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Fetal Scalp Stimulation

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101. Squamous Cell Carcinoma (Skin Cancer), Childhood

diagnosis and result in better outcomes.[ ] Diagnostic Evaluation Initial evaluation of a child or adolescent with a thyroid nodule includes the following: Ultrasound of the thyroid. Serum thyroid-stimulating hormone (TSH) level. Serum thyroglobulin level. Tests of thyroid function are usually normal, but thyroglobulin can be elevated. Fine-needle aspiration as an initial diagnostic approach is sensitive and useful. However, in doubtful cases, open biopsy or resection should be considered.[ ] Treatment (...) . Importantly, if iodinated contrast agents are used, further evaluation and treatment with radioactive iodine may need to be delayed for 2 to 3 months until total body iodine burden decreases. Chest imaging (x-ray or CT) may be considered for patients with substantial cervical lymph node disease. Thyroid nuclear scintigraphy should be pursued only if the patient presents with a suppressed thyroid-stimulating hormone (TSH). The routine use of bone scan or fluorine F 18-fludeoxyglucose positron emission

2012 PDQ - NCI's Comprehensive Cancer Database

102. Adrenocortical Carcinoma, Childhood

diagnosis and result in better outcomes.[ ] Diagnostic Evaluation Initial evaluation of a child or adolescent with a thyroid nodule includes the following: Ultrasound of the thyroid. Serum thyroid-stimulating hormone (TSH) level. Serum thyroglobulin level. Tests of thyroid function are usually normal, but thyroglobulin can be elevated. Fine-needle aspiration as an initial diagnostic approach is sensitive and useful. However, in doubtful cases, open biopsy or resection should be considered.[ ] Treatment (...) . Importantly, if iodinated contrast agents are used, further evaluation and treatment with radioactive iodine may need to be delayed for 2 to 3 months until total body iodine burden decreases. Chest imaging (x-ray or CT) may be considered for patients with substantial cervical lymph node disease. Thyroid nuclear scintigraphy should be pursued only if the patient presents with a suppressed thyroid-stimulating hormone (TSH). The routine use of bone scan or fluorine F 18-fludeoxyglucose positron emission

2012 PDQ - NCI's Comprehensive Cancer Database

103. Ovarian Cancer, Childhood

diagnosis and result in better outcomes.[ ] Diagnostic Evaluation Initial evaluation of a child or adolescent with a thyroid nodule includes the following: Ultrasound of the thyroid. Serum thyroid-stimulating hormone (TSH) level. Serum thyroglobulin level. Tests of thyroid function are usually normal, but thyroglobulin can be elevated. Fine-needle aspiration as an initial diagnostic approach is sensitive and useful. However, in doubtful cases, open biopsy or resection should be considered.[ ] Treatment (...) . Importantly, if iodinated contrast agents are used, further evaluation and treatment with radioactive iodine may need to be delayed for 2 to 3 months until total body iodine burden decreases. Chest imaging (x-ray or CT) may be considered for patients with substantial cervical lymph node disease. Thyroid nuclear scintigraphy should be pursued only if the patient presents with a suppressed thyroid-stimulating hormone (TSH). The routine use of bone scan or fluorine F 18-fludeoxyglucose positron emission

2012 PDQ - NCI's Comprehensive Cancer Database

104. Preoperative Evaluation and Management (Overview)

controlled, and the insulin doses should be adjusted as needed. Management of hypoglycemic agents and different types of insulin can be pivotal. [ ] Hypertension A history of hypertension should alert the physician to check the patient's blood pressure. Patients with elevated pressures may bleed profusely. This is especially true when working on larger areas of the body or in highly vascular regions, such as the scalp. Hypertension is an important cause of perioperative bleeding and hematoma formation (...) , can cause bone growth retardation and staining of dental enamel in the fetus. Lidocaine also appears to be safe in low doses, although excessive amounts can cause fetal CNS and cardiac depression. Acetaminophen (Class B) is routinely used during pregnancy despite its ability to cross the placenta. [ ] Drugs should also be selected carefully during lactation. [ ] Snoring/sleep apnea Eighty percent of patients with breathing problems related to sleep disorders are male. Conscious sedation may

