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161. Diagnosis, Assessment and Management of Constipation in Advanced Cancer: ESMO Clinical Practice Guidelines

Perineal inspection Digitalrectal examination Distension Abdominal masses Liver enlargement Tenderness Increased/decreased bowel sounds Skin tags Fissures Prolapse Anal warts Perianal ulceration Inner haemorrhoids Sphincter tone Tenderness Obstruction/stenosis Impacted faeces Complete absence of stool Tumour masses Blood Clinical Practice Guidelines Annals of Oncology iv116 | Larkin et al. Volume 29 | Supplement 4 | October 2018 Downloaded from https://academic.oup.com/annonc/article-abstract/29 (...) ] Liquid paraf?n A mineral oil that softens and lubricates the stools. Aspiration may cause lipoid pneumonia [93], anal seepage, skin excoriation and a foreign body reaction if there is a break in the anorectal mucosa. Less effective than PEG OIC, opioid-induced constipation; PEG, polyethylene glycol. Table 7. Enemas: contraindications for use Neutropaenia or thrombocytopaenia Paralytic ileus or intestinal obstruction Recent colorectal or gynaecological surgery Recent anal or rectal trauma Severe

2018 European Society for Medical Oncology

162. Commissioning guide for rectal bleeding

haemorrhoids should be given advice about topical treatment, oral fluid intake, high fibre diet and fibre supplementation. 12 Consideration should be given to referral to a specialist community or secondary care provider of colorectal services if symptoms persist/alter or are particularly troublesome. An acute anal fissure is a tear in the skin of the anal canal, and may be treated with dietary advice and a bulking agent. Topical glyceryl trinitrate (GTN) 0.4% ointment should be considered for chronic (...) each dosage form, and prices can vary on a month to month basis and should be regularly checked. Anal fissures with an atypical appearance or a clinical appearance of chronicity such as scarring or tags suggests referral to secondary care may be needed as topical treatments are unlikely to be effective. Low risk patients with rectal bleeding who are concerned about colorectal malignancy should be Commissioning guide 2017 Rectal Bleeding 9 considered for direct access (direct to test) flexible

2018 Association of Coloproctology of Great Britain and Ireland

164. The UK guidelines for management and surveillance of Tuberous Sclerosis Complex

is available should be considered for treatment with an mTOR inhibitor. Those likely to benefit from an mTOR inhibitor according to current evidence are those with progressive deterioration in lung function and those with chylous complications. Skin Skin involvement is common in TSC. Lesions such as facial angiofibromatosis, hypomelanotic macules, shagreen patches, forehead fibrous plaques, skin tags and periungual fibromas are observed in individuals with TSC. Facial angiofibromas can affect approximately (...) or TSC2 lead to over-activation of the mTOR pathway and relatively uncontrolled cell growth that causes growth of benign tumours (hamartomas) in various organs, such as the brain, kidneys, skin, heart, lungs and bones. The management of TSC has varied dependent on treating physician, local and national policies and funding. There are no current UK guidelines. We conducted a Delphi consensus process to reach agreement amongst UK experts on the management of patients with TSC. The Delphi process

2018 Tuberous Sclerosis Association

165. Breast Imaging and Intervention

the digital mammography image acquisition system to the stored DICOM image. Systems must provide all of the information fields listed in the chart below, ideally without additional manual entry by the operator. The DICOM header should contain the following tags: a) Facility Name b) Acquisition Date c) Acquisition Time d) Facility Address e) Station Name f) Operator Initials (or ID number) g) Patient’s First and Last Names h) Patient ID and/or Date of Birth i) kV j) Exposure Time and X-ray Tube Current (...) to tomosynthesis. 2. BREAST ULTRASOUND 48 Breast Ultrasound is an established, effective, diagnostic imaging technique which employs the use of high- frequency ultrasound waves for imaging, Doppler assessment, and elastography. INDICATIONS Appropriate indications for breast sonography include: a) Investigation of palpable abnormalities, skin changes and new dimpling (female or male) b) Investigation of serous or sanguineous nipple discharge (see NIPPLE DISCHARGE INVESTIGATION AND INTERVENTION, below) c

