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Laser Skin Procedure

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3301. Ptosis and Lid Lag

to upgaze while the frontalis muscle is held inactive at the brow. The margin fold distance (MFD) - the distance from the upper eyelid margin to the fold of skin. Other features to look out for on examination These include: Abnormalities of tear production. Lower eyelid laxity or scleral show. Lagophthalmos (difficulty in complete closure of the eyelid over the eyeball). Anterior displacement of the globe within the orbit. Pseudoptosis, which can result from a number of conditions that alter (...) . A similar phenomenon is seen with the lower edge, when the eye moves upwards. If the object is moved too quickly, the diagnosis may be missed. Differential diagnosis Differential diagnosis of congenital ptosis Chronic progressive external ophthalmoplegia (a disorder characterised by slowly progressive paralysis of the extraocular muscles) Acquired myogenic ptosis Blepharochalasis (relaxation of the skin of the eyelid, due to atrophy of the intercellular tissue) Aponeurotic ptosis (the result

2008 Mentor

3302. Pseudoxanthoma Elasticum

calcium and serum phosphate are sometimes elevated but usually normal. Imaging Plain X-rays may show calcified arteries. Echocardiogram for mitral valve involvement. Coronary angiography if indicated Other procedures Regular ophthalmic examination is essential to detect early signs of retinopathy, angioid streaks and retinal haemorrhages. Laser treatment may spare vision. Endoscopy is indicated for any form of frank GI bleeding. Ankle/brachial blood pressure using Doppler methods is useful in patients (...) Guidelines. You may find one of our more useful. In this article In This Article Pseudoxanthoma Elasticum In this article Synonyms: include - PXE and Grönblad-Strandberg syndrome This is a rare, genetic connective tissue disorder with progressive calcification and fragmentation of elastic fibres in the skin, the retina and the cardiovascular system. It is important to recognise the disease early to minimise the problem of retinal or gastrointestinal (GI) haemorrhage and cardiovascular complications

2008 Mentor

3303. Port-wine Stain

at the added efficacy of PDL with topical imiquimod., exogenous heat or intravenous porphyrin derivatives. [ , ] PDL laser is sometimes used in conjunction with a potassium titanyl phosphate (KTP) laser. [ ] Combined selective photothermolysis and imiquod is being explored as an effective option. [ ] Cosmetic camouflage can be useful in hiding the area. It may be prescribed on an FP10. Tattooing of the area with skin-coloured pigment is occasionally carried out. Complications Hyperpigmentation is usual (...) to date with expert written health and lifestyle content. By clicking 'Subscribe' you agree to our and . Subscribe Thanks for your feedback. if you would like to report a specific issue with this page, please visit our . Thank you, we just sent a survey email to confirm your preferences. Further reading and references ; NICE Interventional Procedures Guidance, 2004 ; Microarray analysis of port wine stains before and after pulsed dye laser treatment. Lasers Surg Med. 2013 Feb45(2):67-75. doi: 10.1002

2008 Mentor

3304. Photodynamic Therapy

treatment. What are the limitations of photodynamic therapy? There are a number of limitations to the technique: It requires direction of the light to the appropriate site and tissue depth in order to be effective. It is ablative and does not yield material for histological diagnosis. Diagnosis should be made before treatment. It is complex, requiring optimal light delivery with laser, and collaboration and co-ordination between clinicians. Persistent skin photosensitivity, lasting weeks with some (...) that: There are no major safety concerns associated with PDT for non-melanoma skin tumours (including pre-malignant and primary non-metastatic skin lesions). Evidence of efficacy of this procedure for the treatment of BCC, Bowen's disease and actinic (solar) keratosis is adequate to support its use for these conditions (provided that the normal arrangements are in place for consent, audit and clinical governance). Evidence is limited on the efficacy of this procedure for the treatment of invasive SCC. Recurrence rates

2008 Mentor

3305. Phimosis and Paraphimosis

% by 16-17 years of age. [ ] Phimosis can subsequently occur at any age. Phimosis results when the prepuce is tight and is unable to be pulled forward over the glans. This is often the result of chronic infection caused by poor hygiene. Poor hygiene and enthusiastic attempts to correct congenital phimosis increase the risk of developing pathological phimosis. Phimosis usually occurs in uncircumcised males but can occur after circumcision where any excessive skin becomes sclerotic. In older diabetic (...) %. Phimosis persisting after the age of 2 years may be considered for further treatment, particularly if recurrent balanoposthitis or urinary tract infections are occurring. The options are plastic surgery or circumcision. Plastic surgery Various procedures may be needed, including dorsal incision of the foreskin, partial circumcision, release of adhesions, division of a short frenulum and meatoplasty. The advantage of this approach is that the foreskin, or much of it, can be preserved. The disadvantage

