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61. Assessment of Neuromuscular Transmission (Follow-up)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE0MDg3MC1vdmVydmlldw== processing > Assessment of Neuromuscular Transmission Updated: Jul 06, 2017 Author: Joseph Rios, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE Share Email Print Feedback Close Sections Sections Assessment of Neuromuscular Transmission Overview Overview Due to the efforts of numerous clinicians and basic scientists over many years, we now have a firm understanding of how the motor signal generated in the brain travels down the spinal cord, into a peripheral nerve, and interfaces (...) pathologist Karl Weigert noted that lymphoid cells were present in the muscle and other tissues of persons with this affliction. He also made the connection between MG and thymic hypertrophy and/or neoplasia. Four years later, neurologist E. Farquhar Buzzard noted collections of lymphocytes (lymphorrhages) in the tissues of patients with MG. Shortly after the observations of Weigert and Buzzard became known, clinicians began to use thymectomy as a treatment for MG. [ ] Initially, only actual thymomas were

2014 eMedicine.com

62. Urologic Imaging Without X-rays: Ultrasound, MRI, and Nuclear Medicine (Diagnosis)

observe ultrasound studies during the examination. For patient education information, see the , as well as and . Ultrasound Equipment and Physics An ultrasound probe is a housing structure for an ultrasound transducer and the associated wiring for connection to a console with a computer. The probe is shaped for the desired application, eg, cylindrical for endorectal use. The transducer generates high-frequency sound waves (typically 5-10 MHz) and directs them through body tissues via a probe held (...) ). It is rather homogeneous (with a fairly regular gray pattern). The kidney is not as homogeneous. These 2 organs can be compared to determine if renal medical disease is present. The center, or hilum, of the kidney contains multiple structures, such as the renal pelvis, blood vessels, nerves, fat, and lymphatics. The fat of the renal sinus is particularly echogenic (bright white). These structures transmit sound differently, and, as the sound waves hit these interfaces between 2 such structures, an echo

2014 eMedicine.com

63. Skin, Benign Skin Lesions

is associated with other skin and internal malignancies. Bowen disease (SCC in situ) on the penis is referred to as . The hallmarks of Bowen disease are atypical epithelial changes. These include cytoplasmic vacuolization, nuclear hyperchromasia, multinucleated keratinocytes, cell dyskeratosis, increased mitoses, and acanthosis. In addition, the pattern and strata of maturation are altered. The most significant finding is that despite the obvious atypia, the dermal-epidermal interface is preserved (...) . The etiology of sebaceous adenomas is unclear, but Muir-Torre syndrome is related to a genetic truncating germline mutation. An autosomal dominant inherited germline mutation in one of the DNA mismatch repair genes, most commonly hMSH2 , is associated with the syndrome. It is inherited, with a high degree of penetrance and variable expression, with a male-to-female ratio of 3:2. Sebaceous adenoma is multilobulated with frequent connection to the surface epidermis. At low-power view, it is sharply

2014 eMedicine Surgery

64. Urologic Imaging Without X-rays: Ultrasound, MRI, and Nuclear Medicine (Overview)

ultrasound studies during the examination. For patient education information, see the , as well as and . Ultrasound Equipment and Physics An ultrasound probe is a housing structure for an ultrasound transducer and the associated wiring for connection to a console with a computer. The probe is shaped for the desired application, eg, cylindrical for endorectal use. The transducer generates high-frequency sound waves (typically 5-10 MHz) and directs them through body tissues via a probe held against (...) (with a fairly regular gray pattern). The kidney is not as homogeneous. These 2 organs can be compared to determine if renal medical disease is present. The center, or hilum, of the kidney contains multiple structures, such as the renal pelvis, blood vessels, nerves, fat, and lymphatics. The fat of the renal sinus is particularly echogenic (bright white). These structures transmit sound differently, and, as the sound waves hit these interfaces between 2 such structures, an echo is generated. Because

2014 eMedicine.com

65. Assessment of Neuromuscular Transmission (Overview)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE0MDg3MC1vdmVydmlldw== processing > Assessment of Neuromuscular Transmission Updated: Jul 06, 2017 Author: Joseph Rios, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE Share Email Print Feedback Close Sections Sections Assessment of Neuromuscular Transmission Overview Overview Due to the efforts of numerous clinicians and basic scientists over many years, we now have a firm understanding of how the motor signal generated in the brain travels down the spinal cord, into a peripheral nerve, and interfaces (...) pathologist Karl Weigert noted that lymphoid cells were present in the muscle and other tissues of persons with this affliction. He also made the connection between MG and thymic hypertrophy and/or neoplasia. Four years later, neurologist E. Farquhar Buzzard noted collections of lymphocytes (lymphorrhages) in the tissues of patients with MG. Shortly after the observations of Weigert and Buzzard became known, clinicians began to use thymectomy as a treatment for MG. [ ] Initially, only actual thymomas were

