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Umbilical Cord Prolapse

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141. Down Syndrome (Treatment)

is needed because of the associated risk of cervical spine instability. Preoperative evaluation for anesthesia must include adequate evaluation of the airway and the patient’s neurologic status. Cervical radiography (with flexion and extension views) should be performed when any neurologic deficit suggests spinal-cord compression. During laryngoscopy and intubation, the patient’s head should be maintained in a neutral position, and hyperextension should be avoided. Anticholinergics can be prescribed (...) difficulties that persist through the adolescent years Provide antibiotic prophylaxis during dental and surgical procedures in the presence of mitral valve prolapse Consider bone marrow transplantation if leukemia occurs Discuss sleep apnea, treat airway obstruction medically and surgically. Pay special attention to perioperative modalities because of atlantoaxial instability and problems with the respiratory system Screen for hypothyroidism and diabetes mellitus Manage neurologic problems, including

2014 eMedicine Pediatrics

142. Disorders of the Umbilicus (Treatment)

. (F) Umbilical sinus ending in a fibrous cord attaching to the ileum. (G, H) Omphalomesenteric cyst and sinus without intestinal attachments. Photograph of newborn with intestinal prolapse through a patent omphalomesenteric duct. Both the proximal and distal limbs of the intestine have prolapsed. The umbilicus was explored, the bowel was easily reduced, and the patent duct was excised. The child was discharged from the hospital 2 days later. Anatomic relationship between the umbilicus and its (...) for a small port to perform laparoscopy. The umbilical vein (round ligament), the umbilical arteries (medial umbilical ligaments), and the urachus (median umbilical ligament) can often be identified. Umbilical region viewed from the posterior surface of the abdominal wall of an infant with the umbilical cord attached. UA: Umbilical artery; UV: Umbilical vein; RL: Round ligament (obliterated umbilical vein); UR: Umbilical ring; UL: Umbilical ligament; medial (obliterated umbilical arteries); median

2014 eMedicine Pediatrics

143. Pediatric Urologic Gynecology (Overview)

bladder with a nonocclusive dressing (eg, plastic food wrap) to protect the bladder plate. To prevent unnecessary trauma, ligating the umbilical cord with silk ties rather than a plastic or metal clamp is best. Some children with bladder exstrophy develop functional bladder capacities, whereas others go on to develop small and poorly compliant bladders. The reason for this is not completely understood. The surgical management of bladder exstrophy involves bladder closure within the first days of life (...) . Skene glands (paraurethral glands) These tubular glands arise from the urethral epithelium and are the counterparts to the male prostatic glands. In females, Skene glands may end up in the urethral meatus and hymen. Cysts (tense, yellow, thin-walled) arising partially within the urethral meatus but mostly external to it may resemble a bulging hymen associated with hydrometrocolpos or a prolapsing ureterocele but are usually separate from the urethral opening. [ , ] Bartholin glands The major

2014 eMedicine Pediatrics

144. Rheumatic Heart Disease (Overview)

is consistently low. Decreased levels of regulatory T cells have also been associated with rheumatic heart disease and with increased severity. In utero precursors predisposing to rheumatic heart disease have also been proposed [ , ] ; Eriksson et al suggest increased spiraling of the umbilical cord may increase risk of developing rheumatic heart disease secondary to presumed change in hemodynamic conditions during formation of the mitral valve. [ ] The proposed pathophysiology for development of rheumatic (...) . . Robertson KA, Volmink JA, Mayosi BM. Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovasc Disord . 2005 May 31. 5(1):11. . Sampaio RO, Grinberg M, Leite JJ, et al. Effect of enalapril on left ventricular diameters and exercise capacity in asymptomatic or mildly symptomatic patients with regurgitation secondary to mitral valve prolapse or rheumatic heart disease. Am J Cardiol . 2005 Jul 1. 96(1):117-21. . Swedo SE, Leonard HL, Garvey M, et al. Pediatric

2014 eMedicine Pediatrics

145. Rheumatic Heart Disease (Diagnosis)

is consistently low. Decreased levels of regulatory T cells have also been associated with rheumatic heart disease and with increased severity. In utero precursors predisposing to rheumatic heart disease have also been proposed [ , ] ; Eriksson et al suggest increased spiraling of the umbilical cord may increase risk of developing rheumatic heart disease secondary to presumed change in hemodynamic conditions during formation of the mitral valve. [ ] The proposed pathophysiology for development of rheumatic (...) . . Robertson KA, Volmink JA, Mayosi BM. Antibiotics for the primary prevention of acute rheumatic fever: a meta-analysis. BMC Cardiovasc Disord . 2005 May 31. 5(1):11. . Sampaio RO, Grinberg M, Leite JJ, et al. Effect of enalapril on left ventricular diameters and exercise capacity in asymptomatic or mildly symptomatic patients with regurgitation secondary to mitral valve prolapse or rheumatic heart disease. Am J Cardiol . 2005 Jul 1. 96(1):117-21. . Swedo SE, Leonard HL, Garvey M, et al. Pediatric

