lymphedema: Benzopyrones (eg, coumarin, flavonoids) Retinoidlike agents (eg, acitretin, topical tazarotene) Anthelmintic agents (eg, albendazole) Topical skin products (eg, ammonium lactate lotion, topical urea) Antibiotics (eg, cefazolin, clindamycin, penicillin G) Nonpharmacotherapy Conservative measures for managing lymphedema include the following: Maintenance of appropriate hygiene and skin care Use of complex physical therapy (first-line (...) treatment) [ ] and compression stockings Weight loss (if overweight) Avoiding trauma Avoiding constrictive clothing Elevating affected limb Surgical option Surgical treatment is palliative, not curative, and it does not obviate the need for continued medical therapy. Procedures are divided into physiologic (to improve lymphatic drainage) and excisional (removal of the affected tissues to reduce the lymphedema-related load) surgeries. Surgical intervention is reserved for patients who do not improve

2014 eMedicine Surgery

4934. Tinea (Treatment)

Physician, Department of Emergency Medicine, Long Island Jewish Medical Center Mityanand Ramnarine, MD, FACEP is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Eddy S Lang, MDCM, CCFP(EM), CSPQ Associate Professor (...) Attending Faculty, Department of Emergency Medicine, North Shore-Long Island Jewish Medical Center, Hofstra University School of Medicine Shari Andrews, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Coauthor(s) Mityanand Ramnarine, MD, FACEP Assistant Professor of Emergency Medicine, Associate Chair, Department of Emergency Medicine, Program Director, Emergency/Internal Medicine/Critical Care, Hofstra Northwell School of Medicine at Hofstra University; Attending

2014 eMedicine Emergency Medicine

4935. Toxicity, Chlorine Gas (Treatment)

Medicine, Albert Einstein Medical Center Gerald F O'Malley, DO is a member of the following medical societies: , , , , , Disclosure: Received consulting fee from McNeil Pharmaceuticals for speaking and teaching. Coauthor(s) Robert Bassett, DO, FAAEM Fellow in Medical Toxicology, Department of Emergency Medicine, Einstein Medical Center; Clinical Assistant Professor of Emergency Medicine, Texas Tech University Health Sciences Center, Paul L Foster School of Medicine Robert Bassett, DO, FAAEM is a member (...) . Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Medscape Salary Employment Asim Tarabar, MD Assistant Professor, Director, Medical Toxicology, Department of Emergency Medicine, Yale University School of Medicine; Consulting Staff, Department of Emergency Medicine, Yale-New Haven Hospital Disclosure: Nothing to disclose. John T VanDeVoort, PharmD Regional Director of Pharmacy

2014 eMedicine Emergency Medicine

4936. Aphthous Ulcers

is a member of the following medical societies: , American Academy of Orofacial Pain, , , , , Richmond Dental Society, Virginia Dental Association Disclosure: Nothing to disclose. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Robert M Kellman, MD Professor and Chair, Department of Otolaryngology (...) and Communication Sciences, State University of New York Upstate Medical University Robert M Kellman, MD is a member of the following medical societies: , , , , , , , , Disclosure: Nothing to disclose. Chief Editor Arlen D Meyers, MD, MBA Professor of Otolaryngology, Dentistry, and Engineering, University of Colorado School of Medicine Arlen D Meyers, MD, MBA is a member of the following medical societies: , , Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee

2014 eMedicine Surgery

4937. Asthma and Sinusitis

sinus and appropriate systemic treatment of the likely bacterial pathogens. Drainage can be achieved surgically with sinus puncture and irrigation techniques. Options for medical drainage are as follows: Oral alpha-adrenergic vasoconstrictors (eg, pseudoephedrine, and phenylephrine) for 10-14 days Topical vasoconstrictors (eg, oxymetazoline hydrochloride) for a maximum of 3-5 days Antibiotic treatment is usually given for 14 days. Usual first-line therapy is with one of the following: Amoxicillin (...) of low pH, anoxia, cigarette smoke, chemical toxins, dehydration, and drugs (eg, anticholinergic medications and antihistamines). Exposure to bacterial toxins can also reduce ciliary function. Approximately 10% of cases of acute sinusitis result from direct inoculation of the sinus with a large amount of bacteria. Dental abscesses or procedures that result in communication between the oral cavity and sinus can produce sinusitis by this mechanism. Additionally, ciliary action can be affected after

2014 eMedicine Surgery

4938. Antibiotics, Ototopical

. The use of topical agents allows for the simultaneous modification of the local microenvironment. The pH of the external auditory canal, for example, is normally slightly acidic. The administration of an antibiotic in an acidic drop helps restore and fortify this normal host defense mechanism. Ototopical medications are generally less expensive than systemic medications. Although the newer quinolone antibiotic drops are more expensive than some systemic antibiotics, such as amoxicillin, the quinolone (...) , Roland PS. Ototoxicity of ototopical drops--an update. Otolaryngol Clin North Am . 2007 Jun. 40(3):669-83, xi. . Lawrence TL, Ayers LW, Saunders WH. Drug therapy in otomycosis: an in vitro study. Laryngoscope . 1978 Nov. 88(11):1755-60. . Linder TE, Zwicky S, Brändle P. Ototoxicity of ear drops: a clinical perspective. Am J Otol . 1995 Sep. 16(5):653-7. . Longridge NS. Topical gentamicin vestibular toxicity. J Otolaryngol . 1994 Dec. 23(6):444-6. . Lundy LB, Graham MD. Ototoxicity and ototopical

2014 eMedicine Surgery

4939. Foot Infections (Overview)

structures, joints, deep structures, or tissue planes. Initial treatment for cellulitis as a result of an abrasion in a host who is not immunocompromised includes oral antibiotic therapy using first-generation cephalosporins, aminopenicillins, or quinolones. Knowledge of local community and hospital antibiograms helps guide empiric therapy. [ , ] Group A streptococci are the most common pathogens and are usually susceptible to penicillin V and cephalexin. In more severe cases, oxacillin (2 g IV q4hr (...) below). It can be initiated by a traumatic event such as dropping objects on the toes, having them stepped on, or improper fitting of shoes. Paronychia more frequently results from an ingrown toenail (onychocryptosis). Underlying onychomycosis also can be a predisposing factor, which results in paronychia. [ ] Onychocryptosis with paronychia of medial and lateral nail folds. Treatment consists of oral antibiotic therapy and removal of involved nail borders. Nail borders puncture skin and act

2014 eMedicine Surgery

4940. Cervical Spine Injuries in Sports (Overview)

ownership interest from Alphatec Spine, Inc., BI Members, LLC, Centinal Spine, Inc., Dis. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. William O Shaffer, MD Orthopedic Spine Surgeon, Northwest Iowa Bone, Joint, and Sports Surgeons William O Shaffer, MD is a member of the following medical (...) University School of Medicine; Director of Spine Service, Director of Spine Fellowship, Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, NYU Langone Medical Center Jeffrey A Goldstein, MD is a member of the following medical societies: , , , , , , , Lumbar Spine Research Society, , , Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Medtronic, Nuvasive, NLT Spine, RTI, Magellan Health
Received consulting fee from Medtronic

2014 eMedicine Surgery

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