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Fetal Foot Measurement

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421. Benign Vulvar Lesions (Treatment)

, knees, hands, and feet. Rarely, vulvar involvement occurs and is sometimes triggered or worsened by local factors such as irritation from scratching, irritant soaps, bacterial or yeast superinfections, or increases in heat and humidity secondary to the use of tight synthetic clothing and sanitary napkins. Reiter disease Reiter disease is a sterile oligoarthritis typically associated with conjunctivitis and with a distant infection (eg, Chlamydia trachomatis, Ureaplasma urealyticum, Shigella (...) % of ambiguous genitalia; (2) male pseudohermaphroditism, occurring in approximately 15% of cases; and (3) disorders of differentiation. The preponderance of female pseudohermaphroditism is due to a recessive congenital enzymatic defect of adrenal steroid biosynthesis (most commonly, 21-hydroxylase deficiency), resulting in androgen overproduction that virilizes the external genitalia of a female 46,XX fetus with normal ovaries. Although rare, maternal factors can also virilize a female fetus. In male

2014 eMedicine.com

422. Burns, Electrical (Treatment)

of full neurovascular examination. The risks of electrical injury to the fetus in a pregnant patient are unknown. Pregnant women who are involved in electrical injuries should have a careful examination for traumatic injuries and obstetrical consultation. Women in the second half of pregnancy should be admitted for fetal monitoring in any cases of severe electrical injuries, high-voltage exposures, or minor electrical injuries with significant trauma. Previous Next: Further Inpatient Care and Transfer (...) sodium bicarbonate titrated to a serum pH of 7.5. Obtain adequate intravenous access for fluid resuscitation, whether peripheral or central. Initiate cardiac monitoring for all patients with anything more than trivial low-voltage exposures. Burn care should include tetanus immunization as indicated, wound care, measurement of compartment pressures as indicated, and it may include early fasciotomy. Extremities with severe burns should be splinted in a functional position after careful documentation

2014 eMedicine.com

423. Cancer and Rehabilitation (Treatment)

of the patient with cancer are described below. Preventive interventions Preventive (or "preventative") interventions lessen the effect of expected disabilities and emphasize patient education. Preventive measures also include approaches to improving the patient's physical functioning and general health status. In addition, psychological counseling before treatment can assist with the early identification of adjustment issues to allow for prompt intervention. Restorative interventions Restorative (...) exercise, sports, psychoeducation, and information. Measurements were performed before and after 6 weeks of rehabilitation to assess symptom-limited bicycle ergometry performance, muscle force, and QOL (on the RAND-36 instrument, Rotterdam Symptom Checklist [RSCL], and Multidimensional Fatigue Inventory [MFI]). Statistically significant improvements were found in symptom-limited bicycle ergometry performance, muscle force, and several domains of the QOL instruments (RAND-36, RSCL, and MFI

2014 eMedicine.com

424. Metabolic Disease &amp (Treatment)

to test patients who have any of the following two features: [ ] Decreased sweating (anhidrosis or hypohidrosis) Reddish-purple skin rash in the bathing trunk area (angiokeratomas) Personal and/or family history of kidney failure Personal or family history of "burning" or "hot" pain in the hands and feet, particularly during fevers (acroparesthesias) Personal or family history of exercise, heat, or cold intolerance Patients with sporadic or non-autosomal dominant (no male-to-male) transmission (...) (measured radiologically) increases with advancing age. Left ventricular hypertrophy, conduction defects, valvular deficiencies, and myocardial infarctions are cardiac manifestations of disease in some patients. Proteinuria and progressive renal failure are a result of glycosphingolipid accumulation in the renal glomeruli and tubules. Hemiparesis, vertigo, diplopia, dysarthria, hemianopia, sensory loss, and other typical stroke symptoms characterize CNS involvement. Death, as a result of renal failure

