approach to the pregnant patient with heart disease

... that the erosion is the primary lesion and the redness and scale are secondary, while the correct interpretation would be that the patient has a pruritic eczematous dermatitis with erosions caused ... differential diagnosis (Table 52-4) For instance, the finding of scaling papules (present in patients with psoriasis or atopic dermatitis) places the patient in a different diagnostic category than ... important to differentiate primary from secondary skin lesions If the examiner focuses on linear erosions overlying an area of erythema and scaling, he or she may incorrectly assume that the erosion...

Ngày tải lên: 06/07/2014, 20:20

... elicits the desire to scratch Pruritus is often the predominant symptom of inflammatory skin diseases (e.g., atopic dermatitis, allergic contact dermatitis); it is also commonly associated with ... epidermal atrophy) Scar: A change in the skin secondary to trauma or inflammation Sites may be erythematous, hypopigmented, or hyperpigmented depending on their age or character Sites on hair-bearing ... conditions that can be associated with pruritus include chronic renal disease, cholestasis, pregnancy, malignancy, thyroid disease, polycythemia vera, and delusions of parasitosis Figure 52-3 A schematic...

Ngày tải lên: 06/07/2014, 20:20

... highly with diagnosis (Fig 52-6) For example, a hospitalized patient with a generalized erythematous exanthem is more likely to have a drug eruption than is a patient with a similar rash limited to ... possible to assess the distribution of the eruption accurately The patient should first be viewed from a distance of about 1.5–2 m (4–6 ft) so that the general character of the skin and the distribution ... patient with cutaneous small vessel vasculitis (Courtesy of Robert Swerlick, MD; with permission.)[newpage] APPROACH TO THE PATIENT: SKIN DISORDER In examining the skin it is usually advisable to...

Ngày tải lên: 06/07/2014, 20:20

... The distribution of some common dermatologic diseases and lesions Figure 52-7 Psoriasis This papulosquamous skin disease is characterized by small and large erythematous papules and plaques with...

Ngày tải lên: 06/07/2014, 20:20

... contrast, lesions with a generalized arrangement are common and suggest a systemic etiology Figure 52-9 Erythema multiforme This eruption is characterized by multiple erythematous plaques with a target ... usually represents a hypersensitivity reaction to drugs (e.g., sulfonylamides) or infections (e.g., HSV) (Courtesy of the Yale Resident's Slide Collection; with permission.) Figure 52-10 ...

Ngày tải lên: 06/07/2014, 20:20

... against the surface of the skin and rotated with downward pressure until it penetrates to the subcutaneous tissue The circular biopsy is then lifted with forceps, and the bottom is cut with iris ... area of skin is anesthetized with 1% lidocaine with or without epinephrine The skin lesion in question can be excised or saucerized with a scalpel or removed by punch biopsy In the latter technique, ... History of allergies Presence of photosensitivity Review of systems Family history (particularly relevant for patients with melanoma, atopy, psoriasis, or acne) 10 Social, sexual, or travel history...

Ngày tải lên: 06/07/2014, 20:20

... to document sensitivity to a specific antigen In this procedure, a battery of suspected allergens is applied to the patient' s back under occlusive dressings and allowed to remain in contact with ... best performed by physicians with special expertise in patch testing and is often helpful in the evaluation of patients with chronic dermatitis FURTHER READINGS Dermatology Lexicon Project: www.futurehealth.rochester.edu/dlp2/ ... designed to assess whether a skin lesion will blanch with pressure as, for example, in determining whether a red lesion is hemorrhagic or simply blood-filled Urticaria (Fig 52-11) will blanch with...

Ngày tải lên: 06/07/2014, 20:20

... same as the prognosis of the person with aortic stenosis who develops the first symptoms of congestive heart failure (median survival, ~8 months) However, the patient with heart disease may ... Cancer is the second leading cause of death behind heart disease Deaths from heart disease have declined 45% in the United States since 1950 and continue to decline Cancer has overtaken heart disease ... cancer patient feels that he or she, and not just a body part, is diseased The Magnitude of the Problem No nationwide cancer registry exists; therefore, the incidence of cancer is estimated on the...

Ngày tải lên: 07/07/2014, 01:20

... The past medical history may alert the physician to the presence of underlying diseases that may affect the choice of therapy or the side effects of treatment The social history may reveal occupational ... predisposition and point out the need to begin surveillance or other preventive therapy for unaffected siblings of the patient The review of systems may suggest early symptoms of metastatic disease or a paraneoplastic ... 77-3 Patient Management Important information is obtained from every portion of the routine history and physical examination The duration of symptoms may reveal the chronicity of disease The past...

Ngày tải lên: 07/07/2014, 01:20

... Against Cancer and the American Joint Committee on Cancer (AJCC) The TNM classification is an anatomically based system that categorizes the tumor on the basis of the size of the primary tumor ... other prognostic factors have been identified (Chaps 104, 105, and 106) In addition to tumor burden, a second major determinant of treatment outcome is the physiologic reserve of the patient Patients ... are likely to fare worse, stage for stage, than fully active patients Physiologic reserve is a determinant of how a patient is likely to cope with the physiologic stresses imposed by the cancer...

