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High Pressure Injection Wound

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1481. Bevacizumab and Erlotinib in Treating Patients With Advanced Liver Cancer

or similar tear production test) No stroke or transient ischemic attack within the past 6 months No uncontrolled high blood pressure, history of labile hypertension, or history of poor compliance with an antihypertensive regimen No unstable angina pectoris within the past 6 months No symptomatic congestive heart failure No myocardial infarction within the past 6 months No serious uncontrolled cardiac arrhythmias No uncontrolled diabetes mellitus No active or uncontrolled infection No impaired GI function (...) or disease that may significantly alter the absorption of erlotinib hydrochloride (e.g., ulcerative disease, uncontrolled nausea, vomiting, or diarrhea, malabsorption syndrome, or bowel obstruction) Able to swallow tablets No psychiatric illness or social situation that would limit compliance with study requirements No history of nephrotic-range protein No history of bleeding diathesis No encephalopathy No serious nonhealing wounds, skin ulcers, or bone fractures No clinically significant peripheral

2006 Clinical Trials

1482. Study of FOLFIRI Plus Bevacizumab in Colorectal Cancer Patients

, gastrointestinal perforation, or intra-abdominal abscess within 6 months prior to Day 0, unless affected area has been removed surgically. Any of the following concurrent severe and/or uncontrolled medical conditions which could compromise participation in the study: Uncontrolled high blood pressure, history of labile hypertension, or history of poor compliance with an antihypertensive regimen; Unstable angina; New York Heart Association (NYHA) greater than/equal to grade 2 congestive heart failure Myocardial (...) : March 2011 Resource links provided by the National Library of Medicine related topics: available for: Arms and Interventions Go to Arm Intervention/treatment Experimental: FOLFIRI plus Bevacizumab FOLFIRI [folinic acid (leucovorin) 400 mg/m^2 by vein (IV) Day 1; 5-FU 400 mg/m^2 IV injection Day 1 immediately followed by 2.4 g/m^2 IV over 46 hours over Days 1-3; Irinotecan 180 mg/m^2 IV on Day 1] + Bevacizumab 5 mg/kg over 90 minutes on Day 1 administered alone then 5 mg/kg IV on Day 1 of 14 day

2006 Clinical Trials

1483. Factors affecting the outcome of trabeculectomy: an analysis based on combined data from two phase III studies of an antibody to transforming growth factor beta2, CAT-152. (Abstract)

the treatment groups.Data were from patients (n = 726) with a diagnosis of primary open-angle glaucoma, chronic angle-closure glaucoma, pseudoexfoliative glaucoma, or pigmentary glaucoma (PG) who had an intraocular pressure (IOP) > 21 mmHg and visual field or optic disc changes characteristic of glaucoma and were taking the maximum tolerated dose of medication before trabeculectomy.Patients had trabeculectomy and 4 subconjunctival injections of a human monoclonal antibody to TGF-beta2 (CAT-152) or a placebo (...) . The definition of trabeculectomy success in the protocols was an IOP between 6 and 16 mmHg inclusive at months 6 and 12. Analyses of success used factors identified by ophthalmic experts.Covariates analyzed included patient age, black race, gender, time since diagnosis, primary diagnosis, country, diabetes, mean defect, cup-to-disc (C/D) ratio, suture type, anesthetic, flap type, IOP at listing for surgery, suture release/lysis, needling, reformed anterior chamber, wound leak, severe bleb vascularity