2016 Canadian Association of Radiologists

166. AIUM Practice Parameter for the Performance of an Ultrasound Examination of the Neonatal and Infant Spine

: a. Midline or paramedian masses; b. Midline skin discolorations; c. Skin tags; d. Hair tufts; e. Hemangiomas; f. Small midline dimples; and g. Paramedian deep dimples; 2. The spectrum of caudal regression syndrome, including patients with sacral agenesis, anal atresia or stenosis; 2016—AIUM PRACTICE PARAMETER—Neonatal and Infant Spine 1 neonatalSpine.qxp_0616 6/29/16 4:02 PM Page 13. Evaluation of suspected cord abnormalities such as cord tethering, diastematomyelia, hydromyelia, and syringomyelia; 4 (...) abnormalities, such as syrinx or diastematomyelia. These latter abnormalities should be identified preoperatively. 2. Examination of the contents of a closed neural tube defect if the skin overlying the defect is thin or no longer intact. III. Qualifications and Responsibilities of Personnel See www.aium.org for AIUM Official Statements including Standards and Guidelines for the Accreditation of Ultrasound Practices and relevant Physician Training Guidelines. 14 IV . Written Request for the Examination

2016 American Institute of Ultrasound in Medicine

167. CIRSE Guidelines on Percutaneous Ablation of Small Renal Cell Carcinoma

, an arterial, a nephrographic 100-s phase and a delayed excretory phase) is required to exclude complica- tions such as bleeding or bowel perforation. Post-Procedural Follow-up Care Patients may be seen on an outpatient basis four weeks post treatment. During the ?rst visit, the level of pain, the ability to pass urine and the presence of any haematuria and/or fever are assessed, and the skin entry point is examined. A follow-up contrast CT scan needs to be performed on the day prior to the outpatient (...) of the ureter or ureteropelvic junction 1–3 \ 2 Bowel perforation 1 \ 1 Infection/abscess \ 1 \ 1 Sensory or motor nerve injury 1–3 \ 2 Pneumothorax \ 2 \ 1 Needle tract seeding 1 \ 1 Skin burn 1 \ 1 Table 7 Overview of cT1a RCC percutaneous ablation treatment Overview of cT1a RCC percutaneous ablation treatment Percutaneous ablation represents an alternative to surgery for the treatment of T1a RCCs The technical and functional outcomes of the procedure are excellent The rate of complication is very low

2016 Cardiovascular and Interventional Radiological Society of Europe

169. Recommended Dietary Pattern to Achieve Adherence to the American Heart Association/American College of Cardiology (AHA/ACC) Guidelines: A Scientific Statement From the American Heart Association

, or poached; and skin should be removed from poultry. Although the 2015 US Dietary Guidelines Advisory Committee reported that dietary cholesterol was no longer a nutrient of concern, for some individuals (eg, those with elevated LDL-C), reduced intake of egg yolks (180 mg cholesterol per yolk) may be appropriate. Two egg whites have the same protein content as 1 oz meat. Nuts, seeds, and legumes: Beneficial sources of energy, magnesium, protein, and fiber. Examples are almonds, hazelnuts, mixed nuts

2016 American Heart Association

170. Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumours

Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumours Management of adrenal incidentalomas: European Society of Endocrinology Clinical Practice Guideline in collaboration with the European Network for the Study of Adrenal Tumors in: European Journal of Endocrinology Volume 175 Issue 2 Year 2016 This site uses cookies, tags, and tracking settings to store information (...) incidentaloma, is ‘subclinical Cushing’s syndrome’ ( ). This term aims to define patients with biochemical evidence of cortisol excess, but without the so-called ‘specific’ clinical signs of Cushing’s syndrome (mainly the lack of catabolic features such as myopathy and skin fragility). There is, however, clear evidence that patients with clinically unapparent cortisol excess very rarely develop Cushing’s syndrome ( , , , , , , , ) and that this condition is different from overt Cushing’s syndrome, which

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2016 European Society of Endocrinology

