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Neurogenic Shock

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181. Development of an in vitro model to measure bioactivity of botulinum neurotoxin A in rat bladder muscle strips. Full Text available with Trip Pro

Development of an in vitro model to measure bioactivity of botulinum neurotoxin A in rat bladder muscle strips. Botulinum toxin A (BoNT-A) is a new treatment modality in various causes of bladder dysfunction; like neurogenic detrusor overactivity and overactive bladder. The best technique of administrating BoNT-A in patients is unknown. A validated in vitro model could be used to investigate newer intravesical administration techniques of BoNT-A. In this study, we describe the development (...) and validation of in vitro model to measure inhibitory effects of BoNT-A on bladder strip contractions.Rat bladder strips were mounted in organ baths filled with Krebs' solution. The strips were stimulated chemically (80 mM potassium chloride, 1 μM carbachol) and electrically (Electrical Field Stimulation (EFS) 100 shocks, 50 V, 20 Hz, every 3 minutes). The viability of the strips was measured by carbachol stimulation at the beginning and at the end of the experiments. The strips were incubated in various

2014 BMC Urology

182. Efficacy, Safety, Tolerability of Carbavance Compared to Piperacillin/Tazobactam in cUTIs, Including AP, in Adults

of the following associated risks: Indwelling urinary catheter; Neurogenic bladder with presence or history of urine residual volume of ≥100 mL; Obstructive uropathy (such as, nephrolithiasis, tumor, fibrosis) that is expected to be medically or surgically treated within 48 hours post randomization; Azotemia due to intrinsic renal disease; Urinary retention in men due to previously diagnosed benign prostatic hypertrophy AP Signs or symptoms evidenced by at least 2 of the following: Chills, rigors, or fever (...) or urinary tract surgery planned during the study period (except surgery required to relieve an obstruction or place a stent or nephrostomy). Renal function at screening as estimated by creatinine clearance <50 mL/minute (min) using the Cockcroft-Gault formula. Known non-renal source of infection such as endocarditis, osteomyelitis, abscess, meningitis, or pneumonia diagnosed within 7 days prior to randomization. Any of the following signs of severe sepsis: Shock or profound hypotension defined

2014 Clinical Trials

183. Fibrinogen in the Initial Resuscitation of Severe Trauma (FiiRST)

bleeding, defined as: i. Systolic blood pressure (SBP) ≤ 100mmHg at any time from the injury scene until 30min after hospital admission AND ii. Red blood cell transfusion has been ordered by the trauma team leader (or delegate) Exclusion Criteria: Patients in shock which the etiology is purely not related to bleeding: i. Cardiogenic (myocardial or valvular dysfunction); ii. Distributive (septic, anaphylactic, acute adrenal insufficiency and neurogenic) and iii. Obstructive (cardiac tamponade, tension

2014 Clinical Trials

184. Changes in ALPP in Women With SUI Following Air Instillation

be an alternative to painful, costly surgical procedure. The Trendlines Group lab solution is a non-surgical alternative in the treatment of SUI. The concept of the future treatment solution is based on simple physics: injecting a small amount of air into the urinary bladder, which eliminates or greatly reduces involuntary urinary leakage. The air bubble acts as a "shock absorber" to reduce the temporary pressure increase in the bladder that causes urinary leakage. The concept for the new treatment has been (...) treatment solution is based on simple physics: injecting a small amount of air into the urinary bladder, which eliminates or greatly reduces involuntary urinary leakage. The air bubble acts as a "shock absorber" to reduce the temporary pressure increase in the bladder that causes urinary leakage. The concept for the new treatment has been tested in a lab environment using lab jig tests and pig urinary system (bladder and urethra). The lab tests showed significant improvement in the bladder pressure when

