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Nikolskys Sign

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62. Guideline on the management of patients with extracranial carotid and vertebral artery disease

. Clinical Presentation .e64 3.1. Natural History of Atherosclerotic Carotid Artery Disease .e64 3.2. Characterization of Atherosclerotic Lesions in the Extracranial Carotid Arteries .e66 3.3. Symptoms and Signs of Transient Ischemic Attack and Ischemic Stroke .e66 3.3.1. Public Awareness of Stroke Risk Factors and Warning Indicators .e66 4. Clinical Assessment of Patients With Focal Cerebral Ischemic Symptoms .e67 4.1. Acute Ischemic Stroke .e67 4.2. Transient Ischemic Attack .e67 4.3. Amaurosis Fugax (...) .e67 4.4. Cerebral Ischemia Due to Intracranial Arterial Stenosis and Occlusion .e67 4.5. Atherosclerotic Disease of the Aortic Arch as a Cause of Cerebral Ischemia .e68 4.6. Atypical Clinical Presentations and Neurological Symptoms Bearing an Uncertain Relationship to Extracranial Carotid and Vertebral Artery Disease .e68 5. Diagnosis and Testing .e68 5.1. Recommendations for Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease .e68 5.2. Carotid Duplex

2011 American Academy of Neurology

63. Guideline on the Management of Patients with Extracranial Carotid and Vertebral Artery Disease

. Clinical Presentation .e64 3.1. Natural History of Atherosclerotic Carotid Artery Disease .e64 3.2. Characterization of Atherosclerotic Lesions in the Extracranial Carotid Arteries .e66 3.3. Symptoms and Signs of Transient Ischemic Attack and Ischemic Stroke .e66 3.3.1. Public Awareness of Stroke Risk Factors and Warning Indicators .e66 4. Clinical Assessment of Patients With Focal Cerebral Ischemic Symptoms .e67 4.1. Acute Ischemic Stroke .e67 4.2. Transient Ischemic Attack .e67 4.3. Amaurosis Fugax (...) .e67 4.4. Cerebral Ischemia Due to Intracranial Arterial Stenosis and Occlusion .e67 4.5. Atherosclerotic Disease of the Aortic Arch as a Cause of Cerebral Ischemia .e68 4.6. Atypical Clinical Presentations and Neurological Symptoms Bearing an Uncertain Relationship to Extracranial Carotid and Vertebral Artery Disease .e68 5. Diagnosis and Testing .e68 5.1. Recommendations for Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease .e68 5.2. Carotid Duplex

2011 Congress of Neurological Surgeons

65. Extracranial Carotid and Vertebral Artery Disease: Guideline on the Management of Patients With

Lesions in the Extracranial Carotid Arteries e27 3.3. Symptoms and Signs of Transient Ischemic Attack and Ischemic Stroke e29 3.3.1. Public Awareness of Stroke Risk Factors and Warning Indicators e29 4. Clinical Assessment of Patients With Focal Cerebral Ischemic Symptoms e29 4.1. Acute Ischemic Stroke e29 4.2. Transient Ischemic Attack e29 4.3. Amaurosis Fugax e29 4.4. Cerebral Ischemia Due to Intracranial Arterial Stenosis and Occlusion e30 4.5. Atherosclerotic Disease of the Aortic Arch as a Cause (...) of Cerebral Ischemia e30 4.6. Atypical Clinical Presentations and Neurological Symptoms Bearing an Uncertain Relationship to Extracranial Carotid and Vertebral Artery Disease e30 5. Diagnosis and Testing e30 5.1. Recommendations for Diagnostic Testing in Patients With Symptoms or Signs of Extracranial Carotid Artery Disease e30 5.2. Carotid Duplex Ultrasonography e32 5.3. Magnetic Resonance Angiography e33 5.4. Computed Tomographic Angiography e34 5.5. Catheter-Based Contrast Angiography e35 5.6

2011 American College of Cardiology

66. Phenytoin induced Steven–Johnson syndrome and bronchiolitis obliterans – case report and review of literature Full Text available with Trip Pro

with minimal force (Nikolsky's sign). SJS is typically diagnosed when less than 10% of the skin surface is involved and the term TEN is used in cases with more than 30% involvement. Respiratory involvement in SJS-TEN is common with 30-50% of cases demonstrating respiratory epithelial sloughing with severe short and long term complications. Patients who survive SJS-TEN are often left with impaired respiratory function and bronchiolitis obliterans. Cases of bronchiolitis obliterans with SJS/TEN have been

