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Fetal Scalp Stimulation

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181. Platelet Disorders (Follow-up)

the presence of petechiae and ecchymoses. The presence of lymphadenopathy or suggests other secondary causes of thrombocytopenia rather than ITP. The peripheral smear shows a decreased number of platelets. Often, the smear shows giant platelets, which is a reflection of increased thrombopoietin-induced stimulation of the bone marrow (see images below). Examination of the peripheral smears in immune thrombocytopenic purpura often shows giant platelets. These platelets reflect the increased megakaryocytic (...) mass in the marrow. Peripheral smear of a patient with Bernard-Soulier syndrome showing giant platelets. These platelets are not counted as platelets in most particle counters. At times, the smear may show eosinophilia and lymphocytosis, possibly reflecting hypersensitivity to the inciting viral antigens. The bone marrow shows an increase in the number of megakaryocytes and signs of thrombopoietin-induced megakaryocyte stimulation (increase in number and ploidy, decrease in cytoplasm), resulting

2014 eMedicine.com

182. Abnormal Neonatal EEG (Overview)

it difficult to interpret EEG results, which can discourage the use of EEG testing. Given the close relationships between certain morphological aspects of the developing brain and EEG results, gestational age can be reliably estimated (to ±1 wk) by EEG criteria. In fact, CNS development of the immature brain proceeds at about the same rate during fetal development as in the postnatal environment. The physiological substrate for these early EEG patterns is unknown, but is probably derived from cortical (...) generators that are strongly influenced by subcortical (primarily thalamic) afferent input. Rapid maturation of these structures (and not the corpus callosum) is most likely responsible for the interhemispheric synchrony that occurs close to full-term gestational age; in particular, rapid dendritic spine development and synaptogenesis are typical of the last month of fetal development. The complex development of cerebral sulci during this same period is probably responsible for the neonatal EEG results

2014 eMedicine.com

183. Androgen Excess (Overview)

. The androgen-receptor complex attaches to a specific DNA site and stimulates the production of messenger RNA, which, in turn, stimulates the production of the enzymes and proteins necessary to affect androgen action. Next: Pathophysiology Androgen excess affects mainly the pilosebaceous unit (PSU) and the reproductive system. The PSU secretes sebum and is the unit from which hair grows. Three types of hair, lanugo, vellus, and terminal hairs, exist. The fine hairs of the fetus are lanugo and the peach fuzz (...) . Adrenal androgens increase in response to ACTH stimulation, while androgens do not influence the ACTH secretion. Also, LH stimulates theca cells of the ovaries to secrete androgens; however, there is no feedback regulatory loop that controls androgen secretion in women. Most of the circulating testosterone is metabolized in the liver into androsterone and etiocholanolone, which are conjugated with glucuronic acid or sulfuric acid and execrated in the urine as 17-ketosteroids. Only 20-30% of urinary 17

2014 eMedicine.com

184. Normal Labor and Delivery (Follow-up)

be accomplished with blood sampling from fetal scalp capillaries. This procedure allows for a direct assessment of fetal oxygenation and blood pH. A pH of < 7.20 warrants further investigation for the fetus' well-being and for possible resuscitation or surgical intervention. Routine laboratory studies of the parturient, such as complete blood cell (CBC) count, blood typing and screening, and urinalysis, are usually performed. Intravenous (IV) access is established. Previous Next: Intrapartum Management (...) , in an attempt to avoid shoulder dystocia, deliver the anterior shoulder prior to restitution of the fetal head. Next, the fetus' anterior shoulder is delivered with gentle downward traction on its head and chin. Subsequent upward pressure in the opposite direction facilitates delivery of the posterior shoulder. The rest of the fetus should now be easily delivered with gentle traction away from the mother. If not done previously, the cord is clamped and cut. The baby is vigorously stimulated and dried

2014 eMedicine.com

185. Nonneoplastic Epithelial Disorders of the Vulva (Follow-up)

is evidently a substantial predisposing factor because lesions occur in areas of the skin where sebaceous glands are most active, such as the face, scalp, body folds, and, less commonly, the genitalia. Seborrheic dermatitis is commonly observed in neonates during the early months of life (as a result of sebaceous gland activation by maternal androgens) or after puberty. An association with Pityrosporum yeasts has been noted. Neurologic factors have also been thought to play a role; emotional stress (...) , Parkinson disease, nerve injury, and syringomyelia have been related to onset or worsening of the disease. Seasonal factors, zinc deficiency, and HIV infection have been linked to this disorder. Psoriasis Psoriasis is a hereditary disorder of the skin that affects approximately 2% of the population in the Western world. The characteristic silver-white scales on erythematous plaques are caused by rapid cell turnover and primarily occur in sites of repetitive trauma, such as the scalp, elbows, forearms

