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229 results for

Fetal Scalp Stimulation

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121. 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

122. 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

123. Basal Cell Carcinoma, Eyelid (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

124. 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

125. Abnormal Labor (Follow-up)

reveals signs of compromise with decelerations, and fetal scalp pH is an option when indicated. Probably the most common complication of the medical induction of labor is hyperstimulation of the uterus. If unrecognized and untreated, excessive stimulation of the uterus can result in fetal compromise, cord compression, and uteroplacental insufficiency. , postpartum uterine atony, and may occur and can be life-threatening complications requiring emergent action. Allen et al found that increased duration (...) : May 08, 2017 Author: Nina S Olsen, MD; Chief Editor: Ronald M Ramus, MD Share Email Print Feedback Close Sections Sections Abnormal Labor Follow-up Complications Maternal infection is a risk, especially when rupture of membranes occurs for more than 18 hours. Administer antibiotics for signs and symptoms of chorioamnionitis. Fetal compromise can occur from the inability to tolerate labor (eg, uterine hyperstimulation) or infection, and it must be closely evaluated. Fetal heart monitoring often

2014 eMedicine.com

126. Abnormal Neonatal EEG (Follow-up)

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

127. Lyme Disease (Diagnosis)

by erythematous skin lesions. In the United States, Lyme disease was not recognized until the early 1970s, when a statistically improbable cluster of pediatric arthritis cases occurred in the region around Lyme, Connecticut. This outbreak was investigated by Allen Steere, MD, and others from Yale and stimulated intense clinical and epidemiologic research that led to the discovery of the causative agent and its ecology and an expanding geographic range and list of clinical manifestations. The recognition (...) and that it is not directly responsible for adverse fetal outcomes. Post-treatment Lyme disease syndrome Lingering symptoms, which may persist for more than 6 months, affect 10-20% of patients who receive recommended treatment for Lyme disease. [ ] Common complaints include cognitive disturbances, fatigue, joint or muscle pain, headaches, hearing loss, vertigo, mood disturbances, paresthesias, and difficulty sleeping. This condition is often termed chronic Lyme disease, but is more appropriately called post-treatment

2014 eMedicine.com

128. Lyme Disease (Diagnosis)

by erythematous skin lesions. In the United States, Lyme disease was not recognized until the early 1970s, when a statistically improbable cluster of pediatric arthritis cases occurred in the region around Lyme, Connecticut. This outbreak was investigated by Allen Steere, MD, and others from Yale and stimulated intense clinical and epidemiologic research that led to the discovery of the causative agent and its ecology and an expanding geographic range and list of clinical manifestations. The recognition (...) and that it is not directly responsible for adverse fetal outcomes. Post-treatment Lyme disease syndrome Lingering symptoms, which may persist for more than 6 months, affect 10-20% of patients who receive recommended treatment for Lyme disease. [ ] Common complaints include cognitive disturbances, fatigue, joint or muscle pain, headaches, hearing loss, vertigo, mood disturbances, paresthesias, and difficulty sleeping. This condition is often termed chronic Lyme disease, but is more appropriately called post-treatment

2014 eMedicine.com

129. Lyme Disease (Diagnosis)

by erythematous skin lesions. In the United States, Lyme disease was not recognized until the early 1970s, when a statistically improbable cluster of pediatric arthritis cases occurred in the region around Lyme, Connecticut. This outbreak was investigated by Allen Steere, MD, and others from Yale and stimulated intense clinical and epidemiologic research that led to the discovery of the causative agent and its ecology and an expanding geographic range and list of clinical manifestations. The recognition (...) and that it is not directly responsible for adverse fetal outcomes. Post-treatment Lyme disease syndrome Lingering symptoms, which may persist for more than 6 months, affect 10-20% of patients who receive recommended treatment for Lyme disease. [ ] Common complaints include cognitive disturbances, fatigue, joint or muscle pain, headaches, hearing loss, vertigo, mood disturbances, paresthesias, and difficulty sleeping. This condition is often termed chronic Lyme disease, but is more appropriately called post-treatment

2014 eMedicine.com

130. Lyme Disease (Diagnosis)

by erythematous skin lesions. In the United States, Lyme disease was not recognized until the early 1970s, when a statistically improbable cluster of pediatric arthritis cases occurred in the region around Lyme, Connecticut. This outbreak was investigated by Allen Steere, MD, and others from Yale and stimulated intense clinical and epidemiologic research that led to the discovery of the causative agent and its ecology and an expanding geographic range and list of clinical manifestations. The recognition (...) and that it is not directly responsible for adverse fetal outcomes. Post-treatment Lyme disease syndrome Lingering symptoms, which may persist for more than 6 months, affect 10-20% of patients who receive recommended treatment for Lyme disease. [ ] Common complaints include cognitive disturbances, fatigue, joint or muscle pain, headaches, hearing loss, vertigo, mood disturbances, paresthesias, and difficulty sleeping. This condition is often termed chronic Lyme disease, but is more appropriately called post-treatment

2014 eMedicine.com

131. Anabolic Steroid Use and Abuse (Diagnosis)

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

132. Factor IX (Diagnosis)

, 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

133. Erythrocyte Alloimmunization and Pregnancy (Diagnosis)

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

134. Common Pregnancy Complaints and Questions (Diagnosis)

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

135. Preoperative Evaluation and Management (Treatment)

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

136. Surgical Treatment of Parkinson Disease (Treatment)

, 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

137. Teratology and Drug Use During Pregnancy (Treatment)

with clinically significant risks in pregnancy. In rare cases, promotility agents can be prescribed, though the risks and benefits must carefully be discussed with the patients before the drugs are started. A physician caring for a pregnant patient who requires medication should take care in choosing dosages and types of drugs that maximize effectiveness while minimizing fetal risk. It is essential to understand the effect of medications and to know the point in fetal development when drugs are most toxic (...) and which fetal organs are most susceptible. In addition, healthcare providers who treat pregnant women must be familiar with methods of gathering information about drugs, and they must be aware of online databases that are most useful for this purpose. Several resources are available to expand one’s knowledge of teratology. Teratogen Information System (TERIS) and Reprotox are Internet databases that cover this subject. The Organization of Teratology Information Specialists is a network of risk

2014 eMedicine.com

138. Surgical Treatment of Tremor (Treatment)

, 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

139. Childhood HIV Disease (Treatment)

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 (...) in poor nutritional intake. Appetite stimulants can be useful. High-energy, high-protein nutritional supplements are commonly needed. Caretakers must be instructed to avoid giving the child any food or water that has a high risk of being contaminated with any infectious agent. HIV and accompanying opportunistic infections can worsen GI symptoms. Nasogastric, nasojejunal, and/or gastrostomy tubes may be needed to support the patient's nutritional and fluid status. Gastrostomy tubes are well tolerated

2014 eMedicine.com

140. Anabolic Steroid Use and Abuse (Treatment)

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

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