2014 eMedicine.com

425. Rehabilitation Management of Neuromuscular Disease (Treatment)

involving the intrinsic muscles of the feet and the peroneal muscles. Subjects with CMT produce 20-40% less force than normal controls on quantitative isometric and isokinetic strength measures, even though manual muscle test scores may be normal. No significant side-to-side difference exists with regard to strength. From a functional standpoint, the sensory deficit is usually less severe than the motor deficit. Prior studies have also documented that subjects with CMT have a marked reduction (...) ). [ ] Foot deformities in 16-year-old boy with Charcot-Marie-Tooth disease type 1A. Notably, patients with a related disorder, hereditary neuropathy with liability to pressure palsies (HNPP), show a large deletion, rather than a duplication, in the PMP22 gene. [ ] HNPP is an autosomal dominant disorder that produces episodic recurrent nerve compression with focal demyelination at common sites of compression or entrapment (eg, wrist, elbow, and fibular head). Nerve compression can occur in the absence

2014 eMedicine.com

426. Parkinson Disease in Young Adults (Treatment)

increase the risk for the development of dyskinesia. [ ] If nausea occurs, the levodopa dose can be taken immediately following a meal. Additional measures to alleviate nausea include adding extra carbidopa or introducing domperidone (available outside the United States). Other side effects include dizziness and headache. In elderly patients, confusion, delusions, agitation, hallucinations, and psychosis may be more commonly seen. MAO-B inhibitors MAO-B inhibitors, such as selegiline and rasagiline (...) . [ , ] Moreover, subthalamic stimulation plus medical therapy was superior to medical therapy alone on several key measures of quality of life and motor function. However, 54.8% of the patients in the DBS group suffered serious adverse events, compared to 44.1% of those in the medical-therapy group [ , ] ; 17.7% of patients suffered serious adverse events related to surgical implantation or the neurostimulation device. A study by Foltynie assessed 79 consecutive patients who underwent bilateral subthalamic

2014 eMedicine.com

427. Parkinson Disease Dementia (Treatment)

increase the risk for the development of dyskinesia. [ ] If nausea occurs, the levodopa dose can be taken immediately following a meal. Additional measures to alleviate nausea include adding extra carbidopa or introducing domperidone (available outside the United States). Other side effects include dizziness and headache. In elderly patients, confusion, delusions, agitation, hallucinations, and psychosis may be more commonly seen. MAO-B inhibitors MAO-B inhibitors, such as selegiline and rasagiline (...) . [ , ] Moreover, subthalamic stimulation plus medical therapy was superior to medical therapy alone on several key measures of quality of life and motor function. However, 54.8% of the patients in the DBS group suffered serious adverse events, compared to 44.1% of those in the medical-therapy group [ , ] ; 17.7% of patients suffered serious adverse events related to surgical implantation or the neurostimulation device. A study by Foltynie assessed 79 consecutive patients who underwent bilateral subthalamic

2014 eMedicine.com

428. Parkinson Disease (Treatment)

increase the risk for the development of dyskinesia. [ ] If nausea occurs, the levodopa dose can be taken immediately following a meal. Additional measures to alleviate nausea include adding extra carbidopa or introducing domperidone (available outside the United States). Other side effects include dizziness and headache. In elderly patients, confusion, delusions, agitation, hallucinations, and psychosis may be more commonly seen. MAO-B inhibitors MAO-B inhibitors, such as selegiline and rasagiline (...) . [ , ] Moreover, subthalamic stimulation plus medical therapy was superior to medical therapy alone on several key measures of quality of life and motor function. However, 54.8% of the patients in the DBS group suffered serious adverse events, compared to 44.1% of those in the medical-therapy group [ , ] ; 17.7% of patients suffered serious adverse events related to surgical implantation or the neurostimulation device. A study by Foltynie assessed 79 consecutive patients who underwent bilateral subthalamic