2008 Mentor

3306. Peyronie's Disease

lengthening surgical procedure based on a ventro-dorsal incision of the tunica albuginea, penile prosthesis implantation and double dorsal-ventral patch grafting with porcine small intestinal submucosa. [ ] Carbon dioxide laser: this has been used to good effect in some cases to thin the plaque. Prognosis PD rarely resolves completely. Studies suggest that without treatment, 13% of patients have a diminution or complete resolution of pain with time. One half of the remainder has progressive disease (...) and stitches being palpable beneath the skin and the possibility that circumcision may need to be performed at the time of surgery (to prevent postoperative phimosis). Surgery should not be attempted until the disease has been stable for at least three months (some authorities recommend this period should be 6-12 months). Various techniques are available: Extracorporeal shock wave therapy : the National Institute for Health and Care Excellence (NICE) has produced guidance for professionals and public

2008 Mentor

3307. Prenatal Diagnosis

karyotype analysis from cultured cells, which usually takes 13-14 days. [ , ] Molecular genetic tests : if a disease-causing mutation has been identified in a family, molecular genetic tests can be performed to detect genetic diseases such as cystic fibrosis. The following techniques are used: Amniocentesis [ ] This is the most common invasive prenatal diagnostic procedure carried out in the UK. This is normally carried out from 15 weeks of gestation. A needle is inserted into the amniotic cavity (...) , genetically inherited and endocrine or metabolic conditions, can be performed. See separate article . Fetoscopy This allows visualisation of the fetus, using endoscopic techniques. It is usually carried out between 18-20 weeks of gestation. It allows fetal inspection for structural abnormalities, fetal blood sampling to detect, and possibly allow intervention in, conditions such as haemophilias, thalassaemia and sickle cell disease, as well as fetal skin and liver biopsy. It has also been used

2008 Mentor

3308. Plantar Fasciitis

the pain. For those who are on their feet all day, pain is worst at the end of the day. Walking barefoot, on toes, or up stairs can precipitate pain. Ask about running or jogging and other sports. Ask about footwear and when it was last replaced. Ask about previous trauma to the foot. Examination Look at the foot. Note any obvious deformities, skin changes, or congenital conditions. Look for pes planus or pes cavus. There is often tightness of the Achilles tendon and ankle dorsiflexion may be limited (...) , calf muscles and the Achilles tendon. Again, hard evidence for their use is lacking. [ ] However, benefit has been shown in some studies. [ ] The patient may be taught to do these exercises independently. Deep massage of the sole of the foot also stretches the plantar fascia. A physiotherapist may also recommend ultrasound, laser treatment, or iontophoresis with dexamethasone to assist pain relief and reduce inflammation. Again, evidence for these treatments is limited. Orthotics, splinting

2008 Mentor

3309. Lichen Sclerosus

useful. In this article In This Article Lichen Sclerosus In this article Synonyms: lichen sclerosus et atrophicus, balanitis xerotica obliterans, lichen albus, white spot disease, Csillag's disease, kraurosis vulvae Lichen sclerosus (LS) is a chronic inflammatory dermatosis which usually affects the skin of the anogenital region in women, and the glans penis and foreskin in men - balanitis xerotica obliterans (BXO). It occurs less commonly in extragenital areas. It does not cause any systemic disease (...) outside the skin. Aetiology The cause is unknown: Many findings obtained in recent years point increasingly towards an autoimmune-induced disease in genetically predisposed patients and further away from an important impact of hormonal factors. [ ] Preceding infections may play a provocative part. The role for borrelial infection is still controversial. Trauma and an occlusive moist environment may act as precipitating factors. There is an association with other autoimmune diseases. Epidemiology

2008 Mentor

3310. Macular Disorders

retina from the retinal pigment epithelium in the macular region. Management - mainstays of treatment are observation, photodynamic therapy (PDT) and laser procedures. Observation is feasible due to possible spontaneous recovery in most acute CSCR cases. In general, PDT and laser procedures, such as conventional laser photocoagulation, are used to provide more rapid visual recovery, when disease does not improve spontaneously during observation. Outcome - this tends to be excellent with spontaneous (...) through dilated pupils. Both eyes are photographed for comparison. This enables the identification of abnormal blood vessels, loss of blood vessels, blockages and leaks. Most patients experience a temporary discolouration of the skin (yellow tinge) and urine (orange tinge) and some may experience nausea and vomiting. More serious (but uncommon) adverse effects include allergy and anaphylaxis. For this reason patients are asked to wait in clinic for some time after the angiography. Indocyanine green