2014 Clinical Trials

185. ESWT as a Treatment for Chronic NHO in TBI Patients

provided by (Responsible Party): yaron sacher, Loewenstein Hospital Study Details Study Description Go to Brief Summary: Effect of Extracorporeal Shock Wave Therapy on Chronic Neurogenic Heterotopic Ossification in Traumatic Brain Injured (TBI) patients Chronic Neurogenic Heterotopic Ossification (NHO) - Heterotopic ossification is a well known late complication of traumatic brain injury. Extracorporeal Shock Wave Therapy - ESWT- is used in various medical situations and is being tested for feasibility (...) of use in TBI patients. Condition or disease Intervention/treatment Phase TBI Traumatic Brain Injury Device: ESWT - Extracorporeal Shockwave Therapy Not Applicable Detailed Description: PROTOCOL SYNOPSIS Title Effect of Extracorporeal Shock Wave Therapy on Chronic Neurogenic Heterotopic Ossification in Traumatic Brain Injured (TBI) patients. The investigators primary objective is to determine whether Extracorporeal Shock Wave Therapy (ESWT) is effective in reducing pain and improving function

2014 Clinical Trials

186. Malposition of the Uterus (Overview)

[ ] Uterine Torsion, degrees (n = 212) Signs and Symptoms* Intestinal Urinary Pain Shock (Hemorrhage) Labor Dystocia Other† None ≤90 (n = 66) 10 5 43 4 (6) 7 13 9 >90 to 180 (n = 122) 17 91 22 (13) 19 19 14 >180 to 360 (n = 14) 7 10 14 6 (1) 3 3 0 >360 (n = 6) 0 0 6 6 (1) 6 6 0 Unknown (n = 4) 0 0 4 2 (0) 0 0 0 *Some cases include more than 1 sign or symptom. † Hypertonic uterus, PROM, pre-eclampsia, uterine rupture, etc Pathophysiology In a uterine torsion, the uterus twists more than 45° around its long (...) death, and Cook a case in which both ovaries and uterus were necrotic and the mother in shock at the time of exploration, reminding clinicians of the potential risk. [ , ] When one considers these data, one must remember that the statistics were derived by the compilation of case reports transpiring over years at many different institutions. Therefore, these reported risks are almost certainly not representative of maternal risks in modern, fully equipped hospitals with current diagnostic equipment

2014 eMedicine.com

187. Achilles Tendon Injuries and Tendonitis (Overview)

of strengthening treatment, with most patients achieving 60-90% pain relief [ , , ] Orthotics: Orthotic therapy in Achilles tendinosis consists of the use of heel lifts Nonsteroidal anti-inflammatory drugs (NSAIDs): Tendinosis tends to be less responsive than paratenonitis to NSAIDs Steroid injections: Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture Vessel sclerosis Platelet-rich plasma injections Nitric oxide Shock-wave therapy (...) . Current literature has delineated the terminology further to pinpoint the area of injury in hopes of guiding practitioners to more effective treatment of the patient. Furthermore, through extensive histopathologic study, it has been determined that there is no evidence to support the presence of primary prostaglandin-mediated inflammation in Achilles tendonitis. There are, however, signs of neurogenic inflammation, with neuropeptides such as substance P and calcitonin gene–related peptide present

2014 eMedicine.com

188. Achilles Tendon Rupture (Overview)

of strengthening treatment, with most patients achieving 60-90% pain relief [ , , ] Orthotics: Orthotic therapy in Achilles tendinosis consists of the use of heel lifts Nonsteroidal anti-inflammatory drugs (NSAIDs): Tendinosis tends to be less responsive than paratenonitis to NSAIDs Steroid injections: Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture Vessel sclerosis Platelet-rich plasma injections Nitric oxide Shock-wave therapy (...) . Current literature has delineated the terminology further to pinpoint the area of injury in hopes of guiding practitioners to more effective treatment of the patient. Furthermore, through extensive histopathologic study, it has been determined that there is no evidence to support the presence of primary prostaglandin-mediated inflammation in Achilles tendonitis. There are, however, signs of neurogenic inflammation, with neuropeptides such as substance P and calcitonin gene–related peptide present

