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Tongue Carcinoma

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1621. Use of Local Anesthesia for Pediatric Dental Patients

/anxiolysis can help the patient have a positive experience during adminis- tration of local anesthesia. 3-5 In pediatric dentistry, the dental professional should be aware of proper dosage (based on weight) to minimize the chance of toxicity and the prolonged duration of anesthesia, which can lead to accidental lip, tongue, or soft tissue trauma. 6 Knowledge of gross and neuroanatomy of the head and neck allows for proper placement of the anesthetic solution and helps minimize complications (e.g (...) action in the area. 9 Epinephrine is contraindicated in patients with hyperthyroidism. 9 The dose should be kept to a minimum in patients receiving tricylic antidepressants since dysrhythmias may occur. Levonordefrin and norepinephrine are absolutely contraindicated in these patients. 9 Patients with significant cardiovascular disease, thyroid dysfunction, diabetes, or sulfite sensitivity and those receiving monoamine oxidase inhibitors, tricyclic antidepressants, or phenothiazines may require a med

2015 American Academy of Pediatric Dentistry

1622. Management Considerations for Pediatric Oral Surgery and Oral Pathology

concluded there is no evidence to support 31-34 or refute 1 the prophylactic removal of disease-free impacted third molars. Factors that increase the risk for surgical complications (e.g., coexisting systemic conditions, location of peripheral nerves, history of temporomandibular joint disease, presence of cysts or tumors) 32,33 and position and inclination of the molar in question 35 should be assessed. The age of the patient is only a secondary consideration. 35 Referral to an oral and maxillofacial (...) lesions in the pediatric population. The largest epidemiologic studies in the U.S. place the prevalence rate in children at four to 10 percent with the exclusion of infants. 61,62 Although the vast majority of these lesions re- present mucosal conditions, developmental anomalies, and reactive or inflammatory lesions, it is imperative to be vigilant for neoplastic diseases. Regardless of the age of the child, it is important to estab- lish a working diagnosis for every lesion. This is based

2015 American Academy of Pediatric Dentistry

1623. Bipolar disorder: Antipsychotics

be used with caution in people with: Blood dyscrasias. Cardiovascular disease. Conditions predisposing to seizures; epilepsy. Depression. Diabetes (may raise blood glucose). History of jaundice. Myasthenia gravis. Parkinson’s disease (may be exacerbated). Photosensitisation (may occur with higher dosages). Prostatic hypertrophy. Severe respiratory disease. Susceptibility to angle-closure glaucoma. [ ] What adverse effects of antipsychotics should I be aware of? Antipsychotics can cause a wide range (...) ) - can often be relieved by reducing the dose of the antipsychotic. Tardive dyskinesia - late-onset movement disorder that can occur with prolonged use of antipsychotics. It is characterized by rhythmical, involuntary movements, usually lip-smacking and tongue rotating, although it can affect the limbs and trunk. It may be persistent and can sometimes worsen on treatment withdrawal. The drug should be discontinued on appearance of early signs. Oculogyric crisis has been reported as an adverse effect

2018 NICE Clinical Knowledge Summaries

1624. Anaemia - B12 and folate deficiency: What are the signs and symptoms of vitamin B12 or folate deficiency anaemia?

anaemia and without low serum levels of vitamin B12. Symptoms of vitamin B12 and folate deficiency include: Cognitive changes. Dyspnoea. Headache. Indigestion. Loss of appetite. Palpitations. Tachypnoea. Visual disturbance. Weakness, lethargy. People with pernicious anaemia may present with symptoms of associated disorders, for example, myxoedema, other thyroid disorders, vitiligo, stomach cancer, or Addison's disease. Signs of vitamin B12 and folate deficiency include: Anorexia. Angina (in older (...) people). Angular cheilosis. Brown pigmentation affecting nail beds and skin creases (but not mucous membranes). Congestive heart failure (in older people). Episodic diarrhoea. Glossitis — red smooth and shiny tongue, perhaps with ulcers. Heart murmurs. Liver enlargement. Mild jaundice — a lemon-yellow tint. Mild pyrexia. Oropharyngeal ulceration. Pallor of mucous membranes or nail beds. Tachycardia. Weight loss. Neurological complications associated with vitamin B12 deficiency include: Loss