Ngày tải lên: 07/07/2014, 01:20

... physician also has much to offer the patient for whom curative therapy is no longer an option Often a combination of guilt and frustration over the inability to cure the patient and the pressure of a ... schedule greatly limit the time a physician spends with a patient who is receiving only palliative care Resist these forces In addition to the medicines administered to alleviate symptoms (see below), ... complications of both the disease and its treatment as well as the complex psychosocial problems associated with cancer In the short term during a course of curative therapy, the patient' s functional...

Ngày tải lên: 07/07/2014, 01:20

... trophoblastic Pregnancy disease, gonadal germ cell tumor Calcitonin Medullary cancer of the thyroid Catecholamines Pheochromocytoma Oncofetal Antigens Alphafetoprotein Hepatocellular carcinoma, ... Carcinoembryonic antigen Adenocarcinomas hepatitis Pancreatitis, of the colon, pancreas, hepatitis, lung, breast, ovary inflammatory bowel disease, smoking Enzymes Prostatic acid Prostate cancer phosphatase ... Neuron-specific enolase Lactate dehydrogenase Small cell cancer of the lung,neuroblastoma Lymphoma, Ewing's sarcoma Hepatitis, hemolytic many others Tumor-Associated Proteins anemia, Prostate-specific...

Ngày tải lên: 07/07/2014, 01:20

... most patients who are cured of cancer return to normal lives Supportive Care In many ways, the success of cancer therapy depends on the success of the supportive care Failure to control the symptoms ... nonjudgmental, so that patients are more likely to discuss with the physician what they are actually doing The appearance of unexpected toxicity may be an indication that a supplemental therapy is being ... persists, the multidisciplinary team discusses a new salvage treatment plan If the patient has been rendered disease- free by the original treatment, the patient is followed regularly for disease...

Ngày tải lên: 07/07/2014, 01:20

... on which to indicate the severity of the pain The clinical condition is often dynamic, making it necessary to reassess the patient frequently Pain therapy should not be withheld while the cause ... signals in the chemoreceptor trigger zone in the medulla, the cerebral cortex, and peripherally in the intestinal tract lead to stimulation of the vomiting center in the medulla, the motor center ... caused by chemotherapy (Chap 81) Its severity can be predicted from the drugs used to treat the cancer Three forms of emesis are recognized on the basis of their timing with regard to the noxious...

Ngày tải lên: 07/07/2014, 01:20

... Sexual dysfunction is highly prevalent and needs to be discussed openly with the patient An empathetic health care team is sensitive to the individual patient' s needs and permits negotiation where ... adversely affect the course of treatment Cancer survivors have other sets of difficulties Patients may have fears associated with the termination of a treatment they associate with their continued ... that cancer therapy is substantially more toxic and less effective in the face of malnutrition Nevertheless, it remains unclear whether nutritional intervention can alter the natural history Unless...

Ngày tải lên: 07/07/2014, 01:20

... affected by the diagnosis and is coping with it is an important goal of patient management It is best to speak frankly with the patient and the family regarding the likely course of disease These discussions ... acknowledgment of an incurable disease, and the goal of palliative therapy is embraced in the hope of being able to live with disease; finally, at the disclosure of imminent death, another adjustment in ... difficult for the physician as well as for the patient and family The critical features of the interaction are to reassure the patient and family that everything that can be done to provide comfort...

Ngày tải lên: 07/07/2014, 01:20

... congenital heart disease, the authors have joined together to create such a text utilizing their individual expertise This book outlines the principles of dealing with such patients including the preferences ... and the hardware available The text is divided into two sections: Part I describes the “tricks of the trade.” Although prepared primarily for adult patients with congenital heart disease, the ... level of challenge the operator will face As many of the implanters will be unsure of the anatomy, particularly in relation to the pathways to the venous atrium and ventricle, there is liberal...

Ngày tải lên: 14/08/2014, 07:20

... entry into the vein to its passage up the anterior abdominal wall With the vigorous activity of the leg relative to the immobile iliac vein, the lead is subject to marked stresses with the fulcrum ... vena caval approach to the right heart is inaccessible, the decision is usually made to use the epicardial approach However, there are a number of approaches using the inferior vena The ilio-femoral ... reported in patients with complex congenital heart disease and no access to the heart from above These include transhepatic cannulation [19] and an extra-peritoneal approach directly to the inferior...

Ngày tải lên: 14/08/2014, 07:20

... chambers The advantage to the Locator® is that the curve can be created from the straight position without removing the stylet In the center, the preformed atrial J stylet allows the lead to enter the ... fully inserted into a lead, the clamp at the distal end of the handle attaches to the lead connector and can be removed from the handle to allow the stylet to be partially removed Locator ® J Stylet ... through the annuloplasty ring to the apex of the right ventricle The other lead (white arrow) lies in the body of the right atrium The operation of the Locator® produces only a small change in the...

Ngày tải lên: 14/08/2014, 07:20

... through the long introducer and lies near the floor of the right atrium (white arrows) Right: The ventricular lead has been passed with much difficulty to the apex of the right ventricle below the ... of the great vessels) No venous access to coronary sinus C H APTER 12 Consider growth in teenagers Although this text deals with congenital heart disease in the adult patient, nevertheless, the ... is secured to the tissues via the lead collar, using slowly absorbable suture material The lead can then be drawn into the intravascular path as the teenager grows, especially in the 13–17 age...

Ngày tải lên: 14/08/2014, 07:20