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Fetal Scalp Stimulation

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121. How Do You Advise the Balding Patient?

, Casey ML, McConnell JD, Russell DW. Tissue distribution and ontogeny of steroid 5 alpha-reductase isozyme expression. J Clin Invest. 1993;92(2):903-910. 18. Wester RC, Maibach HI, Guy RH, Novak E. Minoxidil stimulates cutaneous blood flow in human balding scalps: pharmacodynamics measured by laser Doppler velocimetry and photopulse plethysmography. J Invest Dermatol. 1984;82(5):515-517. 19. Lachgar S, Charveron M, Gall Y, Bonafe JL. Minoxidil upregulates the expression of vascular endothelial growth (...) exist for male pattern hair loss. Herbal supplements and products on infomercials make cursory non-FDA-approved claims of hair growth. Minoxidil, once developed for hypertension, is available over the counter as a scalp treatment. Finasteride and the newer dutasteride may curb hair loss but also cause sexual and developmental side effects that preclude use by couples who are pregnant or trying to conceive. Hair transplant surgery is a very expensive but effective and lasting procedure in persons

2010 Clinical Correlations

122. Teratology and Drug Use During Pregnancy (Diagnosis)

, 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

123. Benign Vulvar Lesions (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

124. Nonneoplastic Epithelial Disorders of the Vulva (Diagnosis)

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

125. 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

126. 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

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. Paraneoplastic Diseases (Diagnosis)

have papillomatous thickening of the oral mucosa. Patients who have AN associated with malignancies also have skin changes involving the scalp, areolae, and eyelids. The appearance of paraneoplastic AN usually coincides with the presence of malignancy, but it can precede or follow the diagnosis of cancer and thus may signal a relapse in patients with a history of cancer. Diagnosis The diagnosis of AN is based on clinical findings alone and can be supported by the histopathologic changes (...) 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

130. Preoperative Evaluation and Management (Diagnosis)

, 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 (...) 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

2014 eMedicine.com

131. Normal Labor and Delivery (Diagnosis)

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

132. Normal Labor and Delivery (Overview)

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

133. Nonneoplastic Epithelial Disorders of the Vulva (Overview)

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

134. Lyme Disease (Overview)

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

135. Lyme Disease (Overview)

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

136. Lyme Disease (Overview)

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

137. Lyme Disease (Overview)

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

138. Surgical Treatment of Parkinson Disease (Overview)

, 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 (Overview)

, and significant pruritic dermatoses. Mucocutaneous eruptions may be the first sign of HIV infection and may vary in presentation, depending on the child's immune status. For information on HIV infection in adults and adolescents, see . Previous Next: Pathophysiology HIV can be transmitted vertically, sexually, or via contaminated blood products or IV drug abuse. Vertical HIV infection occurs before birth, during delivery, or after birth. With infection before birth (period 1), the fetus can be hematologically (...) hematopoietic stem cells, the importance is minor. Hematopoietic disturbances are believed to occur as a consequence of changes in the microenvironment of the marrow and of deficiencies in local and systemic growth factors. In typical conditions, the stroma of the marrow promotes stem cell proliferation and differentiation by producing granulocyte colony-stimulating factor (G-CSF) and interleukin (IL)-3. HIV-infected stroma produces less G-CSF and IL-3 than normal and produces excessive tumor necrosis

2014 eMedicine.com

140. Common Pregnancy Complaints and Questions (Overview)

fetal movement and delay maternal detection of fetal movements. As the fetus grows larger, the fetal movement feelings become stronger, regular, and easier to detect. While there is no absolute number that indicates fetal well-being, typical guidance may include that fetuses should move approximately 4 times an hour as they get larger, and some clinicians advise patients to count fetal movements to follow fetal well-being. What kind of breast changes are normal during pregnancy? Pregnancy-related (...) 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

2014 eMedicine.com

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