2018 NICE Clinical Knowledge Summaries

1625. Neck lump: Examination

to be removed). Use a tongue depressor to examine the lateral borders of the tongue. The chest for signs of lung disease. The abdomen for hepatosplenomegaly, and the axillae and groin for lymphadenopathy (if haematological malignancy is suspected). Pulse and blood pressure — abnormalities may indicate thyroid disease. Specific areas from which a suspected lymph node metastasis (a firm lump) may have originated. In general, if the suspected lymph node metastasis is in the upper or mid neck, the primary (...) is likely to be a head and neck tumour (including thyroid). Lateral lymph nodes may be enlarged because of metastasis from squamous cell cancer of mouth, pharynx, and upper oesophagus. If the suspected lymph node metastasis is in the lower neck (supraclavicular lymph nodes), the primary may be from the thyroid, pyriform sinuses, upper oesophagus, or from below the clavicle (for example breast, lung, or intra-abdominal malignancy). An enlarged lymph node in the left supraclavicular fossa may indicate

2018 NICE Clinical Knowledge Summaries

1626. Breastfeeding problems

abnormality such as ankyloglossia (tongue-tie) that may be affecting infant attachment and feeding. Considering specialist referral for possible drug treatment if Raynaud's disease of the nipple, or prolactin deficiency causing a low milk supply, is suspected, and other measures have not worked. Considering referral to a breast specialist for further advice on management, if symptoms do not improve as expected with appropriate treatment. © . (...) , with the introduction of solid food around this time. Benefits to the infant include a reduction in the incidence and severity of infections, asthma, and atopic eczema. Benefits to the mother include reduced rates of breast and ovarian cancer, and reduced incidence of obesity. Breastfeeding problems which may lead to a mother stopping breastfeeding include: Breast pain. Nipple pain. Low milk supply (true and perceived). Oversupply of milk. Breastfeeding problems may have a number of underlying causes, and more than

2018 NICE Clinical Knowledge Summaries

1627. Polymyalgia rheumatica: How should I diagnose polymyalgia rheumatica?

to reduce the risk of serious complications, such as vision loss. Features include abrupt onset headache (usually temporal) and temporal tenderness; visual disturbance, including diplopia; jaw or tongue claudication; prominence, beading, or diminished pulse on examination of the temporal artery; upper cranial nerve palsies; and limb claudication or other evidence of large vessel involvement. For more information on diagnosis and management, see the CKS topic on . Active infection or cancer because (...) treatment with corticosteroids may mask these conditions. Other conditions that can cause similar symptoms to PMR, such as arthritis, thyroid disease, and statin-induced myalgia or myositis. For more information on other conditions to consider, see the section on . Arrange the following tests in all people with suspected PMR to rule out other conditions before starting corticosteroids: full blood count, urea and electrolytes, liver function tests, calcium, alkaline phosphatase, protein electrophoresis

2018 NICE Clinical Knowledge Summaries

1628. Recovery: care of the child/young person

( ) ( ). Common causes of airway obstruction include: tongue ( ) laryngospasm ( ) foreign bodies such as vomit, acidic gastric contents, mucous, blood/secretions and dislodged teeth Determine the need for techniques to open the airway and the continued use/insertion of airway adjuncts until the child begins to regain consciousness: Manual techniques: chin tilt: neutral position for neonates, ‘sniffing the morning air’ for small child. jaw thrust for adolescents/adults Airway adjuncts: ( ) nasopharyngeal (...) by blue hands, feet and fingernail beds ( ). Central cyanosis: indicated by blue lips, tongue and mucous membranes ( ). An anaemic child may not appear cyanotic despite the presence of profound hypoxaemia ( ). Note oxygen saturation readings and maintain oxygen therapy (40 % - 100 %) to ensure oxygen saturation remain above 94%. The duration of oxygen therapy should be determined by the oxygen saturation values in the recovery unit ( ). If required, provide ventilatory support as necessary

