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8701. Radiation Therapy in Gynecology (Diagnosis)

be accomplished without substantial tissue disruption. Postoperative radiotherapy is reserved for cases in which histopathologic analysis of the removed specimen reveals features suggesting a high risk for local recurrence. Primary radiotherapy can provide an opportunity for cure for women with unresectable, locally advanced disease; for women with resectable disease in whom the risk of surgical morbidity is unacceptably high; and for women with medical risk factors that contraindicate primary surgical (...) When hysterectomy is medically contraindicated, primary radiotherapy can offer 5-year disease-specific survival rates of 80-90%, approaching those achieved with surgery. Indications for adjuvant radiation after surgery for endometrial cancer are somewhat controversial. Whole-pelvis external-beam radiotherapy (XRT, or EBRT) and intravaginal brachytherapy are potential adjuvant postoperative therapies for patients with stage I disease. [ ] Recommendations are based on the stage and grade of disease

2014 eMedicine.com

8702. Shoulder and Hemiplegia (Diagnosis)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzI4NzkzLW92ZXJ2aWV3 processing > Shoulder Pain in Hemiplegia Updated: Feb 08, 2019 Author: Robert Gould, DO; Chief Editor: Stephen Kishner, MD, MHA Share Email Print Feedback Close Sections Sections Shoulder Pain in Hemiplegia Hemiplegic Shoulder Pain Good shoulder function is a prerequisite for effective hand function, as well as for performing multiple tasks involving mobility, ambulation, and activities of daily living (ADL). A common sequela of stroke is hemiplegic shoulder pain, which can hamper functional (...) of the shoulder and upper extremity (UE) reported by patients with hemiplegia include the following: Reduced mobility of the shoulder Tenderness Swelling/edema Pain with movement Decreased coordination Physical examination The physical examination of a patient with shoulder dysfunction associated with hemiplegia is extensive, because the physician is required to assess the involved musculoskeletal and neurologic conditions. It should include observation, palpation, and neurologic examination. Observation may

2014 eMedicine.com

8703. Pathophysiology of Chronic Back Pain (Diagnosis)

and interfere with the organism’s capacity to function and cope. Spinal pain is multifaceted, involving structural, biomechanical, biochemical, medical, and psychosocial influences that result in dilemmas of such complexity that treatment is often difficult or ineffective. [ ] Low back pain (LBP) is defined as chronic after 3 months because most normal connective tissues heal within 6-12 weeks, unless pathoanatomic instability persists. A slower rate of tissue repair in the relatively avascular (...) to vibration may contribute to back injuries, the medical literature provides conflicting support for most of these proposed risk factors. Next: Pathophysiology Degenerative cascade The lumbar spine forms the caudal flexible portion of an axial structure that supports the head, upper extremities, and internal organs over a bipedal stance. The sacrum forms the foundation of the spine through which it articulates with the sacroiliac joints to the pelvis. The lumbar spine can support heavy loads

2014 eMedicine.com

8704. Osteoma Cutis (Diagnosis)

, Case Western Metro Health Medical Center Disclosure: Nothing to disclose. Coauthor(s) Thomas N Helm, MD Clinical Professor of Dermatology and Pathology, University of Buffalo, State University of New York School of Medicine and Biomedical Sciences; Director, Buffalo Medical Group Dermatopathology Laboratory Thomas N Helm, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Specialty Editor Board David F Butler, MD Former Section Chief of Dermatology, Central (...) Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic David F Butler, MD is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Rosalie Elenitsas, MD Herman Beerman Professor of Dermatology, University of Pennsylvania School of Medicine; Director, Penn Cutaneous Pathology Services, Department of Dermatology, University of Pennsylvania Health System