2007 Ophthalmology

1484. Snake Bites

, breathing and circulation routine. Assess: Angio-oedema and shock. Confusion and/or drowsiness. Loss of consciousness. Pulse and blood pressure. Examine wound and look for: Local tissue destruction. Oedema. Blisters. Streaking/erythema or discoloration (of affected limb and trunk). Examine for systemic effects: Changes in skin sensation or paraesthesia can signal release of neurotoxin (for example, from coral snakes). [ ] Hypotension. Bleeding (for example, epistaxis, petechial haemorrhages (...) of swelling after two hours may be discharged; all others must be admitted for observation. Wound care: Clean the bite site and splint the limb. Give anti-tetanus prophylaxis as required. General care: Monitor pulse, blood pressure and respiration (every 15 minutes). Apply cardiac monitor to look for arrhythmias. Ensure adequate hydration. Achieve intravenous access. Investigation: Perform ECG twice-daily - looking for nonspecific ECG changes such as T-wave inversion and ST depression. Check U&Es, FBC

2008 Mentor

1485. Pneumothorax

when you ask him or her to take a deep inspiration. The trachea is deviated away from the side of collapse, especially in tension pneumothorax. Percussion reveals hyper-resonance over the collapse. Breath sounds are reduced or absent over the affected area. Bilateral pneumothorax is unusual but the lack of asymmetry of the chest will make clinical diagnosis more difficult. There are specific problems for those who are being ventilated. High peak airway pressure suggests an impending pneumothorax (...) complication [ ] . Antibiotic prophylaxis is not recommended for non-trauma patients requiring a chest drain. Antibiotic prophylaxis should be considered for trauma patients requiring chest drains, especially after penetrating trauma [ ] . There are concerns regarding the development of re-expansion pulmonary oedema [ ] . It is therefore recommended that suction should not be used routinely. Caution is required because of the risk of re-expansion pulmonary oedema. High-volume low-pressure suction systems

2008 Mentor

1486. Prevention of Deep Vein Thrombosis

to either warfarin or LMWH. Repeated risk assessments for VTE should be carried out if women develop intercurrent problems, or they require surgery or re-admission for any reason in the puerperium. For women with additional risk factors lasting more than seven days postpartum (eg, wound infection, prolonged admission), thromboprophylaxis should be continued for up to six weeks or until the risk factors have resolved. © Royal College of Obstetricians and Gynaecologists; reproduced with permission. High (...) to reduce the risk of travel-related DVT. Advise graduated compression stockings: class 1 stockings or proprietary flight socks are generally sufficient. Measure the ankle-brachial pressure index (ABPI) if the person has symptoms of arterial disease. If the ABPI is less than 0.5, compression stockings should not be worn. People at high risk Assess the person's suitability for long-distance travel. Consider seeking specialist advice, or recommend delaying or cancelling the trip (eg, postpone a long-haul

2008 Mentor

1487. Lower Urinary Tract Symptoms (LUTS) in Men

intermittent self-catheterisation; or Has skin wounds, pressure ulcers or irritation that are being contaminated by urine; or Is distressed by bed and clothing changes. Indwelling catheters for urgency incontinence may not result in continence or the relief of recurrent infections. Prostatic stents may be considered as an alternative to indwelling catheters. Permanent use of containment products should only be considered after assessment and exclusion of other methods of management. Experimental treatments (...) are unlikely to cause bladder outflow obstruction and any LUTS developing in early prostate cancer are usually due to coincidental BPH. [ ] Assessment [ , ] General medical history to identify possible causes and comorbidities, including a review of all current medication (including herbal and over-the-counter medication). Examination of the abdomen, including external genitalia and a digital rectal examination. Examination should include blood pressure, signs of uraemia, enlargement of the bladder

2008 Mentor

1488. Keloid Scars

. There are various options. Reviews suggest that combinations of treatments are probably the most effective. [ ] Local steroids [ , ] Intralesional steroid injections, with triamcinolone, are a mainstay of treatment and prevention - reviews suggest that it improves the majority of scars. Injections are given every 2-6 weeks until improvement. Side-effects: pigment changes, telangiectasias and subcutaneous atrophy (which may resolve). Steroid-impregnated tape applied for 12 hours/day may flatten keloids. Pressure (...) or occlusive dressings These are used both for treatment and prevention, with minimal adverse effects, provided they are practical and acceptable to the patient. [ ] Silicone gel - this is applied as topical gel or a gel-impregnated sheet. [ , ] Compression earrings - are used after excision of earlobe keloids and give good rates of recurrence-free healing; they should be worn 24 hours/day. [ ] Other pressure dressings may be used. Surgery [ ] Surgical excision on its own has a very high recurrence rate

