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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. 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

183. 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

184. Varicella Zoster (Diagnosis)

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

185. Urological Management in Neurological Disease (Diagnosis)

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

186. Urinary Diversions and Neobladders (Diagnosis)

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

187. Pyonephrosis (Diagnosis)

Ureteropelvic junction (UPJ) obstruction Obstructing ureterocele Ureterovesical junction obstruction Chronic stasis of urine and hydronephrosis secondary to neurogenic bladder Ureteral strictures Papillary necrosis Tuberculosis Duplicated kidneys with obstructive components Ectopic ureter with ureterocele [ ] Neurogenic bladder Other, rare causes, such as sciatic hernias that cause ureteral obstruction Previous Next: Prognosis The prognosis of pyonephrosis is good in most patients who receive prompt (...) that is not recognized early may rapidly deteriorate and develop . In addition to the morbidity and mortality associated with septic shock, potential complications of delayed diagnosis and treatment of pyonephrosis include irreversible damage to the kidneys, with the possible need for nephrectomy. Even in the modern era of antibiotics, adequately controlling an overwhelming infection in an obstructed renal unit without surgical intervention may be impossible. If the diagnosis is delayed, unduly prolonged illness

2014 eMedicine.com

188. Heterotopic Ossification (Diagnosis)

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

189. Herpes Zoster (Diagnosis)

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

190. Herpes Zoster (Diagnosis)

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

191. Herpes Zoster (Diagnosis)

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. Malposition of the Uterus (Diagnosis)

[ ] 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

193. Inclusion Body Myositis (Diagnosis)

retrotranslocation of misfolded proteins into the cytoplasm for ubiquitination and subsequent proteosomal degradation. In s-IBM muscle, expression of ER chaperone proteins is increased, colocalized with Aβ and APP, suggesting that the UPR is activated in s-IBM and promotes proper APP folding. [ ] Another protective agent is heat shock protein (HSP) 70, which promotes refolding of Aβ and other misfolded or unfolded proteins. [ ] Several protein kinases are also involved in the s-IBM pathogenic cascade. Kinases (...) . 2005 May. 15(5):349-54. . Li M, Dalakas MC. The muscle mitogen-activated protein kinase is altered in sporadic inclusion body myositis. Neurology . 2000 Apr 25. 54(8):1665-70. . Luciano CA, Dalakas MC. Inclusion body myositis: no evidence for a neurogenic component. Neurology . 1997 Jan. 48(1):29-33. . Monsonego A, Zota V, Karni A, et al. Increased T cell reactivity to amyloid beta protein in older humans and patients with Alzheimer disease. J Clin Invest . 2003 Aug. 112(3):415-22. . Nakano S

2014 eMedicine.com

194. Pyonephrosis (Overview)

Ureteropelvic junction (UPJ) obstruction Obstructing ureterocele Ureterovesical junction obstruction Chronic stasis of urine and hydronephrosis secondary to neurogenic bladder Ureteral strictures Papillary necrosis Tuberculosis Duplicated kidneys with obstructive components Ectopic ureter with ureterocele [ ] Neurogenic bladder Other, rare causes, such as sciatic hernias that cause ureteral obstruction Previous Next: Prognosis The prognosis of pyonephrosis is good in most patients who receive prompt (...) that is not recognized early may rapidly deteriorate and develop . In addition to the morbidity and mortality associated with septic shock, potential complications of delayed diagnosis and treatment of pyonephrosis include irreversible damage to the kidneys, with the possible need for nephrectomy. Even in the modern era of antibiotics, adequately controlling an overwhelming infection in an obstructed renal unit without surgical intervention may be impossible. If the diagnosis is delayed, unduly prolonged illness

2014 eMedicine.com

195. Spinal Cord, Topographical and Functional Anatomy (Overview)

: Classic Spinal Cord Syndromes The classic syndromes of spinal cord injury are described here. In most instances, however, incomplete forms are far more common. Complete spinal cord transection syndrome In the acute phase, the classic syndrome of complete spinal cord transection at the high cervical level consists of the following: Respiratory insufficiency Quadriplegia Upper and lower extremity areflexia Anesthesia below the affected level Neurogenic shock (hypotension without compensatory tachycardia (...) ) Loss of rectal and bladder sphincter tone Urinary and bowel retention leading to abdominal distention, ileus, and delayed gastric emptying This constellation of symptoms is called spinal shock. [ ] (ie, ipsilateral ptosis, miosis, and anhydrosis) is also present with higher lesions because of interruption of the descending sympathetic pathways originating from the hypothalamus. Patients experience problems with temperature regulation because of the sympathetic impairment, which leads to . Lower