2015 Publication 1593

1629. Diagnosis of Right Lower Quadrant Pain and Suspected Acute Appendicitis

must disclose any financial conflicts of interest greater than $10,000 and any other relevant business or professional conflicts of interest. Because of their role as end-users, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any conflicts of interest. The list of Key Informants who provided input to this report follows: Anthony Chow, M.D. Division of Infectious Diseases University of British Columbia Vancouver Hospital Vancouver, BC (...) business or professional conflicts of interest. Because of their unique clinical or content expertise, individuals with potential conflicts may be retained. The TOO and the EPC work to balance, manage, or mitigate any potential conflicts of interest identified. The list of Technical Experts who provided input to this report follows: Anthony Chow, M.D. Division of Infectious Diseases University of British Columbia Vancouver Hospital Vancouver, BC, Canada Tyler Hughes, M.D. McPherson Hospital McPherson

2016 Effective Health Care Program (AHRQ)

1630. Acne clinical guideline Full Text available with Trip Pro

and can also be seen in children. This evidence-based guideline addresses important clinical questions that arise in its management. Issues from grading of acne to the topical and systemic management of the disease are reviewed. Suggestions on use are provided based on available evidence. Key words: , , , , , , , , , , , , , , , , , , , , , , , , , , Disclaimer Adherence to these guidelines will not ensure successful treatment in every situation. Furthermore, these guidelines should not be interpreted (...) as setting a standard of care, or be deemed inclusive of all proper methods of care, nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy or technique must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biologic behavior of the disease. This guideline reflects the best available data at the time

2016 American Academy of Dermatology

1631. Persistent Pain with Breastfeeding

(topical), chamo- mile, vitamins A and E, and fragrances. 18,20 (III) 2. Psoriasis Flarescanoccurduringlactationsporadically(usually 4–6 weeks after the birth 21 (III) or as a response to skin injury (koebnerization) from latch, suckling, or biting. 3. Mammary Paget’s disease (Paget’s disease of the nipple) More common in postmenopausal women (60–80% of cases), but observed in younger women, this slow- growing intraductal carcinoma mimics eczema of the nipple. A unilateral, slowly advancing nipple (...) ,suboptimalpositioning ofthe infantduringa breastfeed can lead to a shallow latchandabnormalcompressionofthenipplebetween the tongue and palate. 9–11 (II-2, III, III) B Disorganized or dysfunctional latch/suck: The abil- ity of an infant to properly latch and breastfeed is dependent, among otherfactors, onprematurity, oral and mandibular anatomy, muscle tone, neurological maturity, and re?ux or congenital abnormities, as well as maternal issues such as milk ?ow, breast/ nipple size, and engorgement. Infants who

2016 Academy of Breastfeeding Medicine

1632. Establishing breastfeeding

infections 8 16 RR: 0.68 0.60–0.77 reduced Mortality due to infectious diseases 8 9 OR: 0.48 0.38–0.60 reduced Protection against diarrhoea morbidity/hospital admission 8 15 RR: 0.69 0.58–0.82 reduced Maternal Breast cancer 21 98 OR: 0.78 0.74–0.82 reduced Ovarian cancer 21 41 OR: 0.70 0.64–0.77 reduced Type 2 diabetes 22 6 RR: 0.68 0.57–0.82 reduced BMI in postmenopausal women 23 1 0.22 kg/m 2 0.21–0.22 reduced CI: Confidence Interval; OR: Odds Ratio; RR Relative Risk, BMI: Body Mass Index. See (...) definitions for explanation of OR Queensland Clinical Guideline: Establishing breastfeeding Refer to online version, destroy printed copies after use Page 7 of 28 1.2 Breastfeeding cautions In Australia, there are very few indications for completely avoiding breastfeeding. 2 Individualise care and seek expert advice as required. Table 2. Breastfeeding cautions Aspect Consideration Breastfeeding not recommended • Specialised formula required for: o Galactosaemia o Maple syrup urine disease o