2014 eMedicine.com

429. Paraneoplastic Diseases (Treatment)

to represent a paraneoplastic syndrome. Clinical features suggestive of paraneoplastic AN include the development of AN in nonobese elderly persons and the rapid extensive progression of florid skin lesions in unusual locations, such as the mucosal membranes, palms, and soles of the feet. Other paraneoplastic syndromes that commonly occur with AN include tripe palms and the sign of Leser-Trélat (which are discussed below). [ , ] In a patient presenting with AN, key features of the medical history should (...) include symmetrical, scaly, violaceous plaques on the acral surfaces, with severe forms progressing to bullae. The lesions predominantly occur on the hands, feet, ear helices, nose tip, and scalp. Skin changes may spread to involve the knees, elbows, and malar surface of the face. [ ] Bazex syndrome occurs more commonly in men older than 40 years. [ ] Alopecia and nail changes are common and can be early findings. Subungual hyperkeratosis, onychodystrophy, and white flaking of the nail surface

2014 eMedicine.com

430. Parkinson Disease (Treatment)

increase the risk for the development of dyskinesia. [ ] If nausea occurs, the levodopa dose can be taken immediately following a meal. Additional measures to alleviate nausea include adding extra carbidopa or introducing domperidone (available outside the United States). Other side effects include dizziness and headache. In elderly patients, confusion, delusions, agitation, hallucinations, and psychosis may be more commonly seen. MAO-B inhibitors MAO-B inhibitors, such as selegiline and rasagiline (...) . [ , ] Moreover, subthalamic stimulation plus medical therapy was superior to medical therapy alone on several key measures of quality of life and motor function. However, 54.8% of the patients in the DBS group suffered serious adverse events, compared to 44.1% of those in the medical-therapy group [ , ] ; 17.7% of patients suffered serious adverse events related to surgical implantation or the neurostimulation device. A study by Foltynie assessed 79 consecutive patients who underwent bilateral subthalamic

2014 eMedicine.com

431. Pulmonary Disease and Pregnancy (Treatment)

trimester levels. Uterine contractions result in increased preload due to autotransfusion of 300-500 mL of blood immediately postpartum. A further increase in blood volume occurs due to the contracted uterus. Fetal oxygenation Oxygen delivered to the placenta and fetus is dependent on maternal arterial oxygen content and uterine blood flow. Any decrease in maternal cardiac output can adversely affect fetal oxygenation. Maternal hypotension and endogenous catecholamines may constrict the uterine artery (...) , decreasing blood flow to the fetus. This can also be caused by maternal alkalosis. The umbilical vein PaO 2 rarely exceeds 40 mm Hg, but the fetal oxygen content is relatively high. This is largely due to the marked left shift of the oxygen dissociation curve of fetal hemoglobin, which is 80-90% saturated at a PaO 2 of 30-35 mm Hg. The oxygenated umbilical vein blood mixes with deoxygenated blood in the fetal inferior vena cava, decreasing fetal arterial PaO 2 to 20-25 mm Hg. The fetus has a high

2014 eMedicine.com

432. Posterior Cerebral Artery Stroke (Treatment)

risk, delayed recognition of isolated PCA stroke syndromes, and other factors. Numerous mechanical embolectomy devices have been studied, and few have allowed or incorporated isolated PCA stroke for inclusion. Endovascular therapies are more likely to be used if there is significant vertebrobasilar disease as the cause of PCA stroke or if the patient fails to respond to medical management. When the ICA is the source of stroke via a fetal PCA variant, surgical endarterectomy or endovascular stenting (...) , such as social situation, the patient may qualify for continued outpatient or home therapy. Physical therapy A small percentage of patients with a PCA infarct suffer chronic motor deficits. Approximately 5% of patients who do may require transfer, gait, and stair training with an assistive device. Orthotic devices (eg, ankle-foot orthosis) also may be beneficial. Patients with PCA infarcts may demonstrate delayed postural reactions due to sensorimotor deficits. Programs designed to improve postural control

