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Laser Skin Procedure

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3321. Congenital Nasal Problems

, nose and throat (ENT) surgeons or plastic surgeons or both, depending on the condition. The neurosurgeons may also be involved. The ENT team is a good first point of assessment of the child. Classification A useful way to think about congenital nasal abnormalities is to group them according to the type of problem: [ ] Hypoplasia and atrophy: paucity, atrophy or underdevelopment of skin, subcutaneous tissue, muscle, cartilage and/or bone. Hyperplasia and duplications: anomalies of excess tissue (...) has gained universal acceptance, due to competing advantages/disadvantages of each (eg, success rates, number of operative steps, rates of complication, etc). Carbon dioxide and potassium titanyl phosphate (KTP) lasers are being increasingly used, as they are quick and easy to use and cause minimal discomfort. Polyrhinia Two normally formed noses are a possible but very rare occurrence. Surgical correction involves excision of the medial part of each nose and union of the lateral halves. Clefts

2008 Mentor

3322. Varicose Veins

be required for vein grafting techniques (eg, coronary artery bypass graft). It is the current preferred invasive method. Ambulatory phlebectomy This can be performed, using local anaesthetic, as an outpatient procedure. Small multiple incisions are made in the skin overlying the vein, which is hooked out and extracted in a piece-meal fashion. The technique is particularly suitable for tortuous veins inaccessible to fine-wire techniques such as laser ablation. Contra-indications are reflux (...) recommends that, for confirmed varicose veins with truncal reflux, minimally invasive procedures such as radiofrequency ablation, endovenous laser therapy or foam sclerotherapy should be considered first. Endothermal ablation Endothermal (radiofrequency) ablation involves sealing the lumen of the long saphenous vein by delivering radiofrequency energy via a catheter under ultrasound guidance. An alternative is endovenous laser therapy which works by delivering high-intensity laser through a sheathed wire

2008 Mentor

3323. Hyperhidrosis

hyperhidrosis Generalised hyperhidrosis is usually due to an underlying disorder and management is therefore directed at finding and treating any underlying cause (usually includes specialist referral). Primary focal hyperhidrosis General advice: [ ] Avoid clothes that show sweat marks readily (white or black are suitable colours). Wear loose-fitting clothing. Avoid man-made fibres - eg, nylon. Soap substitutes reduce skin irritation. Avoid any obvious trigger factors. Frequently change clothing, including (...) to allow them to dry fully. 20% aluminium chloride hexahydrate in alcohol solution should be applied to dry skin of the axillae, feet, hands, or face (avoiding the eyes) at night just before sleep and washed off in the morning. The solution should be applied every 1-2 days until the condition improves and then as required. If successful, treatment can be continued indefinitely. [ ] Consider treating any underlying anxiety with (drug treatment may worsen the hyperhidrosis). [ ] Refer to a dermatologist

2008 Mentor

3324. Horner's Syndrome

times to detect it. [ ] Ipsilateral dry skin on the face due to loss of sweating: Take both index fingers and place then together in the middle of the forehead. Then run them laterally over the forehead to just lateral to the eyebrows. On the affected side there may be more friction as the skin is drier because there is no sweating on that side. A lesion in the common carotid artery area causes loss of sweating that involves the entire side of the face. Lesions distal to the carotid bifurcation (...) . 2008 Apr66(4):833. ; Painful Horner's syndrome. Emerg Med J. 2008 May25(5):295. ; Neck procedures resulting in Horner syndrome. Ophthal Plast Reconstr Surg. 2009 Jan-Feb25(1):16-8. ; Post-traumatic dissection of the internal carotid artery associated with ipsilateral facial nerve paralysis: diagnostic and forensic issues. J Forensic Leg Med. 2013 Oct20(7):867-9. doi: 10.1016/j.jflm.2013.06.018. Epub 2013 Aug 13. hi everyone i am maria. So i'm really worried about my ma because of her eyes. Back

