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Deep Learning Technology: Sebastian Arnold, Betty van Aken, Paul Grundmann, Felix A. Gers and Alexander Löser. Learning Contextualized Document Representations for Healthcare Answer Retrieval. The Web Conference 2020 (WWW'20)
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Cerebral vasospasm is the prolonged, intense vasoconstriction of the larger conducting arteries in the subarachnoid space which is initially surrounded by a clot.
Significant narrowing develops gradually over the first few days after the aneurysmal rupture. This spasm usually is maximal in about a week's time following haemorrhage.
Vasospasm is the one of the leading causes of death after the aneurysmal rupture along with the effect of the initial haemorrhage and later bleeding.
Manual carotid self compression is a controversial treatment for DAVF. Patients using this method are told to compress the carotid with the opposite hand for approximately 10 minutes daily, and gradually increasing the frequency and duration of compression. Currently, it is unclear whether this method is an effective therapy.
Small breast hematomas that cause no discomfort often require merely clinical observation, with ultrasound being used to monitor the resolution of the hematoma.
Large breast hematomas, or those that are not becoming smaller or that are causing discomfort, usually require drainage. Also hematomas that occur after surgery for excision of a malignant tumor are drained, because a hematoma to which irradiation is applied is unlikely to ever resolve. A recent hematoma can be drained by means of needle aspiration or (rarely) open surgical drainage.
Vascular occlusion is a blockage of a blood vessel, usually with a clot. It differs from thrombosis in that it can be used to describe any form of blockage, not just one formed by a clot. When it occurs in a major vein, it can, in some cases, cause deep vein thrombosis. The condition is also relatively common in the retina, and can cause partial or total loss of vision. An occlusion can often be diagnosed using Doppler sonography (a form of ultrasound).
Some medical procedures, such as embolisation, involve occluding a blood vessel to treat a particular condition. This can be to reduce pressure on aneurysms (weakened blood vessels) or to restrict a haemorrhage. It can also be used to reduce blood supply to tumours or growths in the body, and therefore restrict their development. Occlusion can be carried out using a ligature; by implanting small coils which stimulate the formation of clots; or, particularly in the case of cerebral aneurysms, by clipping.
Warfarin, heparin and LMWH do not seem to pass into breast milk, so these are not contraindicated in breastfeeding.
Unfractionated heparin, low molecular weight heparin, warfarin (not to be used during pregnancy) and aspirin remain the basis of antithrombotic treatment and prophylaxis both before and during pregnancy.
While the consensus among physicians is the safety of the mother supersedes the safety of the developing fetus, changes in the anticoagulation regimen during pregnancy can be performed to minimize the risks to the developing fetus while maintaining therapeutic levels of anticoagulants in the mother.
The main issue with anticoagulation in pregnancy is that warfarin, the most commonly used anticoagulant in chronic administration, is known to have teratogenic effects on the fetus if administered in early pregnancy. Still, there seems to be no teratogenic effect of warfarin before six weeks of gestation. However, unfractionated heparin and low molecular weight heparin do not cross the placenta.
One approach used for treatment is embolization. A six-vessel angiogram is employed to determine the vascular supply to the fistula. Detachable coils, liquid embolic agents like NBCA, and onyx, or combinations of both are injected into the blood vessel to occlude the DAVF. Preoperative embolization can also be used to supplement surgery.
Rasmussen's aneurysm is a pulmonary artery aneurysm adjacent or within a tuberculous cavity. It occurs in up to 5% of patients with such lesions. It may lead to rupture and haemorrhage. It is named after Fritz Valdemar Rasmussen. It is quoted as the cause of hemoptysis in tuberculosis patients.
While the "classic" terminology relates the lesion to cavitary tuberculosis, the term is now used for the anatomic aneurysm associated with other destructive lung lesions. Even when the pulmonary aneurysm is present, the actual bronchial bleeding may be from the bronchial artery, rather than from the pulmonary artery.
Breast hematoma is a collection of blood within the breast. It arises from internal bleeding (hemorrhage) and may arise due to trauma (breast injury or surgery) or due to a non-traumatic cause.
Emergency exploratory laparotomy with cesarean delivery accompanied by fluid and blood transfusion are indicated for the management of uterine rupture. Depending on the nature of the rupture and the condition of the patient, the uterus may be either repaired or removed (cesarean hysterectomy). Delay in management places both mother and child at significant risk.
Both sex are equally affected
Any age group can develop a parapheryngeal abscess but it is most commonly seen in children and adolescents. Adults who are immunocompromised are also at high risk.
The main goal of treatment is to remove the cause of the phlegmonous process in order to achieve effective treatment and prevention of recidives.
If the patient's condition is mild and signs of inflammatory process are present without signs of infiltrates, then conservative treatment with antibiotics is sufficient.
If the patient's condition is severe, however, immediate operation is usually necessary with application of drainage system. All of these are done under general anaesthesia. During operation, the cavity or place of phlegmonous process are washed with antiseptic, antibiotic solutions and proteolyic ferments.
In post-operative period, patients are treated with intravenous antibiotics, haemosorbtion, vitaminotherapy. Additionally, the use of i/v or i/m antistaphylococci γ-globulin or anatoxin can be taken as immunotherapy.
During operation of phlegmon dissection at any location, it is important:
1. to avoid spreading of pus during operation;
2. to take into account the cosmetic value of the operating site, especially when treating phlegmmonous process of the face; and
3. to avoid damaging nerves.
Treatment usually includes antibiotics, and reducing the mobility of the affected region, either with a back brace or a plaster cast. Without treatment, the patient may form an abscess which may need to be surgically corrected. Due to the poor vascularity of the disc, drugs required for treatment often include potent agents such as Ciprofloxacin along with Vancomycin. Occasionally, oral drugs can be used to treat the infection but it may fail and IV drugs may be required.
