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Uterine Inversion

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141. Developmental rheumatology in children. Scenario: Out-toeing

pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying foot (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

142. Developmental rheumatology in children. Scenario: Clumsy child

pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying foot (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

143. Developmental rheumatology in children. Scenario: Tip-toe walking

pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying foot (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

144. Developmental rheumatology in children. Scenario: Bow legs in children

pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying foot (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

145. Developmental rheumatology in children. Scenario: Flat feet in children

pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying foot (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

146. Developmental rheumatology in children. Scenario: Curly toes in children

, if there is persistent pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

147. Developmental rheumatology in children. Scenario: Growing pains

pain and problems with footwear, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying foot (...) fragility and complications such as stroke, aortic dissection, and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community

2019 NICE Clinical Knowledge Summaries

148. Contraception - progestogen-only methods

guidance from the FSRH (FSRH, 2009) on Progestogen-only pills and Progestogen-only injectable contraception; advice on when to suspect uterine perforation following insertion of an intrauterine device or system has been updated; and the upper age limits on the prescriptions for combined oral contraceptive pills have been changed to 50 years. May 2008 — update to text to reflect new guidance from the FSRH (FSRH, 2008), on progestogen-only implants. April to September 2007 — converted from CKS guidance (...) -operative treatment of moderate to severe symptoms of uterine fibroids. The dose (5 mg daily) is lower than that used for emergency contraception (30 mg as a one-off dose). The manufacturers of Esmya® advise avoiding concomitant use of POPs as they may reduce the efficacy of ulipristal. Basis for recommendation Basis for recommendation These recommendations are based on the Faculty of Sexual and Reproductive Healthcare (FSRH) clinical guidelines, Progestogen-only pills [ ], Drug interactions

2019 NICE Clinical Knowledge Summaries

149. Developmental rheumatology in children

, although there is no gold standard approach to treatment. [ ] Flat feet Flat feet The prevalence of flat feet is inversely related to age [ ] — flat foot (pes planus) is common in infants and children (97% prevalence in children younger than 2 years of age) and has often resolved by adolescence. It is usually physiologic, that is flexible, painless, and of no functional consequence, but rarely it can become stiff, painful, or rigid. This may indicate underlying foot pathology (for example arthritis (...) , and bowel rupture). Family history of sudden early death from aortic aneurysmal dissection/rupture (suggestive of Marfan's syndrome), or spontaneous arterial rupture or uterine rupture in childbirth (suggestive of vascular type Ehlers-Danlos syndrome). Symptoms that do not improve with rest, and resting leads to 'gelling' or stiffness (indicative of an inflammatory condition). Basis for recommendation Basis for recommendation Community management The recommendation on when community management

2019 NICE Clinical Knowledge Summaries

150. Propofol-induced death in children: at a Univ. Hospital

events was inversely related to trough dabigatran concentrations (p=0.045), with age and previous stroke (both p < 0.0001) as significant covariates. Multiple logistic regression showed major bleeding risk increased with dabigatran exposure (p < 0.0001), age (p < 0.0001), ASA use (p < 0.0003), and diabetes (p = 0.018) as significant covariates. The authors concluded that ischemic stroke and bleeding outcomes were correlated with dabigatran plasma concentrations and individual benefit–risk might (...) increased spontaneous abortion (resorption) at doses as low as one fifth the clinical dose. The mechanism by which the drug induces abortion/resorption can be explained by its effect as a prostaglandin and ClC-2 agonist on the uterine muscle. In addition, dyspnea occurred in 2% to 3% of patients treated with lubiprostone; this is unacceptable for the treatment of constipation. Finally, the drug is very expensive. We conclude that lubiprostone is not appropriate for use as a laxative. Too harmful

2015 Med Check - The Informed Prescriber

151. The Acute Management of Thrombosis and Embolism during Pregnancy and the Puerperium

CTPA or V/Q scanning. Ideally, informed consent should be obtained before these tests are undertaken. In the diagnosis of PE in the nonpregnant individual, both the electrocardiogram (ECG) and arterial blood gas (ABG) measurement are of limited diagnostic value. 19,20 However, in pregnancy and the puerperium, one study found that the ECG was abnormal in 41% of women with acute PE; the most common abnormalities were T wave inversion (21%), S 1 Q 3 T 3 pattern (15%) and right bundle branch block (18

2015 Royal College of Obstetricians and Gynaecologists

153. Renal injury after uninephrectomy in male and female intrauterine growth-restricted aged rats. (Full text)

Renal injury after uninephrectomy in male and female intrauterine growth-restricted aged rats. Epidemiological studies report an inverse association between birth weight and risk for kidney disease that may differ between males and females, but studies investigating this association are limited. This study tested the hypothesis that male intrauterine growth-restricted offspring in a model of low birth weight induced by placental insufficiency in the rat exhibit enhanced renal injury in response (...) to a persistent secondary renal insult while female growth-restricted offspring are protected. For this study, control offspring from sham-operated dams and growth-restricted offspring from reduced uterine perfusion dams underwent uninephrectomy or a sham procedure at 18 months of age. One month later, urinary markers of renal injury, renal function, and histological damage were measured. Results were analyzed using 2-way ANOVA. Male and female offspring were assessed separately. Proteinuria and urinary