2008 Mentor

1489. Infection control and instrument sterility for GP minor surgery

for the injection to have its effect. Another way to obtain superficial topical analgesia is to 'freeze' the skin with an ethyl chloride spray. This is a highly volatile liquid that comes in a large ampoule with a spring-loaded rubber stopper. It is inverted over the lesion and vapour pressure of the liquid ensures that when the cap is opened a fine spray of ethyl chloride is directed at the lesion. Usually it takes about 15 to 40 seconds for the area to turn white before beginning the procedure. Although (...) doctors and based on research evidence, UK and European Guidelines. You may find one of our more useful. In this article In This Article Minor Surgery in Primary Care In this article Minor surgery in primary care has long been held to be cost-effective and popular with patients. Minor surgery procedures in primary care include: Cryotherapy. Electrocautery. Curettage. Therapeutic injections used in a variety of conditions - eg: Injections into joints (steroids but also perhaps viscosupplementation

2008 Mentor

1490. Minor Surgery in Primary Care - Procedures Under a Direct Enhanced Service

a few minutes for the injection to have its effect. Another way to obtain superficial topical analgesia is to 'freeze' the skin with an ethyl chloride spray. This is a highly volatile liquid that comes in a large ampoule with a spring-loaded rubber stopper. It is inverted over the lesion and vapour pressure of the liquid ensures that when the cap is opened a fine spray of ethyl chloride is directed at the lesion. Usually it takes about 15 to 40 seconds for the area to turn white before beginning (...) by UK doctors and based on research evidence, UK and European Guidelines. You may find one of our more useful. In this article In This Article Minor Surgery in Primary Care In this article Minor surgery in primary care has long been held to be cost-effective and popular with patients. Minor surgery procedures in primary care include: Cryotherapy. Electrocautery. Curettage. Therapeutic injections used in a variety of conditions - eg: Injections into joints (steroids but also perhaps

2008 Mentor

1491. Minor Surgery in Primary Care - Basic Procedures

for the injection to have its effect. Another way to obtain superficial topical analgesia is to 'freeze' the skin with an ethyl chloride spray. This is a highly volatile liquid that comes in a large ampoule with a spring-loaded rubber stopper. It is inverted over the lesion and vapour pressure of the liquid ensures that when the cap is opened a fine spray of ethyl chloride is directed at the lesion. Usually it takes about 15 to 40 seconds for the area to turn white before beginning the procedure. Although (...) on research evidence, UK and European Guidelines. You may find one of our more useful. In this article In This Article Minor Surgery in Primary Care In this article Minor surgery in primary care has long been held to be cost-effective and popular with patients. Minor surgery procedures in primary care include: Cryotherapy. Electrocautery. Curettage. Therapeutic injections used in a variety of conditions - eg: Injections into joints (steroids but also perhaps viscosupplementation). Aspiration of joints

2008 Mentor

1492. Upper Gastrointestinal Bleeding

). Corticosteroids will also need to be used carefully and probably with concomitant PPI in high-risk patients or those on high doses. Complications The complications of UGIB are self-evident. Other complications can arise from treatments administered - for example: Endoscopy: . Perforation. Complications from coagulation, laser treatments. Surgery: . . Wound problems. Salvage surgery for patients who continue to bleed is associated with a high mortality. Prognosis Elderly patients and people with chronic (...) times as common as bleeding from the lower GIT. It is important to identify patients with a low probability of re-bleeding from patients with a high probability of re-bleeding. The size of the bleeding vessel is important in prognosis. Visible vessels are usually between 0.3 mm and 1.8 mm. Large bleeding vessels cause faster blood loss. Generally, larger vessels are found deeper in the submucosa and serosa and more specifically high in the lesser curve of the stomach and postero-inferiorly