2008 Mentor

3325. History and Physical Examination

examination is to observe. Learn to observe. Look before you lay on hands. Examination of the cardiovascular or respiratory system does not start with the stethoscope. You may get valuable information from the facies, skin colouration, gait, handshake and personal hygiene (reflective of physical, psychological and social background). Note the red eye, the freckles on the lips of Peutz-Jeghers syndrome or the white forelock of Waardenberg's syndrome. A number of endocrine disorders may be immediately (...) think about the issue. Linking specific lifestyle advice to the current illness is far more effective so pick your issue. [ ] However, be careful not to swamp the patient's agenda with your own. Health promotion may also affect your practice's performance under the Management is more than just a prescription. It includes health education and advice. This is not simply a move away from paternalism but aids compliance and may reduce unnecessary attendance. Twin-tray laser printers enable printed

2008 Mentor

3326. External Eye - Lashes Eyelids and Lacrimal System

the eye. Common ones include sebaceous cysts, cysts of Moll (benign, non-tender translucent lesions arising from the apocrine sweat glands) and cysts of Zeis (similar to cysts of Moll but containing oily secretions). Cysts can be removed in a simple minor operative procedure, under local anaesthetic. Tumours [ , ] Eyelid tumours may be benign, precancerous or malignant. 5-10% of all skin cancers occur in the eyelids. Malignant neoplasms represent the leading cause of plastic reconstruction (...) , so giving rise to astigmatism and/or amblyopia), treatment may be warranted. This may involve laser treatment, local steroid injection (there are a number of complications) or systemic steroids if there is associated visceral involvement. Only a few cases need surgical intervention. Malignant tumours [ , , ] The presenting signs of eyelid skin cancers are highly variable. Given their infiltrative growth pattern, they often present with a scar-like appearance or texture.They may also present

2008 Mentor

3327. Essence of Surgery

of a surgical operation. The first hard evidence of early surgical procedures came with the finding of trephined skulls some 10,000 years old. The indications for trephining (or trepanning) are unclear, but most authorities hold that it was done to release evil spirits, and as a treatment for epilepsy and migraine. Although there is little evidence that the Ancient Egyptian practice of mummification led to detailed knowledge of human anatomy, the Edwin Smith papyrus from the 17th BC provides one (...) of the earliest written record of surgical procedures. [ ] Some of you may possess souvenir papyri showing the surgical instruments engraved in the wall of the Temple of Sobek and Horus at Kom-Ombo. [ ] In the early centuries of the Christian era, the Greek surgeon Claudius Galen was an important influence, going to Rome and reviving the Hippocratic method. He stressed the importance of anatomy, and although limited to the study of pigs and apes (it is only rumoured he dissected humans, as this was illegal

2008 Mentor

3328. Examination of the Eye

, involvement of the puncta) and lumps/bumps ( , ). Note any skin abnormality - rashes (varicella zoster), ulcerations ( ), ill-defined thickening ( ). Check eyelashes - if you have access to a slit lamp, look at them under magnification ( , , ). Lid eversion Indication : suspicion of FB, examination of papillae/follicles. Requirements : topical local anaesthetic (LA), two clean cotton buds. Procedure : explain to the patient what you are going to do: Place an anaesthetic drop in the lower fornix. Ask them (...) (it is typically quite firmly embedded). Lacrimal system Examine the lids, as above, and look at the puncta (the openings to the canaliculi - tear drainage channels): are they sitting against the globe, turned in ( ) or drooping out ( )? Look for swellings medial to the canthus - where the lids meet (blocked tear ducts) and any evidence of redness, pain or discharge ( ). Assessing for dry eye Requirements : fluorescein stain (dilute drops), cobalt blue light. Procedure : explain the assessment 'procedure