2014 eMedicine Pediatrics

146. Pediatric Urologic Gynecology (Diagnosis)

bladder with a nonocclusive dressing (eg, plastic food wrap) to protect the bladder plate. To prevent unnecessary trauma, ligating the umbilical cord with silk ties rather than a plastic or metal clamp is best. Some children with bladder exstrophy develop functional bladder capacities, whereas others go on to develop small and poorly compliant bladders. The reason for this is not completely understood. The surgical management of bladder exstrophy involves bladder closure within the first days of life (...) . Skene glands (paraurethral glands) These tubular glands arise from the urethral epithelium and are the counterparts to the male prostatic glands. In females, Skene glands may end up in the urethral meatus and hymen. Cysts (tense, yellow, thin-walled) arising partially within the urethral meatus but mostly external to it may resemble a bulging hymen associated with hydrometrocolpos or a prolapsing ureterocele but are usually separate from the urethral opening. [ , ] Bartholin glands The major

2014 eMedicine Pediatrics

147. Mucopolysaccharidosis Type II (Diagnosis)

distribution of the affected substrate and the degree of enzyme deficiency. Dermatan sulfate is found mostly in skin but is also found in blood vessels, heart valves, lungs, and tendons; thus, accumulation of this GAG results in a characteristic skin deposition, myxomatous valvular changes (mitral valve prolapse), and progressive restrictive lung disease. Heparan sulfate is an essential component of nerve cell membranes; therefore, accumulation causes progressive neurological deterioration. Keratan sulfate (...) . Mucopolysaccharidosis type II in females and response to enzyme replacement therapy. Am J Med Genet A . 2012 Feb. 158A(2):450-4. . Meikle PJ, Grasby DJ, Dean CJ, et al. Newborn screening for lysosomal storage disorders. Mol Genet Metab . 2006 Aug. 88(4):307-14. . Vellodi A, Young E, Cooper A, Lidchi V, Winchester B, Wraith JE. Long-term follow-up following bone marrow transplantation for Hunter disease. J Inherit Metab Dis . 1999 Jun. 22(5):638-48. . Mullen CA, Thompson JN, Richard LA, Chan KW. Unrelated umbilical

2014 eMedicine Pediatrics

148. Minimal Access Surgery (Diagnosis)

; this is minimized by using carbon dioxide instead of other gases. This complication has also been reported during insufflation in infants when using an umbiical incision for entry. Inadvertent preperitoneal insufflation in a patient with a patent umbilical vein can lead to devastating consequences [ ] and should be considered when choosing access techniques in patients younger than 1 month. These complications can be minimized with the use of low pressure and warm humidified gas insufflation, slight (...) is typically performed with three stab wounds without trocars. [ ] The average operating time is approximately 15 minutes. Most patients (>90%) are discharged home within 24 hours. The laparoscopic approach is not universally accepted, because similar results can be achieved by means of Ramstedt pyloromyotomy via an umbilical incision. There is some evidence to suggest that the complication rate is lower with the laparoscopic approach. The cosmetic results of laparoscopic pyloromyotomy are superior

2014 eMedicine Pediatrics

149. Mucopolysaccharidosis Type II (Overview)

distribution of the affected substrate and the degree of enzyme deficiency. Dermatan sulfate is found mostly in skin but is also found in blood vessels, heart valves, lungs, and tendons; thus, accumulation of this GAG results in a characteristic skin deposition, myxomatous valvular changes (mitral valve prolapse), and progressive restrictive lung disease. Heparan sulfate is an essential component of nerve cell membranes; therefore, accumulation causes progressive neurological deterioration. Keratan sulfate (...) . Mucopolysaccharidosis type II in females and response to enzyme replacement therapy. Am J Med Genet A . 2012 Feb. 158A(2):450-4. . Meikle PJ, Grasby DJ, Dean CJ, et al. Newborn screening for lysosomal storage disorders. Mol Genet Metab . 2006 Aug. 88(4):307-14. . Vellodi A, Young E, Cooper A, Lidchi V, Winchester B, Wraith JE. Long-term follow-up following bone marrow transplantation for Hunter disease. J Inherit Metab Dis . 1999 Jun. 22(5):638-48. . Mullen CA, Thompson JN, Richard LA, Chan KW. Unrelated umbilical