2008 Mentor

3311. Upper Gastrointestinal Bleeding

with a Mallory-Weiss tear. Examination The main aim of examination is to assess blood loss and look for signs of shock. A secondary aim is to look for signs of underlying disease and significant comorbid conditions - for example: Pallor and signs of anaemia should be sought. Pulse and blood pressure. Postural hypotension may be detected and usually indicates a blood loss of 20% or more. Other signs of shock: Cool extremities Chest pain Confusion Delirium Evidence of dehydration (dry mucosa, sunken eyes, skin (...) . Surgical intervention Surgical intervention is required when endoscopic techniques fail or are contra-indicated. Clinical judgement is required and consideration given to local expertise. In general, it is recommended: To inform surgeons early of the possibility of surgery. To use the most experienced personnel available. To avoid operations in the middle of the night. The particular procedure required depends on a number of factors, not least the site of bleeding. Gastric ulcers are probably best

2008 Mentor

3312. Sturge-Weber Syndrome

the eyes or orifices, or if the lesions bleed, ulcerate or become infected. Significant re-darkening of port-wine stains has been noted at 10-year follow-up. [ ] External laser treatment of vascular abnormalities may not be effective if they are deep, because the laser beam does not penetrate far beneath the skin. [ ] Intralesional photocoagulation is a laser treatment that involves inserting a laser fibre into the lesion to deliver the light deep within it. [ ] Combined use of PDL therapy and topical (...) of early treatment of facial port wine stains in newborns: a review of 49 cases. Lasers Surg Med. 2007 Aug39(7):563-8. ; Redarkening of port-wine stains 10 years after pulsed-dye-laser treatment. N Engl J Med. 2007 Mar 22356(12):1235-40. ; NICE Interventional Procedures Guidance, 2004 ; Surgical treatment of epilepsy in Sturge-Weber syndrome in children. J Neurosurg. 2007 Jan106(1 Suppl):20-8. ; Pilot study examining the combined use of pulsed dye laser and topical Imiquimod versus laser alone

2008 Mentor

3313. Sterilisation (Female Sterilisation and Vasectomy)

take this to mean a procedure where the opening in the scrotal skin is less than 10 mm in diameter, and any surgical instrument may be used (including a scalpel). Cochrane reviews have shown this method results in fewer early complications and a shorter operation time. [ ] The vas deferens is exposed and isolated. The lumen is occluded and the vas deferens is then divided. There may or may not be a part of the vas deferens excised. Various methods are used for occlusion such as: Coagulation (...) by UK doctors and based on research evidence, UK and European Guidelines. You may find the article more useful, or one of our other . In this article In This Article Sterilisation Vasectomy and Female Sterilisation In this article Sterilisation is a surgical means of obtaining permanent contraception by occluding the Fallopian tubes in women and the vas deferens in men. Compared to many surgical procedures, sterilisation is fraught with cultural, religious, psychosocial, psychosexual

2008 Mentor

3314. Squints Full Text available with Trip Pro

, strabismus or leukocoria as the presenting symptom of retinoblastoma was discovered by a family member in 75% of cases. The three screening methods needed to detect strabismus are: Gross inspection. Light reflex tests, including the Brückner test (inspection for a red reflex). Cover tests. In clinic, ophthalmoscopy and measurement of visual acuity are also crucial. A young baby should be examined for the presence of epicanthic folds (crescenteric folds of skin on each side of the nose) which could give (...) on the globe and so its action is weakened) and antagonistic muscle resection (a segment of muscle is removed, so strengthening its action) is used with the aim to restore binocular function. Sometimes, adjustable sutures are used to enable minor corrections to be made without having to go through a further full surgical procedure. It may take more than one procedure to achieve the satisfactory result but few surgeons would operate more than two or three times. Esotropia: specific treatments [ ] Infantile

2008 Mentor

3315. Systemic Sclerosis (Scleroderma)

and trauma; use warm clothing or heated clothing. For an attack - warm the body, hands and feet gently (the skin may be numb and unable to feel if the heat source is too hot); use gentle arm movements or gentle massage to help restore circulation. Occupational therapists - for adaptations to assist in daily living. Camouflage products - for cosmetic help with skin changes. Laser or pulsed light therapy as well as camouflage may be useful for telangiectasias. Immunotherapy The BSR/BHPR guidelines advise (...) and laser therapy. Surgical removal should be considered if severe or impacting on function/quality of life. Management of musculoskeletal symptoms Immunosuppressant therapy may be considered. Surgical procedures for specific indications such as: Release of contractures. Removal of troublesome calcinosis. Myalgia, arthralgia and painful oedema: Non-steroidal anti-inflammatory drugs (NSAIDs), if tolerated. Simple analgesics. Management of GI symptoms For upper GI symptoms: Lifestyle measures are often