2014 eMedicine.com

66. Spinal Instability and Spinal Fusion Surgery (Overview)

: the lateral masses. Juxtaposed between the pedicles and the lamina and delimited by the articular surfaces of the adjacent facet joints, the paired lateral masses are satisfactory targets for screw insertion. Lateral mass screws at adjacent segments are linked by plates or rods to stabilize the cervical spine. Laminae, spinous processes, and transverse processes can be used as anchor points for wires and hooks connected to rods to form three-point-bending instrumentation constructs. Alternatively (...) constructs (eg, universal hook, wire, screw, rod systems used for thoracolumbar posterior instrumentation), where application of compressive and distractive forces can have significant effects on spine contour. Example of application of biomechanical principles to spine surgery. Insertion of special pedicle screws (Schanz screws) pivoting on rod transfers instantaneous axis of rotation (IAR) to screw-rod interface. Compression of proximal end of screws produces distraction-reduction of vertebral burst

2014 eMedicine Surgery

67. General Principles of Internal Fixation (Follow-up)

General Principles of Internal Fixation (Follow-up) General Principles of Internal Fixation: History of Fracture Treatment, Fracture Repair Biology, Pins, Wires, and Screws Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) , screws, and wires was first documented in the 1880s and 1890s. Early surgical fixation initially was complicated by many obstacles, such as infection, poorly conceived implants and techniques, metal allergy, and a limited understanding of the biology and mechanics of fracture healing. During the 1950s, Danis and Muller began to define the principles and techniques of internal fixation. Since then, advances in biologic and mechanical science have led to contemporary fixation theories and techniques

2014 eMedicine Surgery

68. Spinal Instability and Spinal Fusion Surgery (Diagnosis)

: the lateral masses. Juxtaposed between the pedicles and the lamina and delimited by the articular surfaces of the adjacent facet joints, the paired lateral masses are satisfactory targets for screw insertion. Lateral mass screws at adjacent segments are linked by plates or rods to stabilize the cervical spine. Laminae, spinous processes, and transverse processes can be used as anchor points for wires and hooks connected to rods to form three-point-bending instrumentation constructs. Alternatively (...) constructs (eg, universal hook, wire, screw, rod systems used for thoracolumbar posterior instrumentation), where application of compressive and distractive forces can have significant effects on spine contour. Example of application of biomechanical principles to spine surgery. Insertion of special pedicle screws (Schanz screws) pivoting on rod transfers instantaneous axis of rotation (IAR) to screw-rod interface. Compression of proximal end of screws produces distraction-reduction of vertebral burst

2014 eMedicine Surgery

69. General Principles of Internal Fixation (Diagnosis)

General Principles of Internal Fixation (Diagnosis) General Principles of Internal Fixation: History of Fracture Treatment, Fracture Repair Biology, Pins, Wires, and Screws Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache (...) , screws, and wires was first documented in the 1880s and 1890s. Early surgical fixation initially was complicated by many obstacles, such as infection, poorly conceived implants and techniques, metal allergy, and a limited understanding of the biology and mechanics of fracture healing. During the 1950s, Danis and Muller began to define the principles and techniques of internal fixation. Since then, advances in biologic and mechanical science have led to contemporary fixation theories and techniques

2014 eMedicine Surgery

70. Assessment of Neuromuscular Transmission (Diagnosis)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE0MDg3MC1vdmVydmlldw== processing > Assessment of Neuromuscular Transmission Updated: Jul 06, 2017 Author: Joseph Rios, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE Share Email Print Feedback Close Sections Sections Assessment of Neuromuscular Transmission Overview Overview Due to the efforts of numerous clinicians and basic scientists over many years, we now have a firm understanding of how the motor signal generated in the brain travels down the spinal cord, into a peripheral nerve, and interfaces (...) pathologist Karl Weigert noted that lymphoid cells were present in the muscle and other tissues of persons with this affliction. He also made the connection between MG and thymic hypertrophy and/or neoplasia. Four years later, neurologist E. Farquhar Buzzard noted collections of lymphocytes (lymphorrhages) in the tissues of patients with MG. Shortly after the observations of Weigert and Buzzard became known, clinicians began to use thymectomy as a treatment for MG. [ ] Initially, only actual thymomas were