2014 eMedicine.com

433. Posterior Cerebral Artery Stroke (Treatment)

risk, delayed recognition of isolated PCA stroke syndromes, and other factors. Numerous mechanical embolectomy devices have been studied, and few have allowed or incorporated isolated PCA stroke for inclusion. Endovascular therapies are more likely to be used if there is significant vertebrobasilar disease as the cause of PCA stroke or if the patient fails to respond to medical management. When the ICA is the source of stroke via a fetal PCA variant, surgical endarterectomy or endovascular stenting (...) , such as social situation, the patient may qualify for continued outpatient or home therapy. Physical therapy A small percentage of patients with a PCA infarct suffer chronic motor deficits. Approximately 5% of patients who do may require transfer, gait, and stair training with an assistive device. Orthotic devices (eg, ankle-foot orthosis) also may be beneficial. Patients with PCA infarcts may demonstrate delayed postural reactions due to sensorimotor deficits. Programs designed to improve postural control

2014 eMedicine.com

434. Rheumatoid Arthritis (Treatment)

, and corticosteroids. Early therapy with DMARDs has become the standard of care, because it can both retard disease progression more efficiently than later treatment and, potentially, induce more remissions. [ , , ] In pregnant patients with RA, no special obstetric monitoring is indicated beyond what is performed for usual obstetric care. However, some of the medications used in treating RA can have adverse effects on the fetus and may have to be discontinued several months before conception is planned. Surgical (...) and symptoms and quality of life, all biologic agents significantly retard radiographic progression of joint erosions. Biologic DMARDs include agents such as adalimumab, certolizumab, etanercept, golimumab and infliximab. DMARDs represent the most important measure in the successful treatment of RA. These agents can retard or prevent disease progression and, thus, joint destruction and subsequent loss of function. Successful DMARD therapy may eliminate the need for other anti-inflammatory or analgesic

2014 eMedicine.com

435. Rheumatoid Arthritis (Treatment)

, and corticosteroids. Early therapy with DMARDs has become the standard of care, because it can both retard disease progression more efficiently than later treatment and, potentially, induce more remissions. [ , , ] In pregnant patients with RA, no special obstetric monitoring is indicated beyond what is performed for usual obstetric care. However, some of the medications used in treating RA can have adverse effects on the fetus and may have to be discontinued several months before conception is planned. Surgical (...) and symptoms and quality of life, all biologic agents significantly retard radiographic progression of joint erosions. Biologic DMARDs include agents such as adalimumab, certolizumab, etanercept, golimumab and infliximab. DMARDs represent the most important measure in the successful treatment of RA. These agents can retard or prevent disease progression and, thus, joint destruction and subsequent loss of function. Successful DMARD therapy may eliminate the need for other anti-inflammatory or analgesic

2014 eMedicine.com

436. Psoriasis, Pustular (Treatment)

supportive measures are not taken during the acute phase. The annular (or circinate) type is also known as subacute generalized pustular psoriasis. It tends to run a subacute or chronic course with fewer systemic manifestations. A disproportionately high number of cases are found in the pediatric population. [ ] A juvenile or infantile type of pustular psoriasis has been described, but it is the least common form. Additionally, several disease entities are considered, by some, to be variants of pustular (...) psoriasis. These include the following: Pregnancy-associated impetigo herpetiformis: Occurring predominately in the third trimester, this is a variant of acute pustular psoriasis that carries an increased risk of subsequent stillbirth or fetal abnormalities. [ ] Acrodermatitis continua of Hallopeau: Characterized by pustular eruptions of the tips of fingers and toes, cases are generally refractory to treatment. Subsets of these cases are considered variants of pustular psoriasis, particularly since