2008 Mentor

1493. Travel Advice

that they are at particularly high risk of becoming unwell if they develop severe traveller's diarrhoea. They need to continue taking insulin (possibly at a reduced dose) to avoid ketosis, and they also need to be able to take in calories in order to avoid becoming 'hypo'. This is a difficult situation to manage and they should make sure they are in a position to obtain advice and help should difficulties arise. Patients should carry a letter explaining their need to keep insulin and injection equipment in their hand (...) syringe, 2 ml syringe and needles (in packets, sterile). Protective gloves - 1 pair. Sticking plasters - 1 pack. Blister plasters - 1 pack assorted. Gauze squares 5 cm x 5. Sterile non-stick dressings x 5. Sanitary pad x 1 (for absorbent padding). Cotton bandage 10 cm x 1.5 cm. Crepe bandage 10 cm x 1.5 cm. Duct tape - 1 small roll. Wound closures (Steri-Strips®) - 1 packet. Alcohol swabs x 5. Sunscreen (high-factor if at altitude). Burn cream - eg, silver sulfadiazine or aloe vera gel. Insect

2008 Mentor

1494. Cholera Vaccination

in humans. They include V. parahaemolyticus , V. mimicus , V. damsela and V. hollisae and they also cause diarrhoea. There are also two other related families called aeromonas and plesiomonas and they cause diarrhoea, wound infections, septicaemia, ocular infections and meningitis. Two serotypes of V. cholerae cause epidemic cholera (serotype O1 and serotype O139). Serotype O1 is further divided into classical and El Tor biotypes. The World Health Organization (WHO) reports the emergence of new (...) [ ] . A high infecting dose (as many as 1,011 organisms) is necessary to cause illness in healthy individuals. Drinking untreated water or eating poorly cooked seafood in endemic areas carries a high risk. Large outbreaks are common after natural disasters or in populations displaced by war, where inadequate sewage disposal and contaminated water exist. Travellers living in unsanitary conditions, such as humanitarian relief workers in disaster areas, are also at risk. Presentation The incubation period

2008 Mentor

1495. Cholera

. They include V. parahaemolyticus , V. mimicus , V. damsela and V. hollisae and they also cause diarrhoea. There are also two other related families called aeromonas and plesiomonas and they cause diarrhoea, wound infections, septicaemia, ocular infections and meningitis. Two serotypes of V. cholerae cause epidemic cholera (serotype O1 and serotype O139). Serotype O1 is further divided into classical and El Tor biotypes. The World Health Organization (WHO) reports the emergence of new, apparently more (...) are endemic in India and Bangladesh. Non-O1 and non-O139 V. cholerae can cause mild diarrhoea but do not generate epidemics. There are an estimated 3-5 million cholera cases and 100,000-120,000 deaths due to cholera every year [ ] . Risks for travellers The risk of cholera for most travellers to endemic areas is very low. The overall incidence of cholera in travellers is only 2-3 per million but, for those staying in areas of outbreaks, the incidence rises to 5 per thousand [ ] . A high infecting dose

2008 Mentor

1496. Compartment Syndromes

injections, vascular puncture in anticoagulated patients. Muscle hypertrophy in athletes. [ ] Presentation Acute compartment syndromes usually present within 48 hours of injury. A high index of suspicion is required, especially with an unconscious patient following major trauma. Clinical features include: Increasing pain despite immobilisation of the fracture. Sensory deficit in the distribution of nerves passing through the compartment. Muscle tenderness and swelling. Excessive pain on passive movement (...) or difference between mean arterial pressure and compartment pressure less than 40 mm Hg. The skin and deep fascia must be divided along the whole length of the compartment. Otherwise, the limb should be closely observed until improvement is apparent clinically. If no improvement occurs then a fasciotomy is required. All four compartments may need to be opened in cases involving the leg. After fasciotomy, the wound should be left open. Healing may be encouraged by suturing, skin grafting or the wound left