171. Diagnosis, Staging and Treatment of Patients with Prostate Cancer

per year during 2010-2012, representing about 30% of all deaths in that period (NCRI, 2014a). Cancer incidence data from the National Cancer Registry Ireland (NCRI) and population pr ojections fr om the Central Statistics Office (CSO) have been combined by the NCRI to estimate the number of new cancer cases expected in five year bands fr om 2015 to 2040. The total number of new invasive cancer cases (including non-melanoma skin cancer) is projected to increase by 84% for females and 107% for males (...) between 2010 and 2040, based only on changes in population size and age distribution (demography). If trends in incidence since 1994 are also taken into account, the number of cases is expected to increase by between 86% and 125% for females (depending on the method of projection used) and by between 126% and 133% for males (NCRI, 2014b). Prostate cancer is the most common cancer in men (excluding non-melanoma skin cancer). The annual average incidence for prostate cancer in Ireland between 2010

2016 National Clinical Guidelines (Ireland)

172. Meticillin-resistant Staphylococcus aureus (MRSA): control and management

Meticillin-resistant Staphylococcus aureus (MRSA): control and management Meticillin-resistant Staphylococcus aureus (MRSA): control and management | Great Ormond Street Hospital Google Tag Manager Navigation Search Search You are here Meticillin-resistant Staphylococcus aureus (MRSA): control and management Meticillin-resistant Staphylococcus aureus (MRSA): control and management ) clearly indicate that infection control measures do have an impact on controlling the spread of MRSA (...) or within the first 24 hours of admission and then at least every 30 days during admission (except in areas with local policy for more frequent screening e.g. NICU and PICU). Patients already known to be colonised with MRSA should have a full MRSA screen (nose, throat, hairline, axillae, groin/perineum, any skin lesions and sites of indwelling devices) taken on admission. The swabs need to be sent to the microbiology laboratory to be tested for MRSA ( ). The reasons for taking MRSA swabs must

2016 Publication 1593

173. Radiofrequency treatment for haemorrhoids

patients. Rectal tenesmus was reported in 4% (1/28) of patients who had radiofrequency treatment and 19% (6/32) of patients who had rubber band ligation (p<0.05) in the RCT of 60 patients. 5.5 Skin tag formation at 12-month follow-up was reported in 7 patients who had external haemorrhoids, in the case series of 50 patients. 5.6 In addition to safety outcomes reported in the literature, specialist advisers are asked about anecdotal adverse events (events which they have heard about) and about

2017 National Institute for Health and Clinical Excellence - Interventional Procedures

174. Pilonidal sinus disease

— a chronic, relapsing-remitting, non-infectious inflammatory disease of the gastrointestinal tract. May present with perianal pain or tenderness, anal or perianal skin tag, fissure, fistula, or abscess. See the CKS topic on for more information. Infectious processes, including tuberculosis, syphilis, and actinomycosis — see the CKS topics on and for more information. Basis for recommendation Basis for recommendation The information on differential diagnoses is taken from The treatment of pilonidal (...) Pilonidal sinus disease Pilonidal sinus disease - NICE CKS Share Pilonidal sinus disease: Summary Pilonidal sinus disease is an inflammatory skin condition that usually occurs in the midline of the natal cleft (although there have been few reported cases involving other parts of the body, such as on the scalp, axilla, groin, and between the fingers). Opinions differ as to how it develops; the current consensus is that it is an acquired condition in which loose hairs in the natal cleft

2019 NICE Clinical Knowledge Summaries

175. Crohn's disease

in the right lower quadrant. Perianal pain or tenderness, anal or perianal skin tags, fissure, fistula, or abscess. Signs of malnutrition and malabsorption. Abnormalities of the joints, eyes, liver, and skin. If Crohn's disease is suspected, the person should be referred to secondary care for confirmation of the diagnosis and initiation of treatment. If the person is systemically unwell with symptoms of bloody diarrhoea, fever, tachycardia, or hypotension, emergency hospital admission should be arranged (...) , or fever. On examination there may be: Pallor, clubbing, aphthous mouth ulcers. Abdominal tenderness or mass, for example in the right lower quadrant. Perianal pain or tenderness, anal or perianal skin tag, fissure, fistula, or abscess. Signs of malnutrition and malabsorption — serial weight loss or, in children, faltering growth or delayed puberty. , including abnormalities of the joints, eyes, liver, and skin. Suspect a of Crohn's disease if there is: A history of recurrent urinary tract infections