2014 eMedicine.com

437. Viral Infections of the Mouth (Treatment)

currently unproved. [ , , ] HHV-7 has been isolated from the saliva of healthy adults and has been implicated as one cause of roseola infantum and febrile seizures in children. HHV-8 is associated with (KS), and evidence links it with body-cavity lymphomas and Castleman disease. Pathophysiology Herpesvirus family members are icosahedral DNA viruses. A herpesvirus measures approximately 100 nm without an envelope or 150 nm with an envelope. HHVs replicate in the host cell nucleus. Infected saliva (...) infection as measured by HPV detection in oral rinses (discussed above), oral HPV has to be considered as a sexual transmitted virus and requires counseling of patients by healthcare providers. This counseling must include informing the patients of the up-to-date knowledge on the mode of transmission of oropharyngeal HPV and the possible risks associated with it. This issue is pertinent to deciding on HPV vaccination especially for male patients. Finally, for this reason, younger adolescents

2014 eMedicine.com

438. Viral Encephalitis (Treatment)

infection rates in mosquito pools. Protective clothing and repellents are useful in the prevention of arthropod bites. Avoidance of outdoor activities is also useful. Prompt removal of ticks may decrease the risk of transmission of a tick-borne virus. Effective preventive measures include removing water-holding containers and discarded tires. Insecticides may be useful in the emergency control of infected mosquitoes. Control of the mosquito vector has been used with apparently good results in several (...) ; author reply 2175-6. . CDC. Notes from the Field: Evidence of Zika Virus Infection in Brain and Placental Tissues from Two Congenitally Infected Newborns and Two Fetal Losses — Brazil, 2015. Morbidity and Mortality Weekly Report (MMWR) . February 10, 2016. Available at . Sejvar JJ. The evolving epidemiology of viral encephalitis. Curr Opin Neurol . 2006 Aug. 19(4):350-7. . Rantalaiho T, Farkkila M, Vaheri A, Koskiniemi M. Acute encephalitis from 1967 to 1991. J Neurol Sci . 2001 Mar 1. 184(2):169-77

2014 eMedicine.com

439. Urologic Imaging Without X-rays: Ultrasound, MRI, and Nuclear Medicine (Treatment)

and was adopted by the medical world after World War II. In 1961, Schlegel et al first reported the usefulness of sonography in urology, for the detection of . Ultrasonography is mainly performed by radiologists. However, nonradiologist clinicians commonly perform and interpret specific types of ultrasound (eg, obstetricians, fetal ultrasound; urologists, ). [ ] The ideal ultrasound examination is one in which the clinician interprets it in real time while it is being performed. Therefore, physicians should (...) and diastole. The resistive index is a ratio and is essentially a measure of the end-diastolic flow in the arterial system (resistive index = [peak systolic - end diastolic]/peak systolic). Typical resistive index is 70%. The higher the resistive index, the higher the downstream resistance. A resistive index higher than 90% is definitely abnormal and suggests the possibility of renal artery stenosis. A high resistive index can also indicate ureteral obstruction and may serve as an indirect sign

2014 eMedicine.com

440. Viral Infections and Pregnancy (Treatment)

days prior to delivery or 2 days afterward, poses a risk of severe neonatal varicella, which carries a mortality rate of 30%. Infection at this time prevents development of maternal antibodies that avert transplacental transfer of immunoglobulin G (IgG) antibodies, which confer passive immunity to the fetus. Enterovirus Enterovirus infections are not believed to cross the placenta and cause fetal disease. [ ] However, some studies have linked coxsackievirus and echovirus to miscarriage (...) apoptosis of erythroid precursors and thus inhibiting erythropoiesis. Fetal liver erythroblasts exhibit viral DNA and pathognomonic changes of B19V infection. The myocardium has also been affected, causing myocarditis and resultant heart failure. VZV is a DNA herpes virus. Following primary VZV infection, it can remain latent in the dorsal root ganglia. Primary varicella usually confers lifelong immunity. VZV is most often transmitted to the fetus transplacentally; however, ascending infection from

2014 eMedicine.com

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