2008 Mentor

3316. Dacryocystitis and Canaliculitis

be guided by microbiology results. Whilst Staphylococcus aureus is still the main cause, Gram-negative organisms are increasingly isolated). [ ] The regime is guided by clinical response but, typically, a 10- to 14-day course is required. Incision and drainage may be considered if the infection extends outside the sac and a superficial skin abscess is formed. However, this carries the risk of forming a fistula, resulting in tears draining directly to the skin surface. [ ] Once the infection has settled (...) and in chronic cases, a dacryocystorhinostomy (DCR) is performed. [ ] Chronic dacryocystitis management [ , ] Non-surgical treatment involves warm compresses, massage and probing of the nasolacrimal duct. Probing involves inserting a fine metal probe via the punctum and canalicular system and passing it into the nasolacrimal sac, past the obstruction. This can often be done without a general anaesthetic. If there is acute infection, the procedure is usually deferred for a few days, until antibiotics have

2008 Mentor

3317. Bartholin's Cyst

be palpable if it is infected and there may be fever. If the cyst or abscess bursts, there may be little to find. Investigations [ ] A swab should be taken from the contents of the cyst; often the organisms that are cultured, even from the contents of an abscess, are skin commensals rather than pathogens. Women over the age of 40 presenting with a Bartholin's cyst or abscess should have a biopsy to rule out carcinoma. This is uncommon but a number of types of malignancy of the vulva can occasionally (...) results, a broad-spectrum antibiotic such as co-amoxiclav would be appropriate. [ ] It is not known, however, which is the optimum initial treatment. Flucloxacillin is often prescribed. Local guidelines should be followed where available. Marsupialisation This has been the definitive procedure of choice for many years and many gynaecologists still regard it as the best technique. It can be performed under local anaesthesia although general anaesthetic is often used. A vertical elliptical incision

2008 Mentor

3318. Bowen's Disease

find the article more useful, or one of our other . In this article In This Article Bowen's Disease In this article Synonym: squamous cell carcinoma in situ Bowen's disease is a form of intraepidermal (in situ) squamous cell carcinoma (SCC) of the skin. It was first described by John Bowen in 1912. Bowen's disease arises in the outer layers of the epidermis and the risk of progression to invasive SCC is relatively low at about 3% for typical cases. Epidemiology [ ] The incidence in the UK (...) is estimated at around 15 per 100,000 per year but this is based on data from the USA. Incidence is highest in Caucasians living in areas of high sunlight exposure. It is more common in women (70-85% of cases) than in men. [ ] It most commonly appears between the ages of 60 and 70 years. Risk factors Sun damage : exposure to sunlight (especially with fair skin) is a strong risk factor. Other irradiation damage : radiotherapy, photochemotherapy, sunbeds. Carcinogens : particularly . Exposure to inorganic

2008 Mentor

3319. Anti-inflammatory Eye Preparations

in the sub-Tenon's space and within the globe. Common conditions warranting anti-inflammatory treatment include allergic conjunctivitis and hypersensitivity reactions. These drugs are also very commonly used in specialist units to treat a very wide range of conditions. These include uveitis, cystoid macular oedema, scleritis and episcleritis and certain cases of herpes simplex keratitis, during and after surgical procedures. Topical corticosteroids Overview Examples - betamethasone, dexamethasone (...) by ophthalmologists. Corticosteroids available in ointment form Examples - Betnesol® and hydrocortisone acetate. Use - atopic conditions involving the periocular skin; can be used as a substitute for night-time steroid drop application in some cases and where there is difficulty in applying drops - eg, due to arthritic hands. Corticosteroid/antibiotic combinations [ ] Examples - betamethasone + neomycin, dexamethasone 0.1% + neomycin/polymyxin B/tobramycin, dexamethasone 0.05% + framycetin/gramicidin

2008 Mentor

3320. Corneal Problems - Non Acute

Luetic interstitial keratitis - stromal inflammation associated with syphilis infection. Microsporidial keratitis - bilateral diffuse keratitis or unilateral deep keratitis seen in the immunocompromised. Infectious crystalline keratopathy - a rare indolent infection associated with HSV, acanthamoebic keratitis, Streptococcus viridans and long-term topical steroid therapy. Acute problems following keratoplasty [ , ] Corneal grafting ( ) is a common and successful procedure. It can be performed (...) as an elective procedure to improve vision, or as an emergency in the case of corneal perforation. Early postoperative complications include: Wound leak. Raised intraocular pressure. Persistent epithelial defect (>2 weeks). Endophthalmitis. Graft failure. Graft rejection. Urrets-Zavalia syndrome (iris ischaemia). Presentation - patients who have undergone a keratoplasty and present with the symptoms outlined above should be assumed to have one of the above complications until assumed otherwise. Corneal graft

2008 Mentor

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