2019 NICE Clinical Knowledge Summaries

176. Constipation

loading and/or impaction. Examine the person, with their informed consent: Assess for signs of weight loss and general nutritional status. Perform an abdominal examination to check for abdominal pain, distension, masses, or a palpable colon (suggesting retained faecal masses). Perform an internal rectal examination, checking for: Anal fissures, haemorrhoids, skin tags, rectal prolapse, rectocele, skin erythema or excoriation (may be a sign of faecal leakage). Resting anal sphincter tone; rectal mass

2019 NICE Clinical Knowledge Summaries

177. Vitamin D and periodontal disease

Vitamin D and periodontal disease Vitamin D and periodontal disease - National Elf Service Search National Elf Service Search National Elf Service » » » » Vitamin D and periodontal disease Mar 27 2018 Posted by Vitamin D is fat soluble vitamin produced in the skin following exposure to sunlight or as a result of dietary consumption. Insufficient vitamin D intake has been associated the range of systemic conditions (eg. cardiovascular disease, diabetes, cancer), a beneficial effect for vitamin D (...) on Google+ Share this post: Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+ Share via email Tagged with: , , , , Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal. He

2018 The Dental Elf

178. Use of plumage and gular pouch color to evaluate condition of oil spill rehabilitated California brown pelicans (Pelecanus occidentalis californicus) post-release. (PubMed)

to condition can provide information on physiological status of birds. We evaluated plumage molt and gular pouch skin color of California brown pelicans (Pelecanus occidentalis californicus) following oil contamination and rehabilitation to test for differences between previously oiled and rehabilitated (post-spill) and presumably uncontaminated pelicans. Post-spill pelicans released with either color leg bands alone, or bands plus harness-mounted satellite GPS tags, were relocated and visually assessed (...) in the field at non-breeding communal roosts and compared to surrounding unmarked pelicans in the general population. Non-oiled pelicans bearing GPS tags were also included in the study. Post-spill pelicans lagged the general population in molt of ornamental yellow crown feathers but hind neck transition into white plumage was not significantly different. Both post-spill and non-oiled pelicans wearing GPS tags had lower gular redness scores than the unmarked, non-oiled population. Pre-breeding gular pouch

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2019 PLoS ONE

179. The impact of facial scarring: routinely assess for affective distress

via email Tagged with: , , , , , , , Dr Thompson is a Clinical Health Psychologist based at the University of Sheffield and Sheffield Health & Social Care NHS Foundation Trust. He has published widely (around 100 publications) on the psychosocial issues associated with visible conditions and is the psychological advisor for the All Party Parliamentary Group on Skin and is involved with a number of dermatology and burn care charities. He is a co-author on a Wiley clinical psychology textbook (...) on working with appearance concern, and he is an Associate Editor for The British Journal of Dermatology and the new Sage journal, Scars, Burns, & Healing. Information about the NHS service he is involved in can be found at http://iaptsheffield.shsc.nhs.uk/living-well-with-a-skin-condition/). Information on his publications can be found at https://orcid.org/0000-0001-6788-7222. - Follow me here – Logging In... Profile or Comment Name Email Not published Website We can help you: 1 Keep up to date

2018 The Mental Elf

180. Oral lichen planus: Rate of malignant transformation

Oral lichen planus: Rate of malignant transformation Oral lichen planus: Rate of malignant transformation - National Elf Service Search National Elf Service Search National Elf Service » » » » Oral lichen planus: Rate of malignant transformation Aug 17 2018 Posted by Lichen planus is an inflammatory condition that may affect the skin, hair, nails and mucous membranes. oral lichen planus affects between 0.5 – 2% of the population with a predilection for middle and female. Manifestations of oral (...) on Google+ Share this post: Share on Facebook Tweet this on Twitter Share on LinkedIn Share on Google+ Share via email Tagged with: , , , , , , Derek Richards is the Director of the Centre for Evidence-based Dentistry, Editor of the Evidence-based Dentistry Journal, Consultant in Dental Public Health with Forth Valley Health Board and Honorary Senior Lecturer at Dundee & Glasgow Dental Schools. He helped to establish both the Centre for Evidence-based Dentistry and the Evidence-based Dentistry Journal

2018 The Dental Elf

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