2014 eMedicine.com

186. Hyperthyroidism (Follow-up)

(albeit rarely) with cloacal and scalp (cutis aplasia) abnormalities when given during early gestation. [ , ] Generally, if a nonpregnant woman who is receiving methimazole desires pregnancy, she should be switched to propylthiouracil before conception. After 12 weeks of gestation, she can be switched back to methimazole, with frequent monitoring. Propylthiouracil remains the drug of choice in uncommon situations of life-threatening severe thyrotoxicosis (ie, thyroid storm) because of the additional (...) vasculitis. All of these adverse effects, except agranulocytosis, occur more frequently with propylthiouracil: agranulocytosis occurs in 0.2-0.5% of patients overall and is no more common with one drug than with the other. Patients with agranulocytosis usually present with fever and pharyngitis. After the drug is stopped, granulocyte counts usually start to rise within several days but may not normalize for 10-14 days. Granulocyte colony-stimulating factor (G-CSF) appears to accelerate recovery

2014 eMedicine.com

187. Pathology: Basal Cell Carcinoma

. [ ] The image below depicts BCC of the right lower lid. Basal cell carcinoma of the right lower lid. See , , and , Critical Images slideshows, to help correctly identify various lesions. Signs and symptoms Approximately 85% of BCCs occur on the face, head (scalp included), and neck; others appear on the trunk or extremities; rarely, they may occur on the hands. [ , ] Other characteristic features of BCC tumors include the following: Waxy papules with central depression Pearly appearance Erosion (...) tissues during fetal development. After embryogenesis, it continues to function in regulation of cell growth and differentiation. Loss of inhibition of this pathway is associated with human malignancy, including BCC. The hedgehog gene encodes an extracellular protein that binds to a cell membrane receptor complex to start a cascade of cellular events leading to cell proliferation. Of the 3 known human homologues, sonic hedgehog (SHH) protein is the most relevant to BCC. Patched (PTCH) is a protein

2014 eMedicine Surgery

188. Trauma and Pregnancy

Trauma and Pregnancy Trauma and Pregnancy: Overview, Maternal-Fetal Physiology, Maternal Trauma and the Fetus 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvNDM1MjI0LW92ZXJ2aWV3 processing > Trauma and Pregnancy (...) increase in risk to the fetus occurs from surgery alone, and the risk appears to be greatest in the first and third trimesters. The concern for the fetus adds to complexity of diagnosis and management of trauma during pregnancy. Next: Maternal-Fetal Physiology An understanding of normal maternal-fetal physiology is critical in the diagnosis, surgical management, and postoperative care of pregnant women who require major surgery or who have been injured. Normal clinical and laboratory findings

2014 eMedicine Surgery

189. Skin Malignancies, Basal Cell Carcinoma

. [ ] The image below depicts BCC of the right lower lid. Basal cell carcinoma of the right lower lid. See , , and , Critical Images slideshows, to help correctly identify various lesions. Signs and symptoms Approximately 85% of BCCs occur on the face, head (scalp included), and neck; others appear on the trunk or extremities; rarely, they may occur on the hands. [ , ] Other characteristic features of BCC tumors include the following: Waxy papules with central depression Pearly appearance Erosion (...) tissues during fetal development. After embryogenesis, it continues to function in regulation of cell growth and differentiation. Loss of inhibition of this pathway is associated with human malignancy, including BCC. The hedgehog gene encodes an extracellular protein that binds to a cell membrane receptor complex to start a cascade of cellular events leading to cell proliferation. Of the 3 known human homologues, sonic hedgehog (SHH) protein is the most relevant to BCC. Patched (PTCH) is a protein

2014 eMedicine Surgery

190. Skin Cancer: Basal Cell Carcinoma

. [ ] The image below depicts BCC of the right lower lid. Basal cell carcinoma of the right lower lid. See , , and , Critical Images slideshows, to help correctly identify various lesions. Signs and symptoms Approximately 85% of BCCs occur on the face, head (scalp included), and neck; others appear on the trunk or extremities; rarely, they may occur on the hands. [ , ] Other characteristic features of BCC tumors include the following: Waxy papules with central depression Pearly appearance Erosion (...) tissues during fetal development. After embryogenesis, it continues to function in regulation of cell growth and differentiation. Loss of inhibition of this pathway is associated with human malignancy, including BCC. The hedgehog gene encodes an extracellular protein that binds to a cell membrane receptor complex to start a cascade of cellular events leading to cell proliferation. Of the 3 known human homologues, sonic hedgehog (SHH) protein is the most relevant to BCC. Patched (PTCH) is a protein