2014 eMedicine.com

8705. Oral Manifestations of Systemic Diseases (Diagnosis)

that then is also demineralized. [ ] The prevalence of caries is not increased in persons with GERD, possibly because the acidic environment interferes with the formation of the dental bacterial biofilms. Good dental care and control of acid helps decrease the prevalence of erosion. However, once the erosion occurs, it is irreversible and can only be treated with restorative procedures. Therefore, early recognition and patient education is the most effective treatment. The most effective medical therapy (...) for GERD in adults is proton pump inhibitors (PPIs), although H2-receptor antagonists are also beneficial. [ ] Patients may also benefit from decreased consumption of acidic foods and beverages. [ ] Patients with xerostomia should consider discontinuing medications that may exacerbate hyposalivation or use a salivary supplement. [ ] Also see . Chronic liver disease The liver has numerous synthetic, storage, and excretory functions. The liver synthesizes many of the coagulation factors necessary

2014 eMedicine.com

8706. Osteoarthritis (Diagnosis)

Medication - Oral and/or topical Intra-articular injections Nerve ablation procedures Surgery For other discussions on OA, see , , , and , as well as , , , , , , , , and . Next: Therapeutic Exercise for Osteoarthritis General principles Lifestyle modification, particularly exercise and weight reduction, is a core component of the management of OA, [ , , ] with the aim of such efforts being provision of pain relief, enhancement of physical function, and improvement of quality of life. Therapeutic exercise (...) therapeutic regimens seem to have a greater impact than does single-modality therapy. [ ] Previous Next: Medication for Osteoarthritis The American College of Rheumatology (ACR) 2012 pharmacologic guidelines for the treatment of hip and knee OA include the following [ ] : Up to 4 g/d of acetaminophen can be administered; this is the preferred initial treatment for patients with OA; cases that are unresponsive to acetaminophen at full dosage can be treated with analgesic-dose nonsteroidal anti-inflammatory

2014 eMedicine.com

8707. Oral Malignant Melanoma (Diagnosis)

of Surgical Sciences, East Carolina University School of Dental Medicine Bobby McManus Collins, II, DDS, MS is a member of the following medical societies: , , , North Carolina Dental Society Disclosure: Nothing to disclose. Coauthor(s) E Leon Barnes, Jr, MD Professor of Pathology and Professor of Otolaryngology, University of Pittsburgh School of Medicine E Leon Barnes, Jr, MD is a member of the following medical societies: , , , , , , , Disclosure: Nothing to disclose. Specialty Editor Board Michael J (...) of South Carolina College of Medicine Dirk M Elston, MD is a member of the following medical societies: Disclosure: Nothing to disclose. Acknowledgements John Abernethy, MD Associate Professor, Departments of Dermatology and Pathology, Greensboro Pathology Disclosure: Nothing to disclose. Peter Fritsch, MD Chair, Department of Dermatology and Venereology, University of Innsbruck, Austria Peter Fritsch, MD is a member of the following medical societies: , International Society of Pediatric Dermatology

2014 eMedicine.com

8708. Keloid and Hypertrophic Scar (Diagnosis)

(hematoxylin and eosin stain). Courtesy of Dirk M. Elston, MD. of 6 Tables Contributor Information and Disclosures Author Brian Berman, MD, PhD Dermatologist and Partner, Skin and Cancer Associates; Professor Emeritus of Dermatology and Cutaneous Surgery, University of Miami, Leonard M Miller School of Medicine Brian Berman, MD, PhD is a member of the following medical societies: Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: Aclaris; Bifrontera; Aiviva (...) , Jackson Memorial Hospital, University of Miami, Leonard M Miller School of Medicine Andrea D Maderal, MD is a member of the following medical societies: , Florida Society of Dermatology and Dermatologic Surgery, , Miami Society for Dermatology, Disclosure: Nothing to disclose. Martha H Viera, MD Resident Physician, Department of Dermatology and Cutaneous Surgery, Jackson Memorial Hospital, University of Miami, Leonard M Miller School of Medicine Martha H Viera, MD is a member of the following medical