2008 Mentor

1497. Acute Appendicitis

are initially normal. Low-grade pyrexia then develops. A rising pulse rate may be an indication of peritonitis. Localised tenderness, guarding and rebound tenderness develop in the RIF. Rovsing's sign may be positive: palpation of the left lower quadrant increases the pain felt in the right lower quadrant. This pressure stretches the entire peritoneal lining, and so causes pain in any location where the peritoneum is irritating the muscle. RIF peritonism can also be demonstrated by percussion tenderness (...) value (NPV) of 53% for appendicitis. [ ] Differential diagnosis Other causes of abdominal pain Gastrointestinal , , , , , , mesenteric adenitis, , , , , rectus sheath haematoma, . Urological , , . Gynaecological , torsion or rupture of an , . Others , , , adverse effects from immune modulation therapies (eg, panniculitis in the abdomen at the left iliac fossa, associated with beta-interferon injection). [ ] Other causes of RIF mass These include: Crohn's disease, carcinoma of colon, mucocele

2008 Mentor

1498. Urinary Incontinence Full Text available with Trip Pro

be taught to perform intermittent urethral self-catheterisation. Indwelling catheters (either urethral or suprapubic) may be indicated if: There is chronic urinary retention and the person cannot perform self-catheterisation. Skin wounds, pressure sores or skin irritations are being contaminated by urine. There is distress or disruption caused by changing clothes and the bed. A woman would like this form of management. Suprapubic catheters may have lower complication rates, including lower rates (...) syndrome : urgency that occurs with or without urge incontinence and usually with frequency and nocturia. It may be called 'OAB wet' or 'OAB dry', depending on whether or not the urgency is associated with incontinence. The usual cause of this problem is detrusor overactivity. See the separate article. Overflow incontinence : usually due to chronic bladder outflow obstruction. It is often due to prostatic disease in men. It can lead to obstructive nephropathy due to back pressure; therefore, early

2008 Mentor

1499. Hydrocele

tumour. Hydroceles in older boys and men may also be due to generalised oedema, such as nephrotic syndrome or heart failure. Communicating hydrocele Persistence of the processus vaginalis allows peritoneal fluid to communicate freely with the scrotal portion of the processus. They are congenital but may first present in older boys and men as a result of increased intra-abdominal pressure, continuous peritoneal dialysis or fluid overload. Non-communicating hydrocele Due to imbalance between secretion (...) of the following: Inguinal approach with ligation of the processus vaginalis high within the internal inguinal ring: This is the procedure of choice for paediatric communicating hydroceles. An inguinal approach is essential if a testicular tumour has been identified pre-operatively, or is a possibility. Scrotal approach with excision or eversion and suturing of the tunica vaginalis: This is recommended for secondary non-communicating hydroceles. It is possible in children older than 12 years to repair

2008 Mentor

1500. Eye Trauma

adequate analgesia and antiemetics (important to prevent vomiting which puts pressure on the globe). Treat as a high tetanus risk wound. Intraocular foreign bodies [ , ] IOFBs result from sharp or high-velocity injures. Symptoms typically include decreased or double vision. However, in some cases patients may have no symptoms and the FB may remain undetected for years [ ] . An IOFB must be excluded in high-velocity eye injuries or where the cause/history of injury is unclear. If in doubt, refer. IOFBs (...) or missile - both wounds caused by the same agent. Assessment [ , ] The aim of assessment is to: Understand the mechanism and nature of the injury. Identify associated injuries. Identify factors that could worsen outcome. Decide whether referral is necessary and, if so, immediately or later. History [ ] A detailed, accurate history is important: how the injury was sustained is crucial, as any history of high-velocity injury raises the possibility of penetrating injury. Forceful blunt injuries

2008 Mentor

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