2014 eMedicine.com

189. Achilles Tendonitis (Overview)

treatment, with most patients achieving 60-90% pain relief [ , , ] Orthotics: Orthotic therapy in Achilles tendinosis consists of the use of heel lifts Nonsteroidal anti-inflammatory drugs (NSAIDs): Tendinosis tends to be less responsive than paratenonitis to NSAIDs Steroid injections: Although these provide short-term relief of painful symptoms, there is concern that they can weaken the tendon, leading to rupture Vessel sclerosis Platelet-rich plasma injections Nitric oxide Shock-wave therapy Surgery (...) delineated the terminology further to pinpoint the area of injury in hopes of guiding practitioners to more effective treatment of the patient. Furthermore, through extensive histopathologic study, it has been determined that there is no evidence to support the presence of primary prostaglandin-mediated inflammation in Achilles tendonitis. There are, however, signs of neurogenic inflammation, with neuropeptides such as substance P and calcitonin gene–related peptide present. [ ] Tendon histopathology has

2014 eMedicine.com

190. Acute Renal Failure (Overview)

or external hemorrhage. Prerenal AKI can also result from decreased renal perfusion in patients with heart failure or shock (eg, sepsis, anaphylaxis). Several classes of medications can induce prerenal AKI in volume-depleted states, including ACE inhibitors and angiotensin receptor blockers (ARBs), which are otherwise safely tolerated and beneficial in most patients with chronic kidney disease. Aminoglycosides, amphotericin B, and radiologic contrast agents may also do so. Arteriolar vasoconstriction (...) typically have obstruction at the level of the bladder or downstream to it. To summarize, causes of postrenal AKI include the following: Ureteric obstruction - Stone disease, tumor, fibrosis, ligation during pelvic surgery Bladder neck obstruction - Benign prostatic hypertrophy (BPH), cancer of the prostate (CA prostate or prostatic CA), neurogenic bladder, tricyclic antidepressants, ganglion blockers, bladder tumor, stone disease, hemorrhage/clot Urethral obstruction - Strictures, tumor, phimosis Intra

2014 eMedicine.com

191. Varicella Zoster (Overview)

in 4.3%, and CMV in 2.1%. Organ system involvement Central nervous system Whereas herpes zoster is classically described in sensory (dorsal root) ganglia, it can spread to affect any portion of the central nervous system (CNS). Involvement of the anterior horn cells can produce muscular weakness, cranial nerve palsies, diaphragmatic paralysis, neurogenic bladder, and colonic pseudo-obstruction. Wider involvement of the spinal cord can produce Guillain-Barré syndrome, transverse myelitis, and myositis (...) or aching pain, paresthesia, dysesthesia, hyperesthesia, or electric shock–like pains. The pain can be severe and incapacitating, and may take a long time to resolve, especially in the elderly; it lasts longer than 12 months in nearly 50% of patients older than 70 years. [ ] Previous Next: Cause of Herpes Zoster Herpes zoster (shingles) is caused by VZV infection. VZV is an enveloped, double-stranded DNA virus belonging to the Herpesviridae family; its genome encodes approximately 70 proteins. In humans

2014 eMedicine.com

192. Urological Management in Neurological Disease (Overview)

involvement with bladder sphincter dyssynergia; that is, contraction of the bladder is accompanied by abnormal contraction of the sphincteric mechanism. Spinal cord injury above the sacral segments but below the pontine micturition center results, in the acute phase, in a state of so-called spinal shock. The detrusor is areflexic and insensate. Sphincteric activity continues. The patient may retain a large volume of urine. An indwelling catheter is usually placed to avoid overdistention, which in itself (...) can render the bladder unresponsive. As spinal shock resolves and reflexes are regained, tapping over the bladder often elicits a bladder contraction. The coordinated voiding regulated by the pontine micturition center is lost because of the disconnection of pathways traveling through the area of spinal cord damage. Dyssynergic voiding occurs and, if untreated, can result in very low bladder capacity with frequent contractions, poor emptying, high bladder pressures with trabecular formation