2008 Mentor

3329. Fluid in the Middle Ear and Glue Ear

of acute inflammation. CSOM is long-standing suppurative middle ear inflammation, usually with a persistently perforated tympanic membrane. Mastoiditis is acute inflammation of the mastoid periosteum and air cells occurring when AOM infection spreads out from the middle ear. Cholesteatoma occurs when keratinising squamous epithelium (skin) is present in the middle ear as a result of tympanic membrane retraction. Presentation in children [ ] History Hearing loss is the usual presenting symptom, although (...) . [ ] Grommet insertion has traditionally been performed under general anaesthetic, although it is possible to perform the procedure under local anaesthetic. Topical anaesthetic is applied to the ear canal approximately 30 minutes prior to the procedure. A Cochrane review of 2011 concluded that: [ ] In children with hearing loss induced by OME the effect of grommets on hearing appears small and diminishes after 6-9 months (by which time natural resolution leads to improved hearing in those children

2008 Mentor

3330. Fibroids (Uterine Leiomyoma)

women with symptomatic subserous fibroids, who wish to maintain their fertility. [ ] Hysteroscopic myomectomy is an established surgical procedure for women with submucosal fibroids and excessive uterine bleeding, infertility or repeated miscarriages. [ ] When performed for treatment of abnormal bleeding, this resolves in 74-94% at two years. 12% subsequently require hysterectomy. Laparoscopic laser myomectomy is not recommended by the National Institute for Health and Care Excellence (NICE), other (...) option compared with hysterectomy at one year, saving £1,000 per patient but this gain is lost by five years due to greater rates of secondary intervention. The faster, shorter recovery time needs to be weighed against the need for further treatment in a third of patients. [ ] MRI-guided transcutaneous focused ultrasound: This procedure has low morbidity and very rapid recovery. High-power pulses of ultrasound are used to ablate the fibroid - there may be skin burns as a result. Long-term outcome

2008 Mentor

3331. Oropharyngeal Tumours

in the relevant articles (see links above). T - primary tumour Tis - pre-invasive cancer (carcinoma in situ). T0 - no evidence of primary tumour. T1 - tumour 2 cm or less in greatest dimension. T2 - tumour larger than 2 cm but not larger than 4 cm. T3 - tumour larger than 4 cm. T4 - tumour with extension to bone, muscle, skin, antrum, neck. Tx - minimum requirements to assess primary tumour cannot be met. N - regional lymph nodes N0 - no evidence of regional lymph node involvement. N1 - evidence (...) mucositis, which is a common complication of treatment for head and neck cancers: allopurinol, aloe vera, amifostine, cryotherapy, glutamine (intravenous), honey, keratinocyte growth factor, laser, and polymyxin/tobramycin/amphotericin (PTA) antibiotic pastille/paste. [ ] Surgery Transoral surgery using the carbon dioxide laser under microscopic guidance is now a widely accepted technique that can help organ preservation, mainly in early disease. Robotic surgery has been used and evaluated, especially

2008 Mentor

3332. Osler-Weber-Rendu Syndrome

to stem the flow. Surgical or laser ablation may be required as an emergency or elective procedure. AVMs may need embolisation, ligation of the blood supply or resection. Septoplasty of the nose may be required. Liver transplantation or stereotactic intracranial radiosurgery may be indicated. However, a recently published paper concluded that in adults with unruptured brain AVM, interventional therapy appears to worsen outcomes compared to medical management. [ ] Pregnancy in HHT is associated (...) , patients with HHT were investigated using CT scanning. 74% had vascular abnormalities but only 8% were symptomatic. [ ] In the central nervous system, AVMs, cavernous angiomas and aneurysm may result in headache, seizures or epilepsy, intracranial haemorrhage and stroke. Lesions of the skin do not usually develop until the 20s. They affect the hands and wrists in 41% and the face in 33%. [ ] They do not tend to be a serious problem with regard to haemorrhage. Vascular malformations of the urinary tract