2014 eMedicine.com

71. Therapeutic Injections for Pain Management (Treatment)

inhibition of nociceptive C-fiber transmission, and modulation of nociceptive input within the dorsal horn substantia gelatinosa neurons. Continuous large doses of a corticosteroid adversely affect collagen synthesis, and, therefore, connective tissue strength. [ , ] Frequency of injections and dosages must be monitored by the practitioner to prevent generalized or focal immune suppression such as infection or impaired soft tissue healing. [ ] Therefore, the amount of corticosteroids that can be applied (...) a factor when determining the appropriate injectate. [ ] Highly soluble steroids such as betamethasone sodium phosphate-acetate are rapidly absorbed and pose a lower risk for connective tissue injury, such as tendon rupture, fat atrophy, and muscle wasting. Relatively insoluble steroid esters have a longer duration of action. [ ] Corticosteroids are among the most commonly used active substances for spinal intervention. Particulate steroids should not be placed into the cervical foramina, because

2014 eMedicine.com

72. Assessment of Neuromuscular Transmission (Treatment)

=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTE0MDg3MC1vdmVydmlldw== processing > Assessment of Neuromuscular Transmission Updated: Jul 06, 2017 Author: Joseph Rios, MD; Chief Editor: Nicholas Lorenzo, MD, MHA, CPE Share Email Print Feedback Close Sections Sections Assessment of Neuromuscular Transmission Overview Overview Due to the efforts of numerous clinicians and basic scientists over many years, we now have a firm understanding of how the motor signal generated in the brain travels down the spinal cord, into a peripheral nerve, and interfaces (...) pathologist Karl Weigert noted that lymphoid cells were present in the muscle and other tissues of persons with this affliction. He also made the connection between MG and thymic hypertrophy and/or neoplasia. Four years later, neurologist E. Farquhar Buzzard noted collections of lymphocytes (lymphorrhages) in the tissues of patients with MG. Shortly after the observations of Weigert and Buzzard became known, clinicians began to use thymectomy as a treatment for MG. [ ] Initially, only actual thymomas were

2014 eMedicine.com

73. Rehabilitation Management of Neuromuscular Disease (Treatment)

. An effective rehabilitation program can also minimize secondary medical comorbidity, prevent or limit physical deformity, and allow the patient to integrate into society. Modalities such as range-of-motion and strengthening exercise, along with bracing and appropriate surgical intervention, may prolong ambulation. Today, adaptive devices such as wheelchairs and lifts are now often interfaced with computer technology, providing better strategies for improving the patient’s mobility. Endurance (aerobic (...) (typically, age 5-15 years) and is associated with much less morbidity. [ , ] Kugelberg-Welander disease (type of spinal muscular atrophy). Marked variation in muscle fiber size, along with increased perimysial connective tissue. Mutations in exons 7 and 8 of the telomeric survival motor neuron gene are present in more than 98% of patients with SMA types I-III. Deletions in the neuronal apoptosis inhibitory protein gene are found in about 67% of patients with SMA I, 42% of patients with SMA II or III

2014 eMedicine.com

74. Urologic Imaging Without X-rays: Ultrasound, MRI, and Nuclear Medicine (Treatment)

observe ultrasound studies during the examination. For patient education information, see the , as well as and . Ultrasound Equipment and Physics An ultrasound probe is a housing structure for an ultrasound transducer and the associated wiring for connection to a console with a computer. The probe is shaped for the desired application, eg, cylindrical for endorectal use. The transducer generates high-frequency sound waves (typically 5-10 MHz) and directs them through body tissues via a probe held (...) ). It is rather homogeneous (with a fairly regular gray pattern). The kidney is not as homogeneous. These 2 organs can be compared to determine if renal medical disease is present. The center, or hilum, of the kidney contains multiple structures, such as the renal pelvis, blood vessels, nerves, fat, and lymphatics. The fat of the renal sinus is particularly echogenic (bright white). These structures transmit sound differently, and, as the sound waves hit these interfaces between 2 such structures, an echo

2014 eMedicine.com

75. Therapeutic Injections for Pain Management (Overview)

inhibition of nociceptive C-fiber transmission, and modulation of nociceptive input within the dorsal horn substantia gelatinosa neurons. Continuous large doses of a corticosteroid adversely affect collagen synthesis, and, therefore, connective tissue strength. [ , ] Frequency of injections and dosages must be monitored by the practitioner to prevent generalized or focal immune suppression such as infection or impaired soft tissue healing. [ ] Therefore, the amount of corticosteroids that can be applied (...) a factor when determining the appropriate injectate. [ ] Highly soluble steroids such as betamethasone sodium phosphate-acetate are rapidly absorbed and pose a lower risk for connective tissue injury, such as tendon rupture, fat atrophy, and muscle wasting. Relatively insoluble steroid esters have a longer duration of action. [ ] Corticosteroids are among the most commonly used active substances for spinal intervention. Particulate steroids should not be placed into the cervical foramina, because