2016 Respiratory Medicine Case Reports

67. Determining the Optimal Cut-off Point of PEA by Corsens Device for Discriminating Between MI and Non-MI Subjects

Medical LTD. Recruitment status was: Not yet recruiting First Posted : March 31, 2016 Last Update Posted : March 31, 2016 Sponsor: Corsens Medical LTD Information provided by (Responsible Party): Corsens Medical LTD Study Details Study Description Go to Brief Summary: Acute Myocardial Infarction (MI) is still the leading cause of death in the western world. Early warning (chest pain) signs of an acute MI are often misinterpreted and disregarded. In average it takes between 2-3 hours from the beginning (...) as evidenced by signing the written informed consent. Exclusion Criteria: Obese patients with BMI>35. Subjects with cardiac arrhythmias including atrial fibrillation. Previous MI. Patients after coronary artery bypass grafting Unstable hemodynamic condition. Patient that can't or do not wish to sign the Inform Consent Form Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact

2016 Clinical Trials

68. Cyclosporine and Etanercept in Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis

) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Inclusion will be considered if there are 3 or more of: Clinical Criteria Erythematous to dusky macules that show evidence of coalescing AND/OR denuding skin or blistering in a predominantly truncal distribution. Nikolsky sign (sloughing with direct lateral pressure on non-blistered, but involved, skin) is considered to be a supportive feature. Mucous membrane involvement Prodromal symptoms including fever (...) : Placebos Intravenous and subcutaneous saline to match cyclosporine and etanercept in an identical delivery container/syringe Outcome Measures Go to Primary Outcome Measures : Time to complete re-epithelialization [ Time Frame: 3 weeks ] Absence of erosion and compromised skin Secondary Outcome Measures : Time to first sign of healing or halting of disease progression [ Time Frame: 2 weeks ] No new lesions, cessation of denudation of skin, or any sign of reversal of sloughing All-cause mortality [ Time

2016 Clinical Trials

69. Funtabulously Frivolous Friday Five 132

sign (also known as “indirect Nikolsky sign”or “Nikolsky II sign”) refers to the extension of a blister to adjacent unblistered skin when pressure is put on the top of the bulla. [ ] Nikolsky commonly occurs with Steven’s Johnson Syndrome, Staphylococcal Scolded Skin Syndrome, TEN and Pemphigus vulgarise. Question 2 Why do germs seem to spread in winter? Drier air. Lab experiments have looked at the way flu spreads among groups of guinea pigs. In moister air, the epidemic struggles to build (...) Funtabulously Frivolous Friday Five 132 Funtabulously Frivolous Friday Five 132 Emergency medicine and critical care medical education blog Search LITFL ... | | Funtabulously Frivolous Friday Five 132 , Last updated June 2, 2016 Just when you thought your brain could unwind on a Friday, you realise that it would rather be challenged with some good old-fashioned medical trivia…introducing 132 Question 1 What is the Asboe-Hansen sign, seen in toxic epidermal necrolysis (TEN)? The Asboe-Hansen

2016 Life in the Fast Lane Blog

70. Pemphigus Foliaceus (Diagnosis)

skin that blisters when rubbed (the Nikolsky sign; commonly but incorrectly spelled Nicholsky), a finding named after Dr Piotr Nikolsky, who first described this sign in 1896. [ ] Pemphigus foliaceus is characterized by a chronic course, with little or no involvement of the mucous membranes. Pierre Louis Alphee Cazenave, founder of the first journal dedicated entirely to dermatology, documented the first description of pemphigus foliaceus in 1844 in this journal. The description was of a 47-year (...) -old woman who consulted him at l'Hopital Saint Louis in Paris for a generalized eruption of several years' duration. Nikolsky described lateral extension of the preexisting erosion due to lifting up the collarette (and when applying a lateral pressure to the clinically intact skin), whereas Asboe-Hansen described extension of the intact blister due to pressure that is applied to its roof. Pemphigus foliaceus has the following six subtypes: pemphigus erythematosus (PE), pemphigus herpetiformis (PH

2014 eMedicine.com

71. Oral Manifestations of Autoimmune Blistering Diseases (Diagnosis)

and immunopathologic findings usually are the same as that of human diseases and are not discussed here. Pemphigus group Pemphigus vulgaris is a very rare acantholytic skin disease. In most cases, oral involvement is severe, and the mouth sometimes can be the first site to exhibit lesions. Flaccid vesicles on the gums, tongue, and palate evolve rapidly into erosions and ulcerations with indistinct margins and peripheral sloughing of mucosal epithelium (Nikolsky sign). Pemphigus foliaceus, the most common form (...) Educate patients with autoimmune diseases about the nature of the disease and the possible adverse effects of long-term use of immunosuppressives. In addition, patients should know about the benefits of taking calcium and vitamin D supplements while using systemic corticosteroids. Finally, educate patients to monitor signs and symptoms of infection in order to report possible complications to physicians in a timely manner. Previous References Olivry T, Chan LS. Autoimmune blistering dermatoses