2014 eMedicine Pediatrics

150. Minimal Access Surgery (Overview)

; this is minimized by using carbon dioxide instead of other gases. This complication has also been reported during insufflation in infants when using an umbiical incision for entry. Inadvertent preperitoneal insufflation in a patient with a patent umbilical vein can lead to devastating consequences [ ] and should be considered when choosing access techniques in patients younger than 1 month. These complications can be minimized with the use of low pressure and warm humidified gas insufflation, slight (...) is typically performed with three stab wounds without trocars. [ ] The average operating time is approximately 15 minutes. Most patients (>90%) are discharged home within 24 hours. The laparoscopic approach is not universally accepted, because similar results can be achieved by means of Ramstedt pyloromyotomy via an umbilical incision. There is some evidence to suggest that the complication rate is lower with the laparoscopic approach. The cosmetic results of laparoscopic pyloromyotomy are superior

2014 eMedicine Pediatrics

151. Disorders of the Umbilicus (Overview)

. (C) Fibrous cord attaching ileum to abdominal wall. (D) Intestinal-umbilical fistula. Intestinal mucosa extends to skin surface. (E) Omphalomesenteric cyst arising in a fibrous cord. The cyst may contain intestinal or gastric mucosa. (F) Umbilical sinus ending in a fibrous cord attaching to the ileum. (G, H) Omphalomesenteric cyst and sinus without intestinal attachments. Photograph of newborn with intestinal prolapse through a patent omphalomesenteric duct. Both the proximal and distal limbs (...) the physiologic importance of the umbilicus during development and its importance after birth. During development, the umbilicus functions as a channel that allows blood flow between the placenta and fetus. It also serves an important role in the development of the intestine and the urinary system. After birth, once the umbilical cord falls off, no evidence of these connections should be present. Nevertheless, umbilical disorders are frequently encountered in pediatric surgery. [ ] An understanding

2014 eMedicine Pediatrics

152. Omphalocele and Gastroschisis (Follow-up)

defects. Am J Surg . 2017 Jan 6. . Frybova B, Kokesova A, Zemkova D, Mixa V, Vlk R, Rygl M. Quality of life in patients with gastroschisis is comparable with the general population: A questionnaire survey. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub . 2016 Dec 13. . Zajac A, Bogusz B, Soltysiak P, et al. Cosmetic outcomes of sutureless closure in gastroschisis. Eur J Pediatr Surg . 2016 Dec. 26 (6):537-41. . Media Gallery Baby with an intact omphalocele. Baby with an umbilical cord hernia (...) of the urinary collecting system Performance of bilateral orchiopexies Cloacal exstrophy Repair of cloacal exstrophy includes the following: The prolapsed ileum (the "elephant trunk") is reduced. The flayed-open cecum is separated from the central portion of the bifid bladder, and this placode of cecum is tubularized. The bladder halves are approximated and repaired as in bladder exstrophy. Later, the colostomy may be mobilized and anastomosed to the rudimentary hind gut and a stoma created; or an anus

2014 eMedicine Pediatrics

153. Pediatric Urologic Gynecology (Follow-up)

bladder with a nonocclusive dressing (eg, plastic food wrap) to protect the bladder plate. To prevent unnecessary trauma, ligating the umbilical cord with silk ties rather than a plastic or metal clamp is best. Some children with bladder exstrophy develop functional bladder capacities, whereas others go on to develop small and poorly compliant bladders. The reason for this is not completely understood. The surgical management of bladder exstrophy involves bladder closure within the first days of life (...) . Skene glands (paraurethral glands) These tubular glands arise from the urethral epithelium and are the counterparts to the male prostatic glands. In females, Skene glands may end up in the urethral meatus and hymen. Cysts (tense, yellow, thin-walled) arising partially within the urethral meatus but mostly external to it may resemble a bulging hymen associated with hydrometrocolpos or a prolapsing ureterocele but are usually separate from the urethral opening. [ , ] Bartholin glands The major

2014 eMedicine Pediatrics

154. Disorders of the Umbilicus (Diagnosis)

. (C) Fibrous cord attaching ileum to abdominal wall. (D) Intestinal-umbilical fistula. Intestinal mucosa extends to skin surface. (E) Omphalomesenteric cyst arising in a fibrous cord. The cyst may contain intestinal or gastric mucosa. (F) Umbilical sinus ending in a fibrous cord attaching to the ileum. (G, H) Omphalomesenteric cyst and sinus without intestinal attachments. Photograph of newborn with intestinal prolapse through a patent omphalomesenteric duct. Both the proximal and distal limbs (...) the physiologic importance of the umbilicus during development and its importance after birth. During development, the umbilicus functions as a channel that allows blood flow between the placenta and fetus. It also serves an important role in the development of the intestine and the urinary system. After birth, once the umbilical cord falls off, no evidence of these connections should be present. Nevertheless, umbilical disorders are frequently encountered in pediatric surgery. [ ] An understanding

