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Tongue Carcinoma

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1621. Migraine

disorder. Background information Background information Definition What is it? Migraine is a common primary headache disorder. Primary headaches are headaches which are not associated with another underlying condition. Secondary headaches are headaches which occur as a result of underlying local or systemic pathology such as intracerebral haemorrhage, malignancy or infection. Migraine is characterized by: Attacks of moderate or severe headache (commonly, but not always unilateral, and often described (...) Migraine with typical aura can include: Visual and/or sensory and/or speech/language symptoms — visual aura is the most common type of aura and occurs in over 90% of people who have migraine with aura [ ]. Sensory aura often presents with unilateral pins and needles and or numbness which gradually moves away from the point of origin on the body, face and/or tongue [ ]. The ICHD diagnostic criteria for migraine with typical aura does not include motor, brainstem or retinal symptoms [ ]: Motor symptoms

2019 NICE Clinical Knowledge Summaries

1622. Diverticular disease

, vomiting, reduced flatus. Colorectal cancer — see the CKS topic on for more information. Frequent small or continual rectal bleeds are unlikely to be caused by diverticular disease and require further investigation, even in a person known to have diverticula. In addition, the diverticulitis complication of bowel obstruction may mimic symptoms of colorectal cancer. Gynaecological Pelvic inflammatory disease — see the CKS topic on for more information. Ovarian cyst or torsion — suggested by sharp (...) . Is dehydrated or at risk of dehydration and is unable to take or tolerate oral fluids at home. Is unable to take or tolerate oral antibiotics (if needed) at home. Is frail and/or has significant co-morbidities and/or is immunocompromised (for example has diabetes mellitus, end-stage chronic kidney disease, malignancy, cirrhosis, or is taking immunosuppressive drugs). Manage the person in primary care if there is suspected mild, uncomplicated diverticulitis, depending on clinical judgement: Consider

2019 NICE Clinical Knowledge Summaries

1623. Diarrhoea - antibiotic associated

of a proton pump inhibitor or other acid-suppressive drugs (such as H 2 -receptor antagonists) [ ; ; ; ]. Underlying morbidity such as abdominal surgery, chronic renal disease, inflammatory bowel disease, immunosuppression (such as solid organ or haematopoietic stem cell transplant recipients, people with HIV infection, people undergoing cancer chemotherapy) [ ; ; ; ]. Prolonged hospitalization or residence in a nursing home [ ; ]. Complications What are the complications? The complications of Clostridium (...) and fourth generation), fluoroquinolones, and broad-spectrum penicillins. Factors that increase the risk of C. difficile infection include increased age, history of C. difficile infection, exposure to other cases, concomitant use of a proton pump inhibitor or other acid-suppressing drug, and underlying morbidity (such as abdominal surgery, chronic renal disease, inflammatory bowel disease, and immunosuppression). The complications of C. difficile infection can be severe and include pseudomembranous

2019 NICE Clinical Knowledge Summaries

1624. Gastroenteritis

; and laxative abuse (the condition normally reverses on withdrawal of the drug). Endocrinopathy, for example diabetes, hyperthyroidism, congenital adrenal hyperplasia, Addison's disease, and hypoparathyroidism. Non-enteral infections, for example HIV/AIDS. Secretory tumours, for example carcinoid tumours, medullary tumour of the thyroid, and vasoactive intestinal peptide-secreting adenomas. Basis for recommendation Basis for recommendation This information is from a National Institute for Health and Care (...) Gastroenteritis Gastroenteritis - NICE CKS Share Gastroenteritis: Summary Gastroenteritis is a transient disorder due to enteric infection with viruses, bacteria, or protozoa. About 20% of the UK population develop gastroenteritis each year. The risk of complications (such as dehydration and electrolyte disturbance, haemolytic uraemic syndrome, and malnutrition) is greatest at the extremities of life, in people with concurrent chronic disease, and in those who are immunocompromised

2019 NICE Clinical Knowledge Summaries

1625. Leg ulcer - venous

. There is a suspected of ulceration, such as: Arterial or mixed venous/arterial disease — refer people with an ankle brachial pressure index (ABPI) of less than 0.8 to a specialist vascular clinic for further assessment; if the ABPI is less than 0.5, refer urgently. Also consider referring people with ABPI greater than 1.3 as further assessments may be required to determine their suitability for compression therapy. See the section for more information. Malignancy — refer to dermatology using the suspected cancer (...) arthritis, vasculitis, sickle cell disease, malignancy, and drugs (such as nicorandil, corticosteroids, and nonsteroidal anti-inflammatory drugs). Venous leg ulceration is caused by sustained venous hypertension, which results from chronic venous insufficiency due to venous valve incompetence or an impaired calf muscle pump. Risk factors include obesity, immobility, increasing age, varicose veins, and a history of deep vein thrombosis (DVT). The estimated prevalence of venous leg ulcers in the UK