2016 Queensland Health

1633. The Management of Diabetic Foot Full Text available with Trip Pro

-brachial index; DFU, diabetic foot ulcer; HBO, hyperbaric oxygen; MRI, magnetic resonance imaging; NPWT, negative pressure wound therapy; PAD, peripheral arterial disease; PTB, probe to bone; TcP o 2 , transcutaneous oxygen pressure; XR, radiography. Hide Pane Expand all Collapse all Article Outline Background Diabetes mellitus continues to grow in global prevalence and to consume an increasing amount of health care resources. One of the key areas of morbidity associated with diabetes is the diabetic (...) of the literature. Specific areas of focus included (1) prevention of diabetic foot ulceration, (2) off-loading, (3) diagnosis of osteomyelitis, (4) wound care, and (5) peripheral arterial disease. Results Although we identified only limited high-quality evidence for many of the critical questions, we used the best available evidence and considered the patients' values and preferences and the clinical context to develop these guidelines. We include preventive recommendations such as those for adequate glycemic

2016 Society for Vascular Surgery

1634. Barrett's Esophagus

). Risk factors associated with the development of BE include long-standing GERD, male gender, central obesity (3), and age over 50 years (4, 5). The goal of a screening and surveillance program for BE is to identify individuals at risk for progression to esophageal adenocarcinoma (EAC), a malignancy that has been increasing in incidence since the 1970s (6, 7). The purpose of this guideline is to review the definition and epidemiology of BE, available screening modalities for BE detection, rationale (...) both effective and well tolerated (strong recommendation, moderate level of evidence). In patients with T1b EAC, consultation with multidisciplinary surgical oncology team should occur before embarking on endoscopic therapy. In such patients, endoscopic therapy may be an alternative strategy to esophagectomy, especially in those with superficial (sm1) disease with a well-differentiated neoplasm lacking lymphovascular invasion, as well as those who are poor surgical candidates (strong recommendation

2016 American Gastroenterological Association Institute

1635. Male Urethral Stricture

Male Urethral Stricture Urethral Stricture Guideline - American Urological Association advertisement Toggle navigation About Us About the AUA Membership AUA Governance Industry Relations Education AUAUniversity Education Products & Resources Normal Histology and Important Histo-anatomic Structures Urinary Bladder Prostate Kidney Renovascular Diseases Andrenal Gland Testis Paratesticular Tumors Penis Retroperitoneum Cytology Online Learning For Medical Students Exams/LLL/Certifications Exam Prep (...) who require chronic self-catheterization (e.g. neurogenic bladder), surgeons may offer urethroplasty as a treatment option for urethral stricture causing difficulty with intermittent self-catheterization. (Expert Opinion) 30. Clinicians may perform biopsy for suspected lichen sclerosus (LS), and must perform biopsy if urethral cancer is suspected. (Clinical Principle) 31. In lichen sclerosus (LS) proven urethral stricture, surgeons should not use genital skin for reconstruction. (Strong

2016 American Urological Association

1636. Assessing Fitness to Drive

to relevant medical systems/diseases. The medical requirements for unconditional and conditional licences are summarised in a tabulated to differentiate between the requirements for private and commercial vehicle drivers. Additional information, including the rationale for the standards, as well as a general assessment and management considerations, is provided in the supporting text of each chapter. 5 Part A: 1 About this publication Assessing Fitness to Drive 2016 Part C comprises further supporting (...) • endurance/fatigue and vigilance demands associated with long periods spent on the road. 2.2 Medical conditions and driving 2.2.1 Conditions likely to affect driving Given the many causal factors in motor vehicle crashes, the extent to which medical conditions contribute to vehicle crashes is difficult to assess. There is, however, recognition of the potential for certain conditions to cause serious impairments. Examples of such conditions include: • blackouts • cardiovascular disease • diabetes