2014 eMedicine.com

196. Spinal Orthotics (Overview)

management - The cervical spine must be maintained in neutral alignment at all times; clearing of oral secretions and/or debris is essential to maintaining airway patency and preventing aspiration Hypotension - Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury; a diligent search for occult sources of hemorrhage must be made Neurogenic shock - Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial treatment of choice; maintain adequate (...) : Destruction from direct trauma Compression by bone fragments, hematoma, or disk material Ischemia from damage or impingement on the spinal arteries Edema could ensue subsequent to any of these types of damage. Neurogenic shock Neurogenic shock refers to the hemodynamic triad of hypotension, bradycardia, and peripheral vasodilation resulting from severe autonomic dysfunction and the interruption of sympathetic nervous system control in acute spinal cord injury. Hypothermia is also characteristic

2014 eMedicine.com

197. Spinal Cord Injury: Definition, Epidemiology, Pathophysiology (Overview)

Emergency department care Airway management - The cervical spine must be maintained in neutral alignment at all times; clearing of oral secretions and/or debris is essential to maintaining airway patency and preventing aspiration Hypotension - Hypotension may be hemorrhagic and/or neurogenic in acute spinal cord injury; a diligent search for occult sources of hemorrhage must be made Neurogenic shock - Judicious fluid replacement with isotonic crystalloid solution to a maximum of 2 L is the initial (...) , with the following 3 common abnormalities leading to tissue damage: Destruction from direct trauma Compression by bone fragments, hematoma, or disk material Ischemia from damage or impingement on the spinal arteries Edema could ensue subsequent to any of these types of damage. Neurogenic shock Neurogenic shock refers to the hemodynamic triad of hypotension, bradycardia, and peripheral vasodilation resulting from severe autonomic dysfunction and the interruption of sympathetic nervous system control in acute

2014 eMedicine.com

198. Chronic Renal Failure (Overview)

identical to those observed in humans with chronic kidney disease (CKD). Factors other than the underlying disease process and glomerular hypertension that may cause progressive renal injury include the following: Systemic hypertension Nephrotoxins (eg, nonsteroidal anti-inflammatory drugs [NSAIDs], intravenous contrast media) Decreased perfusion (eg, from severe dehydration or episodes of shock) Proteinuria (in addition to being a marker of CKD) Hyperlipidemia Hyperphosphatemia with calcium phosphate (...) nephritis Polycystic kidneys Cystinosis and other inherited diseases Urinary tract obstruction may result from any of the following: Benign prostatic hypertrophy Urolithiasis (kidney stones) Urethral stricture Tumors Neurogenic bladder Congenital (birth) defects of the kidney or bladder Retroperitoneal fibrosis Previous Next: Epidemiology In the United States, the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK) reports that one in 10 American adults has some level of chronic

2014 eMedicine.com

199. Cardiovascular Concerns in Spinal Cord Injury (Overview)

also be an up-regulation of nitric oxide (a potent vasodilator), altered baroreceptor sensitivity, or altered salt and water balance. [ ] Tachycardia may occur as a consequence of reduced vagal activity via the carotid sinus, but it is not sufficient to compensate for the diminished sympathetic nervous system (SNS) response. Neurogenic shock (reduced blood pressure from neurologic causes) is common in patients with acute tetraplegia or high-level paraplegia (T1-T4). Hypotension may exacerbate (...) (MAP) and the potential role for fluids or pharmacologic treatment. In the setting of neurogenic shock, it is essential to first ensure that intravascular volume is restored, and then vasopressors (dopamine, norepinephrine, phenylephrine) may be used to treat hypotension. Orthostatic hypotension is defined as a drop in systolic blood pressure of greater than 20 mm Hg and/or a decrease in diastolic pressure of greater than 10 mm Hg, when changing from supine to upright positioning. [ ] Symptoms

2014 eMedicine.com

200. Cervical Disc Disease (Overview)

intervertebral disc protrusions at C3-C4 and C7-T1. Understanding requires basic knowledge of anatomy and biomechanics. The intervertebral disc is a functional unit connecting 2 vertebral bodies of the spine. The disc absorbs shock, accommodates movement, provides support, and separates vertebral bodies to lend height to intervertebral foramina. The disc consists of 3 structural components; an eccentrically located nucleus pulposus, a surrounding lamellar annulus fibrosus, and 2 cartilaginous endplates (...) and corticosteroid mixture may be injected into the epidural space (interlaminar) or along the nerve root (transforaminal) after precise radiologic, contrast-enhanced fluoroscopic localization. [ ] Studies indicate that cervical HNP with radiculopathy can be managed conservatively. Surgery is warranted when neurogenic bowel or bladder dysfunction, deteriorating neurologic function, or intractable radicular or discogenic neck pain exists. Specifically, cervical spine surgical outcomes are most favorable

2014 eMedicine.com

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