2014 eMedicine.com

72. Percutaneous Transluminal Coronary Angioplasty (Diagnosis)

) guidelines on the management of NSTE-ACS (updated in 2014 [ ] ) recommend an early invasive strategy in most cases, with timing as follows: Immediate (within 2 hours) - Patients with refractory angina, recurrent angina after initial treatment, signs/symptoms of heart failure, new/worsening mitral regurgitation, hemodynamic instability, sustained ventricular tachycardia, or ventricular fibrillation Early (within 24 hours) - None of the immediate characteristics but new ST-segment depression, a GRACE risk (...) Foundation/AHA guidelines for management of unstable angina/NSTEMI recommend the use of an early invasive strategy or ischemia-guided strategy in patients with NSTE-ACS. An ischemia-guided approach is recommended for patients with a low-risk score (TIMI 0 or 1, GRACE < 109). Other patients will benefit from an early invasive strategy stratified by timing as follows: Immediate (within 2 hours) - Patients with refractory or recurrent angina with initial treatment, signs/symptoms of heart failure, new

2014 eMedicine.com

73. Laser-Assisted Hair Removal (Overview)

by a polarized headlamp with a magnifying loupe (Seymour light). Treatment fluence: The ideal treatment parameters must be individualized for each patient; test sites can be placed at inconspicuous regions of the area to be treated. The fluence is carefully increased while observing the skin for signs of acute epidermal injury, such as whitening, blistering, ablation, or the Nikolsky sign (forced epidermal separation). In general, the treatment fluence should be at 75% of the Nikolsky threshold fluence (...) and duration of changes: The intensity and duration of these tissue changes depend on the hair color and density. The fluence should be reduced if signs of epidermal damage develop. Immediate reaction after laser impact (note erythema, mild edema, sizzling of hairs) Postoperative care Ice packs reduce postoperative pain and minimize swelling. Analgesics are not usually required unless extensive areas are treated. Prophylactic courses of antibiotics or antivirals should be completed. Topical antibiotic

2014 eMedicine.com

74. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (Overview)

and bullae. Lesions, with the exception of central bullae, are typically flat. (Lesions of erythema multiforme are more likely to be palpable.) Less frequently, the initial eruption may be scarlatiniform. See the image below. Extensive blistering and sloughing on the back. Nondenuded areas have a wrinkled paper appearance. A Nikolsky sign is easily demonstrated by applying lateral pressure to a bulla. With regard to the arrangement of lesions, individual macules are found surrounding large areas (...) . In the study, the time from the onset of skin signs to arrest of disease progression and to complete reepithelialization was significantly shorter in the cyclosporine group. All patients in the cyclosporine group survived versus 50% surviving in the cyclophosphamide group. An open-label phase II trial of adults and a retrospective chart review of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis treated with cyclosporine have also demonstrated a decrease in death and the progression

2014 eMedicine.com

75. Fogo Selvagem (Treatment)

daily morning dose until blister formation ceases or the Nikolsky sign disappears. After initial control is achieved, the prednisone dose is reduced to about half the initial dose. This reduction is followed by slow tapering to the minimal effective maintenance dose over weeks to months. Adjuvant therapy includes the use of immunosuppressants such as azathioprine (1-2 mg/kg body weight until lesions clear; with slow tapering of dose), cyclophosphamide (100-200 mg qd, with a reduction (...) to therapy; however, this practice is not universal. Patients taking long-term steroids and/or immunosuppressants should be appropriately followed up and monitored. The lowest possible dose of steroids and immunosuppressants should be used to minimize the potential for systemic toxicities. Be aware of bacterial, viral, or fungal secondary infections and infestations. Disseminated strongyloidiasis is reported. Previous References Nikolsky PV. Materiali K. uchenigu o pemphigus foliaceus [doctoral thesis

2014 eMedicine.com

76. Percutaneous Transluminal Coronary Angioplasty (Treatment)

) guidelines on the management of NSTE-ACS (updated in 2014 [ ] ) recommend an early invasive strategy in most cases, with timing as follows: Immediate (within 2 hours) - Patients with refractory angina, recurrent angina after initial treatment, signs/symptoms of heart failure, new/worsening mitral regurgitation, hemodynamic instability, sustained ventricular tachycardia, or ventricular fibrillation Early (within 24 hours) - None of the immediate characteristics but new ST-segment depression, a GRACE risk (...) Foundation/AHA guidelines for management of unstable angina/NSTEMI recommend the use of an early invasive strategy or ischemia-guided strategy in patients with NSTE-ACS. An ischemia-guided approach is recommended for patients with a low-risk score (TIMI 0 or 1, GRACE < 109). Other patients will benefit from an early invasive strategy stratified by timing as follows: Immediate (within 2 hours) - Patients with refractory or recurrent angina with initial treatment, signs/symptoms of heart failure, new