2019 NICE Clinical Knowledge Summaries

1626. Neutropenic sepsis

with haematological malignancy was 37.8% [ ]. Expert opinion in a review article notes that people with haematological malignancies such as leukaemia have higher rates of mortality from febrile neutropenia than people with solid tumours [ ]. In a US retrospective analysis of paediatric cancer patients on an intensive care unit (n = 359), the overall mortality from sepsis was 17%. This rate increased to 30% in children who had undergone haematopoietic stem cell transplants. Mortality varied by causative pathogen (...) — causes additional immunosuppression [ ]. Antibiotics — antibiotics at the time of onset of febrile neutropenia increases the risk of serious complications by disrupting the normal body flora [ ; ; ]. Advanced malignancy [ ; ]. History of previous febrile neutropenia [ ]. Prolonged hospital admission [ ; ]. Previous surgery [ ]. Co-morbidities such as diabetes mellitus, liver disease, renal disease; poor nutritional status — the risk of complications increases in people with more than one significant

2019 NICE Clinical Knowledge Summaries

1627. Drugs to avoid in 2015

. Citalopram and escitalopram, which can cause QT prolongation, are not included in our list (Rev Prescrire n° 369). We are planning to review this adverse effect with the various SSRI antidepressants. Oncology – Catumaxomab, used in malignant ascites, has serious adverse effects (pos- sibly fatal) in more than three-quarters of patients (Prescrire Int n° 109). It is more prudent to drain ascites, at intervals guided by symptoms. – Panitumumab does not prolong sur- vival in metastatic colorectal cancer (...) assess- ment of a drug’s harm-benefit balance based on individual experience can help to guide further research but is subject to major bias and represents only weak evidence (3,4). For example, it can be dif- ficult to attribute a specific outcome to a particular drug, as other factors must be taken into account, including the nat ural history of the disease, the placebo effect, the effect of another treatment the patient may not have mentioned, or a change in lifestyle or diet. Similarly

2015 Prescrire

1628. Transoral Robotic Surgery

of TORS include lack of tactile feedback, difficult hemostasis and initial investment costs. 5 Malignant lesions of the oral or oropharyngeal cavity are relatively uncommon. The estimated annual incidence worldwide is approximately 123,000, with 79,000 deaths annually. 6 Cancers of the oral and oropharyngeal mucosa are most often squamous cell carcinomas and arise from the palate, tonsils, base of tongue, vellecula and aryepiglottic folds. 3,6 Several risk factors are known to be associated (...) total cost for TORS partial pharyngectomy and partial glossectomy (tongue base) in mild to moderate disease compared to open surgery. There was no significant difference between treatment group for partial glossectomy of the anterior tongue. Richmon 7 demonstrated that compared to non-TORS surgery, TORS was associated with a cost savings of $4,285 in patients with malignant oropharyngeal neoplasm. In 2014, Hammoudi 15 showed that TORS was associated with a significantly higher cost of surgery ($7781

2015 Canadian Agency for Drugs and Technologies in Health - Rapid Review

1629. Langerhans Cell Histiocytosis Treatment (PDQ®): Patient Version

quickly. This causes LCH cells to build up in certain parts of the body, where they can damage or form . LCH is not a disease of the Langerhans cells that normally occur in the skin. LCH may occur at any age, but is most common in young children. Treatment of LCH in children is different from treatment of LCH in adults. The and the are described in separate sections of this summary. Use our to find NCI-supported cancer clinical trials that are accepting patients. You can search for trials based (...) on the type of cancer, the age of the patient, and where the trials are being done. about clinical trials is also available. Family history of cancer or having a parent who was exposed to certain chemicals may increase the risk of LCH. Anything that increases your risk of getting a disease is called a . Having a risk factor does not mean that you will get ; not having risk factors doesn't mean that you will not get cancer. Talk with your doctor if you think you may be at risk. Risk factors for LCH include