If the patient is an adult many surgeons and doctors now recommend moving little and often and within the pain limits of the medication. Discs respond to osmotic pressure therefore movement is beneficial to increase their blood flow and fluid dynamics. This is why disc patients are no longer told to bed rest. In children whether to bed rest or move a little is decided on an individual basis, depending on the site and severity of the discitis.
Treatment can be either conservative or active. Active treatments can be divided into surgical and non-surgical treatments. Newer methods including endovenous laser treatment, radiofrequency ablation and foam sclerotherapy appear to work as well as surgery for varices of the greater saphenous vein.
Parapharyngeal abscess is a deep neck abscess. It is also known as abscess of pharyngomaxillary or lateral pharyngeal space. Parapharyngeal abscess involve the parapharyngeal space.
Parapharyngeal space is lateral to the superior pharyngeal constrictor and medial to the masseter muscle, this space is divided by styloid process into anterior and posterior compartment. This space contains the carotid artery, internal jugular vein, numerous nerves.
The National Institute for Health and Clinical Excellence (NICE) produced clinical guidelines in July 2013 recommending that all people with symptomatic varicose veins (C2S) and worse should be referred to a vascular service for treatment. Conservative treatments such as support stockings should not be used unless treatment was not possible.
The symptoms of varicose veins can be controlled to an extent with the following:
- Elevating the legs often provides temporary symptomatic relief.
- Advice about regular exercise sounds sensible but is not supported by any evidence.
- The wearing of graduated compression stockings with variable pressure gradients (Class II or III) has been shown to correct the swelling, nutritional exchange, and improve the microcirculation in legs affected by varicose veins. They also often provide relief from the discomfort associated with this disease. Caution should be exercised in their use in patients with concurrent peripheral arterial disease.
- The wearing of intermittent pneumatic compression devices have been shown to reduce swelling and increase circulation
- Diosmin/hesperidin and other flavonoids.
- Anti-inflammatory medication such as ibuprofen or aspirin can be used as part of treatment for superficial thrombophlebitis along with graduated compression hosiery – but there is a risk of intestinal bleeding. In extensive superficial thrombophlebitis, consideration should be given to anti-coagulation, thrombectomy, or sclerotherapy of the involved vein.
- Topical gel application helps in managing symptoms related to varicose veins such as inflammation, pain, swelling, itching, and dryness.
Penile Revascularization is a specialized vascular-surgical treatment option for Erectile Dysfunction. The 2009 International Consultation on Sexual Dysfunctions recommended that revascularization be limited to nonsmoker, nondiabetic men younger than 55 years of age with isolated stenosis of the internal pudendal artery with absence of venous leak.
Patients with persistent erectile dysfunction after revascularization may benefit from repeat penile duplex ultrasound and pelvic angiography to evalauate the status of the bypass graft and to exclude the presence of a PASS as the cause. The prevalence of an aberrant obturator artery arising from the inferior epigastric artery is approximately 10.5%. If an aberrant obturator artery is visualized arising from the inferior epigastric artery prior to surgical penile revascularization, consideration should be given toward using an alternative source artery or to embolization to avoid the creation of a Penile Artery Shunt Syndrome encountered in this described case.
Fasting guidelines often restrict the intake of any oral fluid after two to six hours preoperatively. However, it has been demonstrated in a large retrospective analysis in Torbay Hospital that unrestricted clear oral fluids right up until transfer to theatre could significantly reduce the incidence of postoperative nausea and vomiting without an increased risk in the adverse outcomes for which such conservative guidance exists.
If ongoing and rapid haemorrhage is occurring then immediate delivery of the foetus may be indicated if the fetus is sufficiently developed. If the haemorrhage has already occurred and now stopped, an inutero transfusion of red cells to the foetus may be recommended.
A Cochrane review found droperidol, metoclopramide, ondansetron, tropisetron, dolasetron, dexamethasone, cyclizine, and granisetron effective for preventing PONV.
Granisetron and dexamethasone is not recommended due to the higher rate of side effects.
Percutaneous Coil Embolization of the aberrant obturator artery was performed. Arterial flow rapidly improved through the left dorsal penile artery, and brisk opacification was seen through to the glans penis. Post-procedure, the patient experienced an immediate improvement in erectile function.
A uterine scar from a previous cesarean section is the most common risk factor. (In one review, 52% had previous cesarean scars.) Other forms of uterine surgery that result in full-thickness incisions (such as a myomectomy), dysfunctional labor, labor augmentation by oxytocin or prostaglandins, and high parity may also set the stage for uterine rupture. In 2006, an extremely rare case of uterine rupture in a first pregnancy with no risk factors was reported.
Treatment is directed at the prevention of haemorrhagic shock. Standard dose prednisolone does not increase the platelet count. High-dose methylprednisolone therapy in children with Onyalai has been shown to improve platelet count and reduce the requirement for transfusions. Vincristine sulphate may be of benefit to some patients. Splenectomy is indicated in patients with severe uncontrollable haemorrhage. High-dose intravenous gammaglobulin may help in increasing the platelet count and cessation of haemorrhage.
Commonly by bacteria – streptococci, spore and non-spore forming anaerobes, etc.
Factors affecting the development of phlegmons are virulence of bacteria and immunity strength.
There is debate as to the cause, although hematogenous seeding of the offending organism is favored as well as direct spread. It is important to differentiate between spontaneous discitis which is usually from hematologic spread from a urinary or respiratory infection versus that from a post-operative complication which usually involves skin flora such as staph aureus.
It can be caused due to spinal tuberculosis and spread along spinal ligament to involve the adjacent anterior vertebral bodies, causing angulation of the vertebrae with subsequent kyphosis.
The cause may be aseptic.