2014 eMedicine.com

105. Postterm Pregnancy (Overview)

be reviewed. Finally, intrapartum fetal surveillance in an attempt to document fetal intolerance to labor before it leads to acidosis is critical. Whether continuous fetal monitoring or intermittent auscultation is used, interpretation of the results by a well-trained clinician is of paramount importance. If the fetal heart rate tracing is equivocal, fetal scalp stimulation and/or fetal scalp blood sampling may provide the reassurance necessary to justify continuing the induction of labor (...) management of the pregnancy, or (3) antenatal testing. Each of these 3 options may be used at any particular time during this 2-week period. Note that if the pregnancy is at risk for an adverse outcome from an underlying condition, either maternal or fetal, inducing labor may proceed without documented lung maturity. Also, an elective induction of labor may proceed at or after 39 weeks of gestation in the absence of documented lung maturity provided that 36 weeks have elapsed since documentation

2014 eMedicine.com

106. Normal Labor and Delivery (Overview)

cardiotocography. This review concluded that continuous cardiotocography during labor is associated with a reduction in neonatal seizures but not cerebral palsy or infant mortality; however, continuous monitoring is associated with increased cesarean and operative vaginal deliveries. [ ] If nonreassuring fetal heart rate tracings by cardiotography (eg, late decelerations) are noted, a fetal scalp electrode may be applied to generate sensitive readings of beat-to-beat variability. However, a fetal scalp (...) 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

2014 eMedicine.com

107. Erythrocyte Alloimmunization and Pregnancy (Overview)

and at 28 weeks gestation. Pending fetal blood type, the patient should also receive Rhesus Immunoglobulin following delivery. [ ] Fetal hydrops. Ultrasound image of edema of the scalp and face in a hydropic fetus. Additionally, advancements in fetal surveillance and treatment have allowed for successful outcomes for most affected fetuses. This article reviews the pathophysiology, diagnosis, and management of erythrocyte Rh D alloimmunization and includes a discussion of rarer erythrocyte antigens. Next (...) from white individuals, and agglutination was observed in 85% of the samples (Rh D positive). The remaining 15% of the samples were Rh D negative; this finding corresponds remarkably to the currently known prevalence of Rh D–negative blood type in whites. Following this discovery, Levine determined that hemolytic disease of the fetus and newborn was usually caused by Rh incompatibility (ie, the fetal stimulation of Rh D antibody development in an Rh D–negative woman). In 1953, Chown verified

2014 eMedicine.com

108. Factor IX (Overview)

, hematologists, and neonatologists in the United States for the treatment of pregnant carriers and newborns with hemophilia and intracranial hemorrhage (ICH) showed that more than 94% of the major facilities reviewed had no written guidelines. Survey findings led to the following recommendations [ , ] : Vacuum devices and fetal scalp monitors should not be used during vaginal delivery of known carriers of hemophilia All infants with intracranial hemorrhage should be evaluated for a bleeding disorder, Women (...) express TF only when stimulated by serine proteases, such as thrombin, and by inflammatory cytokines. In vivo, under physiologic conditions, only a trace amount of FVII is present in the activated form (activated factor VII [FVIIa] of approximately 1%). When TF becomes available, it complexes with FVII or FVIIa, and current concepts support the view that activation of FIX to FIXa is more rapid with the TF-FVII complex than with activated factor XI (FXIa). [ ] The activation peptide for FIX

2014 eMedicine.com

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

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 (...) for aromatase; thus, it is not converted to estrogenic metabolites. DHT has been shown to bind avidly to receptors in tissues, such as skin, scalp, and prostate, and to exert 3-4 times the androgenic effect of testosterone. Thus, the primary hormone mediating the androgenic effects of testosterone is actually the 5-alpha reduced DHT. Other mechanisms of direct and indirect anabolic effects include anti-glucocorticoid activity mediated by displacement of glucocorticoids from their receptor, [ ] increases