2014 eMedicine.com

8709. Laparoscopic Pelvic Lymph Node Dissection (Diagnosis)

predictive probability (95% confidence interval) of the patient having a given final pathologic stage based on a multinomial log-liner regression of all 3 variables. [ ] Contributor Information and Disclosures Author Robert G Moore, MD Clinical Associate Professor of Urology, Wake Forest University School of Medicine; Staff Urologist, Department of Surgery, Veterans Affairs Medical Center Robert G Moore, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s (...) Professor of Surgery, University of Utah College of Medicine Jay T Bishoff, MD is a member of the following medical societies: , , Disclosure: Received honoraria from Pfizer for speaking and teaching; Received none from PerSys for consulting. Specialty Editor Board Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Chief

2014 eMedicine.com

8710. Laparoscopic and Robotic Radical Prostatectomy (Diagnosis)

, placement of stitch in dorsal vein complex, dissection of prostate off bladder, dissection around prostate; development of plane between prostate and rectum, preservation of neurovascular bundles and division of dorsal vein complex and urethra. Procedure performed by Samuel Sterrett, DO, Bon Secours Medical Group, Greenville, SC. Courtesy of BroadcastMed (http://uro.broadcastmed.com/4120/videos/robotic-prostatectomy). See , a Critical Images slideshow, to help determine the best diagnostic approach (...) of 402 mL. The authors also reported a decreased mean hospital stay, due predominantly to earlier removal of the Foley catheter. Even in the hands of these skilled laparoscopists, nerve-sparing dissection and construction of the urethrovesical anastomosis were demanding. With advances in medical technology, improved optics, and the widespread use of new laparoscopic instrumentation such as ultrasonic cutting and coagulating devices (eg, Harmonic scalpel), laparoscopic radical prostatectomy began

2014 eMedicine.com

8711. Kartagener Syndrome (Diagnosis)

is a member of the following medical societies: , , , , Disclosure: Nothing to disclose. Coauthor(s) Arvind K Badhey, MD Resident Physician, Department of Otolaryngology, Icahn School of Medicine at Mount Sinai Disclosure: Nothing to disclose. Elena B Willis, MD Resident Physician, Department of Otorhinolaryngology, Albert Einstein College of Medicine, Montefiore Medical Center Elena B Willis, MD is a member of the following medical societies: , , Disclosure: Nothing to disclose. Specialty Editor Board (...) Francisco Talavera, PharmD, PhD Adjunct Assistant Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference Disclosure: Received salary from Medscape for employment. for: Medscape. Daniel R Ouellette, MD, FCCP Associate Professor of Medicine, Wayne State University School of Medicine; Chair of the Clinical Competency Committee, Pulmonary and Critical Care Fellowship Program, Senior Staff and Attending Physician, Division of Pulmonary and Critical Care

2014 eMedicine.com

8712. Normal Labor and Delivery (Diagnosis)

hard and round. In a breech presentation, a large, nodular body is felt. The second maneuver involves palpation in the paraumbilical regions with both hands by applying gentle but deep pressure. The purpose is to differentiate the fetal spine (a hard, resistant structure) from its limbs (irregular, mobile small parts) to determinate the fetus' position. The third maneuver is suprapubic palpation by using the thumb and fingers of the dominant hand. As with the first maneuver, the examiner ascertains (...) infusion if uterine activity is inefficient. Oxytocin infusion starts at 4 mili IU/min (or even 6 mili IU/min) and increases by 4 mili IU/min (or 6 mili IU/min) every 15 minutes until a rate of 7 contractions per 15 minutes is achieved or until the maximum infusion rate of 36 mili IU/min is reached. [ , ] Although active management of labor was originally intended to shorten the length of labor in nulliparous women, its application at the National Maternity Hospital in Dublin produced a primary