2018 PDQ - NCI's Comprehensive Cancer Database

1630. CCS and CPCA Position Statement on the Approach to Syncope in the Pediatric Patient Full Text available with Trip Pro

of sudden death or heart disease in young individuals Abnormal cardiac examination New medication with potential cardiac side effects (eg, ) Figure 3 ECG findings in syncope. “Red light” might suggest malignant arrhythmia in certain contexts; “yellow light” might require a nonurgent evaluation in cardiology; “green light” indicates normal variants with no further management needed. AV, atrioventricular; bpm, beats per minute; ECG, electrocardiogram; PVC, premature ventricular complexes. ∗ Manual (...) , 2016 Accepted: September 28, 2016 ; Received: September 13, 2016 ; | ---- Figure 1 Clinical pathway for pediatric syncope patients. ECG, electrocardiogram; VVS, vasovagal syncope. ---- | ---- Figure 2 History and physical examination. ECG, electrocardiogram; LOC, loss of consciousness; LQTS, long QT syndrome. ---- | ---- Figure 3 ECG findings in syncope. “Red light” might suggest malignant arrhythmia in certain contexts; “yellow light” might require a nonurgent evaluation in cardiology; “green

2016 Canadian Cardiovascular Society

1631. Milk Thistle (PDQ®): Health Professional Version

and selective estrogen receptor modulator activity of silymarin compared with ethinylestradiol in ovariectomized rats. Phytomedicine 17 (2): 116-25, 2010. [ ] Scambia G, De Vincenzo R, Ranelletti FO, et al.: Antiproliferative effect of silybin on gynaecological malignancies: synergism with cisplatin and doxorubicin. Eur J Cancer 32A (5): 877-82, 1996. [ ] Bhatia N, Zhao J, Wolf DM, et al.: Inhibition of human carcinoma cell growth and DNA synthesis by silibinin, an active constituent of milk thistle (...) has also been shown to neutralize a wide range of . Reports that associate the flavonolignans with potential estrogenic effect (e.g., via mediation of the ) are sparse and currently not supported by or experimental evidence.[ ] Laboratory experiments conducted using cancer have suggested that silibinin enhances the of and against and cancer cells.[ ] Silybin appears to have direct anticancer effects against , breast, and tumor cells.[ ] Silybin may also affect the cell cycle in cancer cells

2018 PDQ - NCI's Comprehensive Cancer Database

1632. 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

1633. 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

1634. Urticaria

(leaving a residual pigmented lesion, such as petechial haemorrhage, purpura, or bruising). There may be systemic symptoms, such as fever, malaise, and arthralgia. Causes include infection (hepatitis B or C, glandular fever, or streptococcal infection), certain drugs (for example penicillins, fluoxetine, thiazide diureticss, allopurinol, quinolones, or carbamazepine), autoimmune disease, paraproteinaemia, and malignancy. Basis for recommendation Basis for recommendation This information is based (...) of antihistamines, the dose of the first choice antihistamine should be increased gradually to up to four times the standard licensed dose (if appropriate). Assessing disease severity and impact on quality of life: this update includes the recommendation to consider assessing disease severity and impact on quality of life using validated tools, such as the Urticaria Activity Score (UAS7) and the Chronic Urticaria Quality of Life Questionnaire (CU-Q2oL), respectively. Previous changes Previous changes May 2016

2018 NICE Clinical Knowledge Summaries

1635. Balanitis

. Other infections including anaerobes and sexually transmitted infections (STIs). Skin conditions such as contact dermatitis, seborrhoeic dermatitis, psoriasis, lichen planus, or lichen sclerosus. Pre-malignant penile conditions. Balanitis affects about 4% of uncircumcised boys between the ages of 2–5 years. Complications may include phimosis, meatal stenosis, urethral stricture, sexual dysfunction, and penile squamous cell carcinoma, depending on the underlying cause. A diagnosis of balanitis should (...) of foreskin ('Cayenne pepper' spots). It may be secondary to irritation due to prolonged skin contact with urine (a 'dysfunctional foreskin'). Circinate balanitis — this is a chronic balanitis which may occur in men with post-infective Reiter's syndrome and/or psoriasis, although it can occur in isolation. It presents with well-demarcated red or grey plaques on the glans penis with a ragged white border, which coalesce to form 'geographical' areas with a white margin. Pre-malignant conditions (carcinoma