2014 eMedicine Surgery

191. Skin, Anatomy

is related to melanosome size rather than cell number. Sun exposure, melanocyte-stimulating hormone (MSH), adrenocorticotropic hormone (ACTH), estrogens, and progesterones stimulate melanin production. With aging, a decline is observed in the number of melanocytes populating the skin of an individual. Since these cells are of neural crest origin, they have no ability to reproduce. Langerhans Cells Langerhans cells originate from the bone marrow and are found in the basal, spinous, and granular layers (...) glands, or holocrine glands, are found over the entire surface of the body except the palms, soles, and dorsum of the feet. They are largest and most concentrated in the face and scalp where they are the sites of origin of acne. The normal function of sebaceous glands is to produce and secrete sebum, a group of complex oils that include triglycerides and fatty acid breakdown products, wax esters, squalene, cholesterol esters, and cholesterol. Sebum lubricates the skin to protect it against friction

2014 eMedicine Surgery

192. Breast Embryology

or diverticula of the epidermis into the dermis. Sebaceous glands, or holocrine glands, are found over the entire surface of the body except the palms, soles, and dorsum of the feet. They are largest and most concentrated in the face and scalp where they are the site of origin of acne. The normal function of sebaceous glands is to produce sebum, a group of complex oils including triglycerides and fatty acid breakdown products, wax esters, squalene, cholesterol esters, and cholesterol. Eccrine sweat glands (...) develop within the buds that coalesce and elongate to form the lactiferous ducts. The canalization of the mammary buds with formation of the lactiferous ducts is induced by placental hormones entering the fetal circulation. These hormones include progesterone, growth hormone, insulinlike growth factor, estrogen, prolactin, adrenal corticoids, and triiodothyronine. At term, approximately 15-20 lobes of glandular tissue have formed, each containing a lactiferous duct. Support for the breast comes from

2014 eMedicine Surgery

193. Burns, Electrical

the subject cannot release the grasp of the conductor. The maximum current a person can tolerate when holding a conductor in one hand and still let go of the conductor using the muscles directly stimulated by the current is termed the "let-go" current. This tetanizing effect on voluntary muscles is most pronounced in the frequency range of 15-150 Hz. Such strong muscular reactions may cause fractures and/or dislocations. Numerous reports of bilateral and and fractures in electric accidents attest

2014 eMedicine Surgery

194. Childhood HIV Disease (Follow-up)

weeks old Unfortunately, antepartum treatment is not without risk to the fetus. In a study of HIV-negative infants born to HIV-positive mothers, Lipshultz et al concluded that fetal exposure to ART was associated with various cardiac effects, including reduced left ventricular (LV) dimension, LV mass, and septal wall thickness z-scores, as well as increased LV fractional shortening and contractility up to age 2 years. [ ] These effects are more pronounced in girls than in boys Exposure to ART (...) Flucytosine Amphotericin Sulfonamides Trimethoprim, trimethoprim-sulfamethoxazole Pyrimethamine Pentamidine Infectious agents such as parvovirus B19 can cause myelosuppression, as can invasive neoplastic processes of the marrow. Granulocyte-macrophage colony-stimulating factor (GM-CSF) and granulocyte colony-stimulating factor (G-CSF) are used to treat neutropenia and to promote granulocyte production and function. GM-CSF has more adverse effects than G-CSF, and it promotes viral replication. However, GM

2014 eMedicine.com

195. Dermatologic Manifestations of Hematologic Disease (Follow-up)

criteria) for definite APS. The criteria, developed by consensus among international clinical and laboratory experts, were originally referred to in 1999 as the Sapporo criteria [ ] and then modified at a meeting in Sydney in 2006. [ ] The primary diagnostic criteria include arterial thrombosis, venous thrombosis, recurrent fetal loss, and thrombocytopenia. One of the listed primary criteria is required for diagnosis, combined with a sustained elevated titer of immunoglobulin G (IgG) anticardiolipin (...) . [ ] According to the Cooperative Study of Sickle Cell Disease, approximately 25% of patients with sickle cell disease in the United States have a history of active ulcers or developed ulcers during the 8 years of observation. The incidence is low in children younger than 10 years because of the protective effect of persistent fetal hemoglobin. Other risk factors for developing leg ulceration are anemia, male sex, combined HLA-B35 and HLA-Cw4, and antithrombin III deficiency. Based on clinical experience