2014 eMedicine.com

193. Urinary Diversions and Neobladders (Overview)

when other less-invasive options have failed. The primary indications for diversion include preservation of renal function, prevention of recurrent infection, and elimination of the need for permanent indwelling catheters. Indications for diversion arise when the native bladder becomes inherently dangerous to the host. The most common indications for diversion are as follows, in descending order of frequency: Bladder cancer requiring cystectomy Neurogenic bladder conditions that threaten renal (...) -invasive tumors (T2 or greater tumor stage) or those who have a particularly aggressive and/or progressive T1 tumor stage are most often treated with a . The cystectomy includes a in men and a with or without an anterior layer of vaginal tissue in women. [ , ] Neurogenic conditions that require urinary diversion are most often caused by either traumatic or congenital etiologies. Traumatic most often affects men aged 16-35 years. Of patients who experience spinal cord trauma, 25% are incomplete

2014 eMedicine.com

194. Bladder Stones (Overview)

minimally invasive techniques, thus decreasing hospital stay and recovery times. Continued advances in surgical equipment and the ability to downsize without the sacrifice of effectiveness could eventually render open surgery for stones obsolete. In addition, continued aggressive management of , specifically in the pediatric neurogenic bladder population, may lead to a rise in both the incidence of struvite stones and the development of creative and minimally invasive surgical techniques for augmented (...) supersaturation on 24-hour urine studies, suggesting that multiple factors, including metabolic abnormalities, may contribute to the pathogenesis of bladder calculi. [ ] In general, if an otherwise healthy person in the United States or Europe is found to have a bladder stone, a complete urologic evaluation must be undertaken to find a cause for urinary stasis. Potential causes include , , neurogenic bladder, diverticula, and congenital anomalies such as and bladder neck contracture. In females, examples

2014 eMedicine.com

195. Gynecologic Pain (Overview)

produces minimal pain. Frank hemorrhage can lead to hemoperitoneum and hypovolemic shock. Generalized abdominal pain and syncope are features of such a presentation. Treatment includes laparoscopy or laparotomy, evacuation of clots, and control of ovarian bleeding. Ovarian cyst The most common causes are dermoid cyst, cystadenoma, and endometrioma. Because the amount of blood loss is usually minimal, hypovolemia does not supervene. Peritoneal irritation due to leakage of cyst fluid can lead (...) High fever or severe nausea and vomiting Inability to comply with an outpatient regimen Failed outpatient therapy Adolescence Significant fertility issues For more information, see . Tubo-ovarian Abscess A ruptured abscess can lead to gram-negative endotoxic shock; therefore, this condition is a surgical emergency. The most common presentation is bilateral, palpable, fixed, tender masses. Patients often present with generalized abdominal pain and rebound tenderness caused by peritoneal inflammation

2014 eMedicine.com

196. Anorexia Nervosa (Overview)

data revealing a decrease in triiodothyronine (T3) and thyroxine (T4) and an increase in reverse T3. These changes are characteristic of the euthyroid sick syndrome and, similar to the cardiac changes, represent an adaptive mechanism; hormonal replacement is not necessary. An associated impaired release of vasopressin consistent with diabetes insipidus is present. This defect is of the neurogenic type; concentration of urine is observed after administering vasopressin. This condition affects 40 (...) , decreased gonadotropin levels and hypogonadism may occur among males who are affected. Cardiovascular effects of anorexia nervosa include the following [ , , ] : Cardiomyopathy Mitral valve prolapse Supraventricular and ventricular dysrhythmias Long QT syndrome Bradycardia Orthostatic hypotension Shock due to congestive heart failure Renal disturbances include the following: Decreased glomerular filtration rate (GFR) Elevated BUN Edema Acidosis with dehydration Hypokalemia Hypochloremic alkalosis