2014 eMedicine.com

76. Rehabilitation Management of Neuromuscular Disease (Follow-up)

. An effective rehabilitation program can also minimize secondary medical comorbidity, prevent or limit physical deformity, and allow the patient to integrate into society. Modalities such as range-of-motion and strengthening exercise, along with bracing and appropriate surgical intervention, may prolong ambulation. Today, adaptive devices such as wheelchairs and lifts are now often interfaced with computer technology, providing better strategies for improving the patient’s mobility. Endurance (aerobic (...) (typically, age 5-15 years) and is associated with much less morbidity. [ , ] Kugelberg-Welander disease (type of spinal muscular atrophy). Marked variation in muscle fiber size, along with increased perimysial connective tissue. Mutations in exons 7 and 8 of the telomeric survival motor neuron gene are present in more than 98% of patients with SMA types I-III. Deletions in the neuronal apoptosis inhibitory protein gene are found in about 67% of patients with SMA I, 42% of patients with SMA II or III

2014 eMedicine.com

77. Therapeutic Injections for Pain Management (Follow-up)

inhibition of nociceptive C-fiber transmission, and modulation of nociceptive input within the dorsal horn substantia gelatinosa neurons. Continuous large doses of a corticosteroid adversely affect collagen synthesis, and, therefore, connective tissue strength. [ , ] Frequency of injections and dosages must be monitored by the practitioner to prevent generalized or focal immune suppression such as infection or impaired soft tissue healing. [ ] Therefore, the amount of corticosteroids that can be applied (...) a factor when determining the appropriate injectate. [ ] Highly soluble steroids such as betamethasone sodium phosphate-acetate are rapidly absorbed and pose a lower risk for connective tissue injury, such as tendon rupture, fat atrophy, and muscle wasting. Relatively insoluble steroid esters have a longer duration of action. [ ] Corticosteroids are among the most commonly used active substances for spinal intervention. Particulate steroids should not be placed into the cervical foramina, because

2014 eMedicine.com

78. Urologic Imaging Without X-rays: Ultrasound, MRI, and Nuclear Medicine (Follow-up)

observe ultrasound studies during the examination. For patient education information, see the , as well as and . Ultrasound Equipment and Physics An ultrasound probe is a housing structure for an ultrasound transducer and the associated wiring for connection to a console with a computer. The probe is shaped for the desired application, eg, cylindrical for endorectal use. The transducer generates high-frequency sound waves (typically 5-10 MHz) and directs them through body tissues via a probe held (...) ). It is rather homogeneous (with a fairly regular gray pattern). The kidney is not as homogeneous. These 2 organs can be compared to determine if renal medical disease is present. The center, or hilum, of the kidney contains multiple structures, such as the renal pelvis, blood vessels, nerves, fat, and lymphatics. The fat of the renal sinus is particularly echogenic (bright white). These structures transmit sound differently, and, as the sound waves hit these interfaces between 2 such structures, an echo

2014 eMedicine.com

79. Microdermabrasion

rejuvenation and was modified to its modern form in the 1950s. Dermabrasion involves ablating the skin to the level of the dermis to promote skin regrowth. Based on the power dental equipment design, the dermabrasion machine uses a wire brush with a diamond fraise to mechanically ablate the skin. Local anesthesia is required to perform the dermabrasion procedure. The technique is operator dependent, and, thus, highly skilled surgical technique is required to obtain optimal results. Reported complications (...) is found mainly in the palms of the hands and soles of the feet and contains a dense layer of keratin filaments that provides additional structural support. The stratum granulosum contains granules containing a lipid rich content that creates a waterproof barrier for the skin. The stratum spinosum is the thickest layer of the epidermis and contains multiple polygonal spiny cells rich in cytokeratin and with desmosomal intercellular connections. Langerhans cells, dendritic cells, and other

2014 eMedicine Surgery

80. Therapeutic Injections for Pain Management (Diagnosis)

inhibition of nociceptive C-fiber transmission, and modulation of nociceptive input within the dorsal horn substantia gelatinosa neurons. Continuous large doses of a corticosteroid adversely affect collagen synthesis, and, therefore, connective tissue strength. [ , ] Frequency of injections and dosages must be monitored by the practitioner to prevent generalized or focal immune suppression such as infection or impaired soft tissue healing. [ ] Therefore, the amount of corticosteroids that can be applied (...) a factor when determining the appropriate injectate. [ ] Highly soluble steroids such as betamethasone sodium phosphate-acetate are rapidly absorbed and pose a lower risk for connective tissue injury, such as tendon rupture, fat atrophy, and muscle wasting. Relatively insoluble steroid esters have a longer duration of action. [ ] Corticosteroids are among the most commonly used active substances for spinal intervention. Particulate steroids should not be placed into the cervical foramina, because

2014 eMedicine.com

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