2014 eMedicine.com

110. 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

111. 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

112. Trauma and Pregnancy

to the clinician faced with a pregnant woman with an acute abdomen. Clinical evidence of alpha-adrenergic stimulation raises a concern regarding reduced uterine blood flow and subsequent fetal compromise, despite maternal blood pressures within the reference range. Alpha-adrenergic stimulation is manifested by marked peripheral vasoconstriction, cold and clammy extremities, a decrease in capillary refill in response to skin pressure, widened pulse pressure, decreased urinary output, and increased sweating (...) pseudocholinesterase is decreased by 20% in late pregnancy; however, clinically significant increases in the duration of succinylcholine neuromuscular block are reported rarely. Venous distention increases the caliber of epidural veins. The dose of epidural anesthetic agents is reduced by 50%. The uterine vasculature is sensitive to alpha-adrenergic stimulation. Maternal stress response, maternal anxiety, or alpha-adrenergic vasopressors can result in fetal hypoxia and acidosis. Previous Next: Maternal Trauma

2014 eMedicine Surgery

113. Anabolic Steroid Use and Abuse (Overview)

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 (...) for aromatase; thus, it is not converted to estrogenic metabolites. DHT has been shown to bind avidly to receptors in tissues, such as skin, scalp, and prostate, and to exert 3-4 times the androgenic effect of testosterone. Thus, the primary hormone mediating the androgenic effects of testosterone is actually the 5-alpha reduced DHT. Other mechanisms of direct and indirect anabolic effects include anti-glucocorticoid activity mediated by displacement of glucocorticoids from their receptor, [ ] increases

2014 eMedicine.com

114. Extremely Low Birth Weight Infant (Diagnosis)

, including chronic oxygen dependency. Immediately after birth, the infant should be dried and placed on a radiant warmer, and a hat or another covering should be placed on his or her head, as the scalp is a site of large heat loss. Studies have shown that placing a plastic film over the baby immediately after drying or placing the infant on a warming mattress can further minimize evaporative and convective heat losses. [ , ] For transport to the neonatal intensive care unit (NICU) from the delivery room (...) . Although chemical heating pads are commonly used to provide a warm surface on which to place the baby, the unregulated heat source may burn the very fragile skin of the infant; therefore, such pads are not recommended. Caution is due when using any of the currently available methods to prevent hypothermia; frequent monitoring of temperature is necessary to prevent overheating given any combination of approaches. Hypoglycemia Fetal euglycemia (maintenance of normal blood glucose levels) is maintained

2014 eMedicine Pediatrics

115. Common Pregnancy Complaints and Questions (Follow-up)

the fetal head and the maternal pelvis. Relaxin was also thought to loosen pelvic ligaments when secreted from the ovaries, contributing to enlargement of the pelvis, but this is not proven in human pregnancies. The symphysis pubis can enlarge from about 3-4 mm in nulliparas to about 4.5 mm (or as much as 8 mm) in multiparas, but during gestation itself the average separation is about 7-8 mm. When is fetal movement usually felt? Most women feel the beginnings of fetal movement before 20 weeks' gestation (...) . In a first pregnancy, this can occur around 18 weeks' gestation, and in following pregnancies it can occur as early as 15-16 weeks' gestation. Early fetal movement is felt most commonly when the woman is sitting or lying quietly and concentrating on her body. It is usually described as a tickle or feathery feeling below the umbilical area. The point at which a woman feels the baby move is termed quickening. Placental location can impact the timing of quickening. An anterior placenta can "cushion" against

2014 eMedicine.com

116. Surgical Treatment of Parkinson Disease (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

117. 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

118. Dermatologic Manifestations of Hematologic Disease (Diagnosis)

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

119. Dermatologic Manifestations of Cardiac Disease (Diagnosis)

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

120. Basal Cell Carcinoma (Diagnosis)

. [ ] 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.com

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