2014 eMedicine.com

8713. Pediculosis (Diagnosis)

” policies should be educated to abandon these policies. The Centers for Disease Control and Prevention (CDC), American Association of Pediatrics, and National Association of School Nurses recommend discontinuation of these policies. [ ] Noncompliance is a common cause of treatment failure in all 3 types of lice infestations. Therefore, time is well-spent providing patients with detailed instructions regarding the application and timing of medications used in the treatment of lice. Fomites may harbor (...) mouthparts. Body lice look similar but lay their eggs (nits) on clothing fibers instead of hair fibers. The pubic louse, Pthirus pubis, is identified by its wide crablike body. of 7 Tables Contributor Information and Disclosures Author Lyn C C Guenther, MD, FRCPC, FAAD Medical Director, The Guenther Dermatology Research Centre; President, Guenther Research, Inc; Professor of Dermatology, Department of Medicine, Western University, Canada Lyn C C Guenther, MD, FRCPC, FAAD is a member of the following

2014 eMedicine.com

8714. Parkinson-Plus Syndromes (Diagnosis)

to discontinue the medication. Some patients may find that a low dose helps them stay mobile or improve rigidity, and this dose can be maintained. The patient and caregiver should have easy access to the physician during the trial of levodopa. Treatment of cognitive problems Pimavanserin (Nuplazid) was approved in April 2016 for treatment of hallucinations and delusions associated with Parkinson disease psychosis. It is the first drug to be approved for this condition. It is a selective serotonin inverse (...) stockings. and can be helpful when other measures fail. Other medications for treatment of orthostatic hypotension include droxidopa and pyridostigmine. [ ] Previous Next: Progressive Supranuclear Palsy (PSP) is reportedly the second most common cause of idiopathic parkinsonism. Generally, there is no family history and no strong genetic component is known in this idiopathic condition. However, some rare familial clusters have been reported. The disease usually begins when patients are in their 50s

2014 eMedicine.com

8715. Neural Tube Defects (Diagnosis)

occurs, and independent mobility is unlikely. [ ] Bowel and bladder function are affected in roughly 90–95% of patients with myelomeningocele, manifesting as neurogenic bladder and/or fecal incontinence. [ ] Presence or severity of urinary dysfunction cannot be predicted by location of the spinal lesion or by neurologic exam. The level of spinal cord responsible for mediating bladder function is below the level that controls lower extremity function. [ ] Despite aggressive medical care, 10–15 (...) with Chiari malformation, in whom the tonsils have descended to the level of C2. MRI of a cervical syrinx in the sagittal plane. MRI of a cervical syrinx in the axial plane. of 5 Tables Contributor Information and Disclosures Author Nir Shimony, MD Neurosurgeon, Pediatric, Epilepsy, NeuroOncology, Neuroscience Researcher, Geisinger Health System, Johns Hopkins University School of Medicine Nir Shimony, MD is a member of the following medical societies: , , , Disclosure: Nothing to disclose. Coauthor(s

2014 eMedicine.com

8716. Indoor Aeroallergens (Diagnosis)

treatment options for individuals with allergic diseases, including allergic asthma: Aeroallergen avoidance Medications Allergen immunotherapy More than 90% of the average person's time in developed countries is spent indoors. This statistic underscores the importance of avoidance measures, especially in those who are allergic to indoor allergens. Modern medicine has vastly increased the effective treatment of allergic disorders and asthma. However, the first line of treatment for these diseases (...) photomicrograph of Dermatophagoides farinae. See , a Critical Images slideshow, to help identify a variety of allergens and symptoms. Avoidance Measures and Interventions The physician has the following 3 treatment options for individuals with allergic diseases, including allergic asthma: Aeroallergen avoidance Medications Allergen immunotherapy Avoidance of the offending agent is the first line of treatment for allergic disorders and asthma. It is the most cost-effective treatment modality, and it sometimes

