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227 results for

Fetal Scalp Stimulation

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141. Autoimmune Thyroid Disease and Pregnancy (Treatment)

association exists between MMI and fetal scalp defects, aplasia cutis, and choanal and/or esophageal atresia. Some studies have reported a positive association between the two and others reported no association, which may be due to the fact that the studies showing no association were underpowered or did not assess outcomes at the optimal ages. [ ] Additionally, PTU has recently been shown to increase the risk of malformations, usually milder than those with MMI, but a change from one to the other has (...) , beta-blockers are associated with fetal morbidity. Therefore, these drugs should be used for only a short period (ie, 2 wk) while one waits for the ATDs to take effect. Iodide decreases serum T4 and T3 levels by 30-50% in 10 days. Iodide is used in combination with ATDs and beta-blockers during the preoperative treatment of patients with hyperthyroidism. Iodide can also be used in the medical treatment of patients with thyroid storm. Fetal hypothyroidism resulting from placental passage is reported

2014 eMedicine.com

142. Normal Labor and Delivery (Treatment)

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

143. Paraneoplastic Diseases (Treatment)

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

144. Platelet Disorders (Treatment)

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

145. Postterm Pregnancy (Treatment)

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

146. Paraneoplastic Diseases (Overview)

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

147. 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

148. Surgical Treatment of Tremor (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

149. Basal Cell Carcinoma, Eyelid (Overview)

. [ ] 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

150. Basal Cell Carcinoma (Overview)

. [ ] 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

151. Basal Cell Carcinoma (Overview)

. [ ] 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

152. Teratology and Drug Use During Pregnancy (Overview)

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

153. Common Pregnancy Complaints and Questions (Overview)

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

154. 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

155. 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

156. 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

157. 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

158. Dermatologic Manifestations of Hematologic Disease (Overview)

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

159. Platelet Disorders (Overview)

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

160. Dermatologic Manifestations of Cardiac Disease (Overview)

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

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