2008 Mentor

3333. Photodynamic Therapy in Advanced Tracheobronchial Cancers Full Text available with Trip Pro

Photodynamic Therapy in Advanced Tracheobronchial Cancers Photodynamic therapy (PDT) has been introduced in the early eighties for treating patients with malignancies in the tracheobronchial tract. After intravenous injection of the photosensitizers, the tumor area in the tracheobronchial tree is illuminated bronchoscopically using a laser fiber to transmit light of a specific wavelength during the procedure. Secondary tissue necrosis ensues, because of the thrombosis of the tumor vasculature (...) leading to late tissue hypoxia. Ample data have shown that PDT is effective to obtain full depth tissue necrosis with relative sparing of the normal tissue. Local tumor control can be achieved. Competitive endoscopic techniques such as lasers and electrocautery are applicable to debulk tumor in a less selective but more immediate manner. Skin photosensitivity is a potential morbidity of PDT, especially in using the first generation photosensitizers. This limits its palliative potential. More selective

1999 Diagnostic and therapeutic endoscopy

3334. Surgery With or Without Combination Chemotherapy in Treating Patients With Stomach Cancer

trial to compare the effectiveness of surgery with or without combination chemotherapy in treating patients who have stage II, stage III, or stage IV stomach cancer. Condition or disease Intervention/treatment Phase Gastric Cancer Drug: cisplatin Drug: fluorouracil Drug: leucovorin calcium Procedure: neoadjuvant therapy Phase 3 Detailed Description: OBJECTIVES: Compare overall survival in patients with locally advanced gastric cancer treated with surgery alone or in combination with neoadjuvant (...) : Creatinine no greater than 1.25 times ULN Creatinine clearance greater than 60 mL/min Cardiovascular: No prior atrial or ventricular arrhythmias No prior congestive heart failure No myocardial infarction within the past 6 months Other: Not pregnant or nursing Negative pregnancy test Fertile patients must use effective contraception No other prior or concurrent neoplasm except curatively treated nonmelanoma skin cancer or carcinoma in situ of the cervix No active infection No allergy to protocol drugs

1999 Clinical Trials

3335. Quality-of-Life Assessment of Patients Who Have Cancer of the Esophagus

radical radiotherapy with or without chemotherapy Prior endoscopic procedure to relieve dysphagia allowed No distant liver or bone metastasis if undergoing esophagectomy Group II: Metastatic esophageal cancer or local anastomotic recurrence of esophageal cancer or deemed unsuitable for esophagectomy Prior palliation by endoscopic or open intubation, laser treatment, tumor necrosis with alcohol injection or diathermy, or intraluminal radiotherapy allowed Prior palliative radiotherapy or chemotherapy (...) Procedure: psychosocial assessment and care Procedure: quality-of-life assessment Detailed Description: OBJECTIVES: I. Test the psychometric, clinical, and cross cultural validity and reliability of the quality-of-life questionnaire EORTC-QLQ-C30 (version 3.0) in conjunction with the esophageal cancer-specific module EORTC QLQ-OES-24 in patients with esophageal cancer. OUTLINE: This is a multicenter study. Patients are stratified by treatment (potentially curative vs purely palliative). Patients

1999 Clinical Trials

3336. Gene Therapy for Gyrate Atrophy

will undergo the following gene therapy procedure: Skin biopsy-A small piece of skin is surgically removed from the patient's thigh. Gene transfer-Skin cells called keratinocytes are taken from the biopsied tissue and grown in the laboratory. The normal gene that produces OAT is inserted into the cells, causing them to produce more of the enzyme. Skin graft-Under local anesthesia, a patch of skin about 2 1/4 inches x 2 1/4 inches is surgically removed from the upper thigh and some of the cells (...) . These tests will evaluate whether the treated skin cells are producing the deficient OAT enzyme and, if so, how much and for how long. They will also indicate whether the enzyme produced is sufficient to lower ornithine blood levels. Patients will also undergo various eye examinations before grafting and at scheduled follow-up visits. These tests may include electrophysiologic (ERG) testing, fundus photographs, scanning laser ophthalmoscope, visual field test, fluorescein angiogram, visual acuity