2014 eMedicine.com

197. Herpes Zoster (Overview)

in 4.3%, and CMV in 2.1%. Organ system involvement Central nervous system Whereas herpes zoster is classically described in sensory (dorsal root) ganglia, it can spread to affect any portion of the central nervous system (CNS). Involvement of the anterior horn cells can produce muscular weakness, cranial nerve palsies, diaphragmatic paralysis, neurogenic bladder, and colonic pseudo-obstruction. Wider involvement of the spinal cord can produce Guillain-Barré syndrome, transverse myelitis, and myositis (...) or aching pain, paresthesia, dysesthesia, hyperesthesia, or electric shock–like pains. The pain can be severe and incapacitating, and may take a long time to resolve, especially in the elderly; it lasts longer than 12 months in nearly 50% of patients older than 70 years. [ ] Previous Next: Cause of Herpes Zoster Herpes zoster (shingles) is caused by VZV infection. VZV is an enveloped, double-stranded DNA virus belonging to the Herpesviridae family; its genome encodes approximately 70 proteins. In humans

2014 eMedicine.com

198. Herpes Zoster (Overview)

in 4.3%, and CMV in 2.1%. Organ system involvement Central nervous system Whereas herpes zoster is classically described in sensory (dorsal root) ganglia, it can spread to affect any portion of the central nervous system (CNS). Involvement of the anterior horn cells can produce muscular weakness, cranial nerve palsies, diaphragmatic paralysis, neurogenic bladder, and colonic pseudo-obstruction. Wider involvement of the spinal cord can produce Guillain-Barré syndrome, transverse myelitis, and myositis (...) or aching pain, paresthesia, dysesthesia, hyperesthesia, or electric shock–like pains. The pain can be severe and incapacitating, and may take a long time to resolve, especially in the elderly; it lasts longer than 12 months in nearly 50% of patients older than 70 years. [ ] Previous Next: Cause of Herpes Zoster Herpes zoster (shingles) is caused by VZV infection. VZV is an enveloped, double-stranded DNA virus belonging to the Herpesviridae family; its genome encodes approximately 70 proteins. In humans

2014 eMedicine.com

199. Herpes Zoster (Overview)

in 4.3%, and CMV in 2.1%. Organ system involvement Central nervous system Whereas herpes zoster is classically described in sensory (dorsal root) ganglia, it can spread to affect any portion of the central nervous system (CNS). Involvement of the anterior horn cells can produce muscular weakness, cranial nerve palsies, diaphragmatic paralysis, neurogenic bladder, and colonic pseudo-obstruction. Wider involvement of the spinal cord can produce Guillain-Barré syndrome, transverse myelitis, and myositis (...) or aching pain, paresthesia, dysesthesia, hyperesthesia, or electric shock–like pains. The pain can be severe and incapacitating, and may take a long time to resolve, especially in the elderly; it lasts longer than 12 months in nearly 50% of patients older than 70 years. [ ] Previous Next: Cause of Herpes Zoster Herpes zoster (shingles) is caused by VZV infection. VZV is an enveloped, double-stranded DNA virus belonging to the Herpesviridae family; its genome encodes approximately 70 proteins. In humans

2014 eMedicine.com

200. Heterotopic Ossification (Overview)

of heterotopic ossification induces local inflammation in humans. Bone . 2013 Apr 6. . Sautter-Bihl ML, Liebermeister E, Nanassy A. Radiotherapy as a local treatment option for heterotopic ossifications in patients with spinal cord injury. Spinal Cord . Jan 2000. 38(1):33-6. Reznik JE, Biros E, Lamont AC, et al. A preliminary investigation on the effect of extracorporeal shock wave therapy as a treatment for neurogenic heterotopic ossification following traumatic brain injury. Part I: Effects on pain. Brain (...) Inj . 2017. 31 (4):526-32. . Reznik JE, Biros E, Sacher Y, et al. A preliminary investigation on the effect of extracorporeal shock wave therapy as a treatment for neurogenic heterotopic ossification following traumatic brain injury. Part II: Effects on function. Brain Inj . 2017. 31 (4):533-41. . Banovac K, Gonzalez F, Renfree KJ. Treatment of heterotopic ossification after spinal cord injury. J Spinal Cord Med . 1997 Jan. 20(1):60-5. . Media Gallery of 0 Tables Contributor Information

2014 eMedicine.com

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