2014 eMedicine.com

77. Pemphigus Foliaceus (Treatment)

with pemphigus that is relatively resistant to systemic steroid therapy. [ ] Toth and Jonkman also reported on successful therapy with intravenous immunoglobulin (low dose). [ ] References Nikolski PV. Materiali K.uchenigu o pemphigus foliaceus [doctoral thesis]. Kiev . 1896. Chorzelski T, Jablonska S, Blaszczyk M. Immunopathological investigations in the Senear-Usher syndrome (coexistence of pemphigus and lupus erythematosus). Br J Dermatol . 1968 Apr. 80(4):211-7. . Jablonska S, Chorzelski TP, Beutner EH (...) Research. N Engl J Med . 2000 Jul 6. 343(1):23-30. . Fariba G, Ayatollahi A, Hejazi S. Pemphigus foliaceus. Indian Pediatr . 2012 Mar 8. 49(3):240-1. . Metry DW, Hebert AA, Jordon RE. Nonendemic pemphigus foliaceus in children. J Am Acad Dermatol . 2002 Mar. 46(3):419-22. . Daoud YJ, Foster CS, Ahmed R. Eyelid skin involvement in pemphigus foliaceus. Ocul Immunol Inflamm . 2005 Sep-Oct. 13(5):389-94. . Uzun S, Durdu M. The specificity and sensitivity of Nikolskiy sign in the diagnosis of pemphigus. J

2014 eMedicine.com

78. Pemphigus Foliaceus (Overview)

skin that blisters when rubbed (the Nikolsky sign; commonly but incorrectly spelled Nicholsky), a finding named after Dr Piotr Nikolsky, who first described this sign in 1896. [ ] Pemphigus foliaceus is characterized by a chronic course, with little or no involvement of the mucous membranes. Pierre Louis Alphee Cazenave, founder of the first journal dedicated entirely to dermatology, documented the first description of pemphigus foliaceus in 1844 in this journal. The description was of a 47-year (...) -old woman who consulted him at l'Hopital Saint Louis in Paris for a generalized eruption of several years' duration. Nikolsky described lateral extension of the preexisting erosion due to lifting up the collarette (and when applying a lateral pressure to the clinically intact skin), whereas Asboe-Hansen described extension of the intact blister due to pressure that is applied to its roof. Pemphigus foliaceus has the following six subtypes: pemphigus erythematosus (PE), pemphigus herpetiformis (PH

2014 eMedicine.com

79. Percutaneous Transluminal Coronary Angioplasty (Overview)

) guidelines on the management of NSTE-ACS (updated in 2014 [ ] ) recommend an early invasive strategy in most cases, with timing as follows: Immediate (within 2 hours) - Patients with refractory angina, recurrent angina after initial treatment, signs/symptoms of heart failure, new/worsening mitral regurgitation, hemodynamic instability, sustained ventricular tachycardia, or ventricular fibrillation Early (within 24 hours) - None of the immediate characteristics but new ST-segment depression, a GRACE risk (...) Foundation/AHA guidelines for management of unstable angina/NSTEMI recommend the use of an early invasive strategy or ischemia-guided strategy in patients with NSTE-ACS. An ischemia-guided approach is recommended for patients with a low-risk score (TIMI 0 or 1, GRACE < 109). Other patients will benefit from an early invasive strategy stratified by timing as follows: Immediate (within 2 hours) - Patients with refractory or recurrent angina with initial treatment, signs/symptoms of heart failure, new

2014 eMedicine.com

80. Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis (Treatment)

and bullae. Lesions, with the exception of central bullae, are typically flat. (Lesions of erythema multiforme are more likely to be palpable.) Less frequently, the initial eruption may be scarlatiniform. See the image below. Extensive blistering and sloughing on the back. Nondenuded areas have a wrinkled paper appearance. A Nikolsky sign is easily demonstrated by applying lateral pressure to a bulla. With regard to the arrangement of lesions, individual macules are found surrounding large areas (...) . In the study, the time from the onset of skin signs to arrest of disease progression and to complete reepithelialization was significantly shorter in the cyclosporine group. All patients in the cyclosporine group survived versus 50% surviving in the cyclophosphamide group. An open-label phase II trial of adults and a retrospective chart review of patients with Stevens-Johnson syndrome/toxic epidermal necrolysis treated with cyclosporine have also demonstrated a decrease in death and the progression

2014 eMedicine.com

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