1999 Clinical Trials

3337. MRI-Guided Ultrasound Energy in Treating Patients With Stage I, Stage II, or Stage IIIA Breast Cancer

Sponsor: InSightec Information provided by (Responsible Party): InSightec Study Details Study Description Go to Brief Summary: RATIONALE: Imaging procedures, such as MRI, may allow the doctor to better detect the tumor. Highly focused ultrasound energy may be able to kill tumor cells by heating the breast tumor cells without affecting the surrounding tissue. PURPOSE: Phase II trial to study the effectiveness of MRI-guided ultrasound energy in treating women who have stage I, stage II, or stage IIIA (...) , and histology, using this procedure. Compare the appearance of gross and microscopic histopathologic tissue post coagulation with the pre- and post-coagulation magnetic resonance appearance of the targeted volume and measure any residual cancer cells in patients after this procedure. Determine patient acceptance of this procedure, in terms of positioning, pain, safety, and follow-up cosmesis. OUTLINE: This is a pilot study. Patients undergo MRI-guided focused ultrasound (MRgFUS) ablation of the breast

2001 Clinical Trials

3338. Assessment of Blood Vessel Density in Kaposi s Sarcoma Lesions

density and blood flow in these lesions could be useful in evaluating the effectiveness of both standard and experimental treatments for this disease. Patients 18 years of age or older with Kaposi s sarcoma involving the skin may be eligible for this study. Participants will have photographs taken of their lesions and will undergo three imaging procedures (described below) at the beginning of the study (baseline) and then about once every 3 months or so while on the study (up to 2 years) to compare (...) the test results over time. (Imaging may be done at more or less frequent intervals depending on the findings.) A small amount of blood (less than a tablespoon) will be drawn the day of each imaging procedure. Laser Doppler imaging This technique measures the amount of blood flow in KS lesions by scanning the lesions with a low-power laser beam. Each lesion takes about 3 minutes to scan. The imaging may be done before and after a blood pressure cuff around the arm is inflated for a short time (usually

2001 Clinical Trials

3339. Dosing Study of Replagal in Patients With Fabry Disease

in a particular area of skin that did not sweat enough. A small amount of a medicine called acetylcholine is put on the skin and made to enter the skin using a very small electric current. Doppler skin blood flow: This test measures blood flow to the blood vessels of the skin. A machine takes pictures of blood flow in the skin of the forearm using a laser beam. Pictures are taken before and during application of medicines that cause blood vessels to dilate. Acetylcholine is used on one forearm (...) and nitroprusside is used on the other. The medication is made to enter the skin using a small el... Condition or disease Intervention/treatment Phase Fabry Disease Drug: Replagal Phase 2 Detailed Description: Objectives: The goal of this study is to determine whether higher frequency of dosing of enzyme replacement therapy (ERT) can either significantly slow the decline of renal function or continuously sustain the normalization of other objective functions in patients with Fabry disease who have been

2003 Clinical Trials

3340. Propranolol to Treat Fainting Due to Sympathoadrenal Imbalance

session, and blood flows and skin electrical conduction are measured intermittently. Blood flow is measured using sensors applied to the skin and a blood pressure cuff around the limb. For skin blood flow measurements, a laser beam scans the skin surface. The skin electrical conduction test measures how well the skin conducts electricity. This is measured through sensors placed on the fingers or other sites. The effects of the test drug are allowed to wear off for 1 week, after which the entire tilt (...) test procedure is repeated. Patients who were given propranolol for the first test session take placebo for the repeat session, and those who were given placebo take propranolol. Condition or disease Intervention/treatment Phase Neurocardiogenic Syncope Drug: Propranolol Phase 4 Detailed Description: This protocol is to evaluate treatment with oral propranolol for a particular form of neurocardiogenic syncope (NCS), characterized by a neuroendocrine pattern called, sympathoadrenal imbalance, (SAI

2003 Clinical Trials

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