2018 NICE Clinical Knowledge Summaries

1636. Diarrhoea - adult's assessment

(for example, small bowel resection, internal fistulae). Chronic pancreatitis, pancreatic carcinoma. Radiation enteropathy. Endocrine disorders — for example, hyperthyroidism, diabetes (may be metformin-associated), hypoparathyroidism, Addison’s disease. Cystic fibrosis. Factitious diarrhoea — the person adds water to their stools or uses laxatives. Small bowel enteropathy (for example Whipple’s disease, tropical sprue, amyloid). Hormone secreting tumours (for example VIPoma, gastrinoma, carcinoid (...) . Other causes include drugs, anxiety, food allergy, and acute appendicitis. Causes of chronic diarrhoea include irritable bowel syndrome, diet, inflammatory bowel disease, coeliac disease, and bowel cancer. Diarrhoea is one of the most common symptoms for which people seek medical advice. Assessment for acute and chronic diarrhoea should include: Determining onset, duration, frequency, and severity of symptoms. Identifying red flag symptoms. Ascertaining the underlying cause. Looking

2018 NICE Clinical Knowledge Summaries

1637. Feverish children - risk assessment

should be accepted as a valid indicator of fever. Feverish illness in young children usually indicates an underlying infection, and fever is part of the body's natural response to this. It is theorized that fever may inhibit bacterial and viral replication, and strengthen the body's immune response to pathogens. In a minority of children, fever may be due to a non-infectious condition such as Kawasaki disease or malignancy. [ ; ; ; ] Prevalence How common is it? A UK prospective cohort study (1991 (...) associated symptoms suggesting an underlying cause of fever. Any perinatal complications such as maternal fever and/or premature delivery. Any significant medical conditions, such as known immunosuppression or immunodeficiency. Any recent antipyretic drug and/or antibiotic use. The child's immunization history, and any missed immunizations. Any recent foreign travel. Any recent contact with people with serious infectious diseases. Parental/carer health beliefs about fever and previous family experience

2018 NICE Clinical Knowledge Summaries

1638. Angio-oedema and anaphylaxis

Angio-oedema and anaphylaxis Angio-oedema and anaphylaxis - NICE CKS Share Angio-oedema and anaphylaxis: Summary Angio-oedema is swelling of deep dermis, subcutaneous, or submucosal tissue, often affecting the face (lips, tongue, and eyelids), genitalia, hands, or feet. Less commonly, submucosal swelling affects the bowel and airway. The main types are allergic angio-oedema, non-allergic drug reaction (usually caused by angiotensin-converting enzyme [ACE] inhibitor treatment), hereditary angio (...) to assess whether venom immunotherapy would be suitable. Statement 4. Ongoing training in adrenaline auto-injector use. [ ] Background information Background information Definition What is it? Angio-oedema is swelling of deep dermis, subcutaneous, or submucosal tissue, often affecting the face (lips, tongue, and eyelids), genitalia, hands, or feet. Less commonly, submucosal swelling affects the bowel and airway. Angio-oedema most commonly occurs with urticaria (a superficial swelling of the epidermis

2018 NICE Clinical Knowledge Summaries

1639. Gingivitis and periodontitis

clinical judgement and consider referring urgently using a local suspected cancer referral pathway (to be seen within 2 weeks) or seek immediate advice from an oral medicine or oral and maxillofacial specialist. Advise routine regular review by a dentist or hygienist. Review interval will depend on the advice of the dentist. People with predisposing risk factors may require frequent professional cleaning. For people with diabetes, explain that they are at increased risk of periodontal (gum) disease (...) Effectiveness Programme on Prevention and treatment of periodontal diseases in primary care which state that this can be a sign of undiagnosed leukaemia in adults and children and urgent referral to a physician should be considered if the clinical picture is inconsistent with the person's level of oral hygiene [ ]. The recommendation to consider underlying conditions such as aggressive periodontitis, malignancy, and immunosuppression in young people with periodontitis, or people in whom periodontitis

2018 NICE Clinical Knowledge Summaries

1640. Blackouts

beats) or sustained atrial arrhythmia may be seen on ECG. Pulmonary embolism — suggested by dizziness, shortness of breath, pleuritic chest pain, thromboembolic (TE) risk factors, such as previous TE disease, prolonged immobilisation (e.g. flight > 4 hours), smoking, contraceptive pill or HRT use, known malignancy, or family history of thromboembolism. Be aware that syncope is a relatively common finding in older people with a PE (24% of people aged over 65 years). For more information, see the CKS (...) underlying cause being vasovagal syncope. Diagnosing the underlying cause of a blackout will usually include: Assessment of vital signs, measurement of lying and standing blood pressure, and recording an ECG. Documenting details of the event (from a witness if possible). Determining whether there have been any previous blackouts, considering the person's medical and family history of cardiac disease/sudden cardiac death, reviewing whether any current medication may have contributed to the blackout

2018 NICE Clinical Knowledge Summaries

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