2014 eMedicine.com

8717. Incontinence, Urinary: Nonsurgical Therapies (Diagnosis)

deficiency is trauma to the bladder neck or prostate, resulting from due to high-impact deceleration injuries. Contributing factors with aging-related urinary incontinence include a weakening of connective tissue, genitourinary atrophy due to hypoestrogenism, increased incidence of contributing medical disorders, increased nocturnal diuresis, and impairments in mobility and cognitive functioning. [ , ] Vitamin D deficiency has been identified as a risk factor for urinary incontinence in older adults (...) urinary tract dysfunction (eg, delirium, psychiatric disorders, urinary infection, impaired mobility) See for more detail. Diagnosis Patients with urinary incontinence should undergo a basic evaluation that includes a history, physical examination, and urinalysis. In selected patients, the following may also be needed: Voiding diary Cotton swab test Cough stress test Measurement of postvoid residual (PVR) urine volume Cystoscopy Urodynamic studies (see the image below) Urinary incontinence. Urodynamic

2014 eMedicine.com

8718. Rotator Cuff Injury (Overview)

and New Jersey Regenerative Institute; Director of Research, Atlantic Health; Clinical Professor, Department of Physical Medicine and Rehabilitation, University of Medicine and Dentistry of New Jersey-New Jersey Medical School; Fellow, American College of Sports Medicine Gerard A Malanga, MD is a member of the following medical societies: , , , , , Disclosure: Serve(d) as a speaker or a member of a speakers bureau for: Lipogems. Coauthor(s) Christopher J Visco, MD Assistant Professor, Department (...) of Rehabilitation and Regenerative Medicine, Columbia University College of Physicians and Surgeons; Assistant Residency Program Director, New York Presbyterian Hospital Christopher J Visco, MD is a member of the following medical societies: , , , , , , Disclosure: Nothing to disclose. Jay E Bowen, DO Assistant Professor, Department of Physical Medicine and Rehabilitation, Rutgers New Jersey Medical School Jay E Bowen, DO is a member of the following medical societies: , , , , , , Physiatric Association

2014 eMedicine.com

8719. Rotation Flaps (Overview)

and Reconstructive Surgeon, Yuma Regional Medical Center Daniel D Sutphin, MD, FACS is a member of the following medical societies: , Disclosure: Nothing to disclose. Specialty Editor Board David F Butler, MD Former Section Chief of Dermatology, Central Texas Veterans Healthcare System; Professor of Dermatology, Texas A&M University College of Medicine; Founding Chair, Department of Dermatology, Scott and White Clinic David F Butler, MD is a member of the following medical societies: , , , , Disclosure: Nothing (...) to disclose. John G Albertini, MD Private Practice, The Skin Surgery Center; Clinical Associate Professor (Volunteer), Department of Plastic and Reconstructive Surgery, Wake Forest University School of Medicine; President-Elect, American College of Mohs Surgery John G Albertini, MD is a member of the following medical societies: , Disclosure: Serve(d) as a director, officer, partner, employee, advisor, consultant or trustee for: QualDerm Partners; Novascan
Have a 5% or greater equity interest

2014 eMedicine.com

8720. Scalp Reconstruction (Overview)

to mobilize for wound closures. In general, flaps have limited applications in larger wounds on the scalp, although they may be used more often in smaller wounds. Flaps discussed in this article are categorized as random pattern flaps. While the blood supply to these flaps comes from their pedicles, the blood supply to the pedicle comes from the random vascular supply in the epidermis, dermis, and subcutaneous fat. Random pattern flaps are distinguished from interpolated flaps, which derive their blood (...) removal of the calvaria, and other extensive procedures, are not covered. Common procedures performed on the scalp range from those that are medically indicated to those performed for cosmetic reasons. These procedures include incisional and excisional biopsies, excisions of benign and malignant tumors, and scalp reduction surgery. Incisional and excisional biopsies may be performed to aid in diagnosing benign and malignant lesions. Benign lesions include nevus sebaceous, epidermoid cysts

2014 eMedicine.com

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