2016 Cardiac Society of Australia and New Zealand

1637. ASCIA Clinical Update - Anaphylaxis

tumours (e.g. carcinoid syndrome, VIPomas) • Alcohol related • Medullary carcinoma of thyroid • “Red Man Syndrome” (vancomycin related) Neurological syndromes • Epileptic seizures • Strokes Other causes of collapse • Vasovagal episodes • Systemic Capillary Leak Syndrome • Shock (septic, cardiogenic, haemorrhagic) Acute respiratory distress • Asthma Panic disorders • Globus hystericus • Laryngospasm (can be triggered by anxiety but more commonly triggered by oesophageal reflux) • Vocal cord dysfunction (...) for insect allergy) Anaphylaxis Watch for any one of the following signs of anaphylaxis: • Difficult/noisy breathing • Swelling of tongue • Swelling/tightness in throat • Difficulty talking and/or hoarse voice • Wheeze or persistent cough • Persistent dizziness or collapse • Pale and floppy (young children) Note: Urticaria, erythema and angioedema may be transient, subtle and easily overlooked. In 1 out of 6 fatal food induced anaphylaxis cases, severe cardiovascular symptoms developed without skin

2016 Australasian Society of Clinical Immunology and Allergy

1638. Clearing the Smoke on Cannabis: Medical Use of Cannabis and Cannabinoids ? An Update

for medical purposes are not assured the reliable, standardized and reproducible dose they would otherwise receive from using cannabinoid products delivered in controlled doses (e.g., capsules, oral sprays). • Research is currently examining the efficacy of potential therapeutic uses of cannabinoid products for conditions such as multiple sclerosis, psychiatric disorders, epilepsy, inflammatory diseases, cancer, obesity, glaucoma and neurodegenerative disorders. Although findings from this research (...) studied in cell cultures (test-tube studies) and in animals with tumours, no firm conclusions about their clinical use are yet possible. It has been confirmed repeatedly that THC and various other cannabinoids binding to CB 1 and CB 2 cannabinoid receptors, and CBD acting through different mechanisms, can promote cancer cell death, or retard or prevent the growth of cancer cells of various types, including lung, prostate, pancreas, colon and brain cancer (Dando et al., 2013; De Petrocellis et al

2016 Canadian Centre on Substance Abuse

1639. Establishing breastfeeding

infections 8 16 RR: 0.68 0.60–0.77 reduced Mortality due to infectious diseases 8 9 OR: 0.48 0.38–0.60 reduced Protection against diarrhoea morbidity/hospital admission 8 15 RR: 0.69 0.58–0.82 reduced Maternal Breast cancer 21 98 OR: 0.78 0.74–0.82 reduced Ovarian cancer 21 41 OR: 0.70 0.64–0.77 reduced Type 2 diabetes 22 6 RR: 0.68 0.57–0.82 reduced BMI in postmenopausal women 23 1 0.22 kg/m 2 0.21–0.22 reduced CI: Confidence Interval; OR: Odds Ratio; RR Relative Risk, BMI: Body Mass Index. See (...) definitions for explanation of OR Queensland Clinical Guideline: Establishing breastfeeding Refer to online version, destroy printed copies after use Page 7 of 28 1.2 Breastfeeding cautions In Australia, there are very few indications for completely avoiding breastfeeding. 2 Individualise care and seek expert advice as required. Table 2. Breastfeeding cautions Aspect Consideration Breastfeeding not recommended • Specialised formula required for: o Galactosaemia o Maple syrup urine disease o

2016 Clinical Practice Guidelines Portal

1640. Solitary Granular Cell Tumor of Cecum: A Case Report Full Text available with Trip Pro

Solitary Granular Cell Tumor of Cecum: A Case Report Granular cell tumor (GCT) was first described by Abrikossof in 1926. This tumor is a benign neoplasm of unclear histogenesis that is generally believed to be of nerve sheath origin. GCT is not common and most often affects the tongue, skin, and soft tissue, although it may occur anywhere in the body. Gastrointestinal tract involvement, and especially that of the colon, is very rare. This usually benign tumor appears as a submucosal nodule (...) , measuring less than 2 cm in diameter and is often found incidentally during colorectal examinations. We describe the case of a 27-year-old man with a GCT in the cecum that was detected after a screening colonoscopy. Endoscopic examination revealed a yellowish submucosal tumor, 0.7 cm in diameter. An endoscopic mucosal polypectomy was done for histological confirmation and treatment.

2010 ISRN gastroenterology

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