2019 PLoS ONE PubMed abstract

154. Use and outcomes of minimally invasive hysterectomy for women with nonendometrioid endometrial cancers (Full text)

hysterectomy for women with uterine cancer and high-risk histologic subtypes.We used the National Cancer Database to identify women with stages I-III uterine cancer who underwent hysterectomy from 2010-2014. Women with serous carcinomas, clear cell carcinomas, and sarcomas were examined. Women who had laparoscopic or robotic-assisted hysterectomy were compared with those who underwent open abdominal hysterectomy. After a propensity score inverse probability of treatment weighted analysis, the effect (...) Use and outcomes of minimally invasive hysterectomy for women with nonendometrioid endometrial cancers Minimally invasive hysterectomy is now used routinely for women with uterine cancer. Most studies of minimally invasive surgery for endometrial cancer have focused on low-risk endometrioid tumors, with few reports of the safety of the procedure for women with higher risk histologic subtypes.The purpose of this study was to examine the use of and survival associated with minimally invasive

2018 EvidenceUpdates PubMed abstract

155. Genetics of Skin Cancer (PDQ®): Health Professional Version

invade tissue locally or regionally, sometimes following along nerves. A tendency for superficial necrosis has resulted in the name rodent ulcer .[ ] Some debate remains about the origin of SCC; however, these cancers are likely derived from epidermal stem cells associated with the hair follicle.[ ] A variety of tissues, such as lung and uterine cervix, can give rise to SCC, and this cancer has somewhat differing behavior depending on its source. Even in cancer derived from the skin, SCC from

2018 PDQ - NCI's Comprehensive Cancer Database

157. Breast Cancer Prevention (PDQ®): Health Professional Version

in young parous women.[ ] Numerous observational studies on the relationship between the level of physical activity and breast cancer risk have shown an inverse relationship.[ ] The average RR reduction is 30% to 40%, but confounding variables—such as diet or a genetic predisposition to breast cancer—have not been addressed. A prospective study of more than 25,000 Norwegian women found that heavy manual labor or at least 4 hours of exercise per week is associated with decreased breast cancer risk (...) who were monitored for a mean of 3.9 years. Invasive breast cancer incidence was approximately the same for both drugs, but there were fewer noninvasive cancers in the tamoxifen group. Adverse events of uterine cancer, venous thrombolic events, and cataracts were more common in tamoxifen-treated women, and there was no difference in ischemic heart disease events, strokes, or fractures.[ ] Treatment-associated symptoms of dyspareunia, musculoskeletal problems, and weight gain occurred less

2018 PDQ - NCI's Comprehensive Cancer Database

158. Genetics of Breast and Gynecologic Cancers (PDQ®): Health Professional Version

a significant role in a woman’s risk for disease. Approximately 3% to 5% of uterine cancer cases are attributable to a hereditary cause,[ ] with the main hereditary endometrial cancer syndrome being Lynch syndrome, an autosomal dominant genetic condition with a population prevalence of 1 in 300 to 1 in 1,000 individuals.[ , ] (Refer to the section in the PDQ summary on for more information.) Non-Lynch syndrome genes may also contribute to endometrial cancer risk. In an unselected endometrial cancer cohort (...) is mismatch repair (MMR) deficiencies, including the presence of (MSI), and the absence of specific MMR proteins. In addition to these molecular changes, there are also histologic changes including tumor-infiltrating lymphocytes, peritumoral lymphocytes, undifferentiated tumor histology, lower uterine segment origin, and synchronous tumors. Considerations in Risk Assessment and in Identifying a Family History of Breast and Ovarian Cancer Risk The accuracy and completeness of family histories must be taken

2018 PDQ - NCI's Comprehensive Cancer Database

159. Breast Cancer Prevention (PDQ®): Health Professional Version

in young parous women.[ ] Numerous observational studies on the relationship between the level of physical activity and breast cancer risk have shown an inverse relationship.[ ] The average RR reduction is 30% to 40%, but confounding variables—such as diet or a genetic predisposition to breast cancer—have not been addressed. A prospective study of more than 25,000 Norwegian women found that heavy manual labor or at least 4 hours of exercise per week is associated with decreased breast cancer risk (...) who were monitored for a mean of 3.9 years. Invasive breast cancer incidence was approximately the same for both drugs, but there were fewer noninvasive cancers in the tamoxifen group. Adverse events of uterine cancer, venous thrombolic events, and cataracts were more common in tamoxifen-treated women, and there was no difference in ischemic heart disease events, strokes, or fractures.[ ] Treatment-associated symptoms of dyspareunia, musculoskeletal problems, and weight gain occurred less

2018 PDQ - NCI's Comprehensive Cancer Database

160. Ewing Sarcoma Treatment (PDQ®): Health Professional Version

are characterized by paracentric inversion of chromosome X and a BCOR-CCNB3 rearrangement; alternative BCOR partners, including MAML3 and ZC3H7B , have also been reported.[ ] Despite clinical pathologic similarities to Ewing sarcoma, these tumors are biologically different by expression profiling and single-nucleotide polymorphism array analysis. (Refer to the section of this summary for more information about the treatment of this disease.) Other undifferentiated round cell sarcomas are characterized by a CIC

2018 PDQ - NCI's Comprehensive Cancer Database

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