2014 eMedicine Pediatrics

155. Pregnancy, Breech Delivery (Diagnosis)

, 2015 Author: Philippe H Girerd, MD; Chief Editor: Ronald M Ramus, MD Share Email Print Feedback Close Sections Sections Breech Delivery Overview Background occurs when the fetus presents to the birth canal with buttocks or feet first. This presentation creates a mechanical problem in delivery of the fetus. Next: Pathophysiology The buttocks and feet of the fetus do not provide an effective wedge to dilate the cervix. The umbilical cord may prolapse, and/or the aftercoming head may get trapped (...) . In addition, complications can occur as a result of umbilical cord compression due to the unusual presentation to the maternal pelvis. Increased birth trauma: The inexperienced provider is more likely to pull on the fetus prematurely, and to perform the maneuvers to faciliate delivery incorrectly, increasing the risk of traumatic injury. In addition, as the duration of umbilical cord compression increases, the practitioner may try to deliver the infant more rapidly than advisable, thus increasing

2014 eMedicine Emergency Medicine

156. Pregnancy, Breech Delivery (Overview)

, 2015 Author: Philippe H Girerd, MD; Chief Editor: Ronald M Ramus, MD Share Email Print Feedback Close Sections Sections Breech Delivery Overview Background occurs when the fetus presents to the birth canal with buttocks or feet first. This presentation creates a mechanical problem in delivery of the fetus. Next: Pathophysiology The buttocks and feet of the fetus do not provide an effective wedge to dilate the cervix. The umbilical cord may prolapse, and/or the aftercoming head may get trapped (...) . In addition, complications can occur as a result of umbilical cord compression due to the unusual presentation to the maternal pelvis. Increased birth trauma: The inexperienced provider is more likely to pull on the fetus prematurely, and to perform the maneuvers to faciliate delivery incorrectly, increasing the risk of traumatic injury. In addition, as the duration of umbilical cord compression increases, the practitioner may try to deliver the infant more rapidly than advisable, thus increasing

2014 eMedicine Emergency Medicine

157. Making it Stick

this: Like this: Like Loading... AUTHOR Justin Morgenstern Emergency doctor working in the community. FOAM enthusiast. Evidence based medicine junkie. “One special advantage of the skeptical attitude of mind is that a man is never vexed to find that after all he has been in the wrong.” - William Osler You may also like Published A simplified approach to the initial assessment and management of emergency department patients with umbilical cord prolapse Share this: Like this: Like Loading... Published

2016 First10EM

158. Nonreassuring Fetal Status

Studies (from Trip Database) Ontology: Fetal Hypoxia (C0349489) Definition (NCI_FDA) Caused by conditions such as inadequate placental function (often abruptio placentae), preeclamptic toxicity, prolapse of the umbilical cord, or complications from anesthetic administration. Definition (NCI) Hypoxia in utero, caused by conditions such as inadequate placental function (often abruptio placentae), preeclamptic toxicity, prolapse of the umbilical cord, or complications from anesthetic administration

2015 FP Notebook

159. Management of calcium channel blocker overdose in the emergency department

this: Like Loading... Published A simplified approach to the initial assessment and management of emergency department patients with umbilical cord prolapse Share this: Like this: Like Loading... Published A simplified approach to the initial assessment and management of emergency department patients with massive hemoptysis Share this: Like this: Like Loading... Leave a Reply 2 thoughts on “ Management of calcium channel blocker overdose in the emergency department ” Dr. Dani August 4, 2015, Very helpful

2015 First10EM

160. Vasa Previa

previa must be distinguished from funic presentation (prolapse with the umbilical cord between the presenting part and the internal cervical os), in which fetal blood vessels wrapped with Wharton jelly can be seen covering the cervix. In funic presentation, unlike in vasa previa, the umbilical cord moves away from the cervix during ultrasound evaluation; in vasa previa, the cord is fixed in place. Treatment Antenatal monitoring to detect cord compression Cesarean delivery Antenatal management of vasa (...) of Placenta Previa SOCIAL MEDIA Add to Any Platform Loading , MD, Main Line Health System Click here for Patient Education NOTE: This is the Professional Version. CONSUMERS: Topic Resources Vasa previa occurs when membranes that contain fetal blood vessels connecting the umbilical cord and placenta overlie the internal cervical os. Vasa previa can occur on its own (see Figure: ) or with placental abnormalities, such as a velamentous cord insertion. In velamentous cord insertion, vessels from the umbilical

2013 Merck Manual (19th Edition)

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