2014 eMedicine.com

196. Dermatologic Manifestations of Cardiac Disease (Follow-up)

Clubbing (Hypertrophic Osteoarthropathy) Definition represents a localized drumsticklike swelling of the distal segments of fingers and toes, particularly over the extensor surface. It is caused by connective tissue proliferation leading to increases in the sponginess of the soft tissue at the base of the nails due to stimulation by a humoral substance that causes dilation of the vessels of the fingertip or toe tip. [ ] Differential diagnosis Clubbing, as illustrated below, is seen in persons (...) is observed in some infants born to mothers with . This may be due to various factors, such as fetal myocarditis, idiopathic hemorrhage and necrosis involving conduction tissue, degeneration and fibrosis related in some instances to the transplacental passage of anti-Ro/ss-A antibody, and other immune complexes from mothers. Neonatal lupus erythematosus and its dermatologic manifestations were reviewed by Neiman et al. [ ] They studied 47 mothers (83% white) whose sera contained anti-SSA/Ro, anti-SSB/La

2014 eMedicine.com

197. Teratology and Drug Use During Pregnancy (Follow-up)

, have performed many studies in this area. Specific drugs should be investigated before they are used. Risk-benefit assessment and counseling should involve the patient in the setting of her current state of health. The physician must consider the effects of drug exposure on the developing fetus or embryo and acknowledge specific susceptibilities at each point in fetal development, as balanced against the risks of worsening maternal illness. The patient must consider her symptoms, quality of life (...) exposures may alter the size, shape, performance, and production of sperm. This observation suggests that drug exposure in the male may put the fetus at risk. Animal studies have shown that paternal teratogenic exposure may lead to pregnancy loss or failure of the embryo to develop. However, unlike teratogenic agents taken by pregnant woman, teratogenic agents affecting the father do not seem to directly interfere with normal fetal development. Animal studies show that paternal teratogenic exposure may

2014 eMedicine.com

198. Androgenetic Alopecia (Follow-up)

. [ ] Finasteride Finasteride is given orally and is a 5-alpha reductase type 2 inhibitor. [ ] It is not an antiandrogen. The drug can be used only in men because it can produce ambiguous genitalia in a developing male fetus. Finasteride has been shown to diminish the progression of androgenetic alopecia in males who are treated, and, in many patients, it has stimulated new regrowth. Although it affects vertex balding more than frontal hair loss, the medication has been shown to increase regrowth in the frontal (...) minizones on the scalp. Measurements of the hair growth, density, diameter, pigmentation, and anagen/telogen ratio were performed throughout the study. At 24 weeks, an increase in hair density was noted at the latanoprost-treated site compared with baseline and the placebo site. They concluded that this medication could be useful for stimulating hair follicle activity and treating hair loss. [ ] Androgenetic alopecia is very common; therefore, not surprisingly, it may accompany other forms of hair loss

2014 eMedicine.com

199. Anabolic Steroid Use and Abuse (Follow-up)

present in females in small amounts. Due to the negative feedback system, the release of LH and FSH decline, leading to a decrease in estrogens and progesterone. AAS use by a pregnant woman can cause pseudohermaphroditism or virilization in the female fetus or may even cause fetal death. The American College of Obstetricians and Gynecologists (ACOG) includes anabolic steroids in the list for routine substance-abuse-disorder screening. Healthcare professionals are encouraged to address the use (...) negative feedback inhibition upon gonadotropin-releasing hormone (GnRH). Since GnRH stimulates follicle-stimulating hormone (FSH) and LH release in the pituitary, this negative feedback can be seen to inhibit subsequent testosterone production and effect spermatogenesis. Testosterone activity is mediated via an androgen receptor that is present in various tissues throughout the human body. Testosterone binds to an intracellular receptor found in the cytosol of cells, forming a receptor complex

2014 eMedicine.com

200. Surgical Treatment of Tremor (Diagnosis)

, dopaminergic) The target area is well defined (ie, striatum) Postsynaptic receptors are relatively intact The neurons provide tonic stimulation of the receptors and appear to serve a modulatory function In double-blind studies, neither transplantation of autologous adrenal medullary cells nor transplantation of fetal porcine cells has been found to be effective; both have been abandoned. Although open-label studies of fetal dopaminergic cell transplantation yielded promising results, 3 randomized, double (...) physiologically. Medtronics Activa Tremor control system consists of 3 components: (1) stimulating lead, which is implanted to desired target; (2) extension cable, which is tunneled under scalp and soft tissues of neck to anterior chest wall; and (3) pulse generator, which is programmable source of electrical impulses. Stereotactic headframe is applied at start of surgery. MRI-localizing box is attached to frame only during targeting MRI. Localizer defines working volume of frame and provides reference

2014 eMedicine.com

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