A carotid endarterectomy is performed in a sterile surgical suite or standard operating room. You may go home the same day or stay 1–2 nights after the procedure depending on your medical condition. You receive a local anesthetic or general anesthesia. Your vascular surgeon makes an incision at the front of your neck. After removing the plaque from the artery your vascular surgeon repairs the artery by stitching in a natural graft (formed from a piece of vein from elsewhere in your body) or a woven patch. The incision is closed

Pulmonary hypertension is a type of high blood pressure that affects the arteries in your lungs and the right side of your heart. In one form of pulmonary hypertension, tiny arteries in your lungs, called pulmonary arterioles, and capillaries become narrowed, blocked or destroyed. This makes it harder for blood to flow through your lungs, and raises pressure within your lungs' arteries. As the pressure builds, your heart's lower right chamber (right ventricle) must work harder to pump blood through your lungs, eventually causing your heart muscle to weaken and fail. Some forms of pulmonary hypertension are serious conditions that become progressively worse and are sometimes fatal. Although some forms of pulmonary hypertension aren't curable, treatment can help lessen symptoms and improve your quality of life. Pulmonary hypertension care at Mayo Clinic

Severe combined immunodeficiency (SCID) is a life-threatening syndrome of recurrent infections, diarrhea, dermatitis, and failure to thrive. It is the prototype of the primary immunodeficiency diseases and is caused by numerous molecular defects that lead to severe compromise in the number and function of T cells, B cells, and occasionally natural killer (NK) cells. Clinically, most patients present before age 3 months. Without intervention, SCID usually results in severe infection and death in children by age 2 years. A committee of experts, initially sponsored by the World Health Organization (WHO), meets every 2 years with the goal to classify the group of primary immunodeficiency diseases according to current understanding of the pathways that become defective in the immune system.[1] Eight classification groups have been determined, with SCID being one of the best studied. Over the past few decades, the diverse molecular genetic causes of SCID have been identified with progress from studies of the immune system.[2] SCID is considered a pediatric emergency because survival depends on expeditious stem cell reconstitution, usually by bone marrow transplantation (BMT). Appropriate diagnosis is essential because instituting proper treatment is lifesaving. Despite the heterogeneity in the pathogenesis of immune defects, common cutaneous manifestations and typical infections can provide clinical clues in diagnosing this pediatric emergency.[3] Skin manifestations were prevalent in primary immunodeficiency disorders studied in 128 pediatric patients in Kuwait; skin infections were the most prevalent findings, seen in 39 patients (30%), followed by dermatitis in 24 (19%).[4] Skin infections were significantly more prevalent in those with congenital defects in phagocyte number, function, or both, as well as in those with well-defined immunodeficiencies. Dermatitis was evident in all patients with hyper–immunoglobulin (Ig) E syndrome and Wiskott-Aldrich syndrome.[4] Erythroderma of infancy with diffuse alopecia was seen exclusively in patients with SCID disorders, and telangiectasia in patients with ataxia telangiectasia; and partial albinism with silvery gray hair was associated with Chediak-Higashi syndrome. With the advances in BMT and gene therapy, patients now have a better likelihood of developing a functional immune system in a previously lethal genetic disease. However, once an infant develops serious infections, intervention is rarely successful.

A ventricular septal defect (VSD), a hole in the heart, is a common heart defect that's present at birth (congenital). The hole occurs in the wall that separates the heart's lower chambers (septum) and allows blood to pass from the left to the right side of the heart. The oxygen-rich blood then gets pumped back to the lungs instead of out to the body, causing the heart to work harder. A small ventricular septal defect may cause no problems, and many small VSDs close on their own. Larger VSDs need surgical repair early in life to prevent complications.

The incidence of digitalis toxicity has declined in recent years, due to decreased use of this drug along with improved technology for monitoring of drug levels and increased awareness of drug interactions. Nevertheless, cardiac glycoside toxicity continues to be a problem in the United States because of the wide use of digoxin (a preparation of digitalis) and its narrow therapeutic window. Digitalis is a plant-derived cardiac glycoside commonly used in the treatment of chronic heart failure (CHF), atrial fibrillation, and reentrant supraventricular tachycardia.[1, 2] Digoxin is the only available preparation of digitalis in the United States. (See Etiology and Epidemiology.) Cardiac glycosides are found in certain flowering plants, such as oleander and lily-of-the-valley. Indigenous people in various parts of the world have used many plant extracts containing cardiac glycosides as arrow and ordeal poisons. The ancient Egyptians used squill (Urginea maritime) as a medicine. The Romans employed it as a diuretic, heart tonic, emetic, and rat poison. Digitalis, or foxglove, was mentioned in the year 1250 in the writings of Welsh physicians. Fuchsius described it botanically 300 years later and named it Digitalis purpurea. William Withering published his classic account of foxglove and some of its medical uses in 1785, remarking upon his experience with digitalis. He recognized many of the signs of digitalis toxicity, noting, "The foxglove, when given in very large and quickly repeated doses, occasions sickness, vomiting, purging, giddiness, confused vision, objects appearing green or yellow; increased secretion of urine, slow pulses, even as low as 35 in a minute, cold sweats, convulsions, syncope, death." (See Presentation and Workup.) During the early 20th century, as a result of the work of Cushny, Mackenzie, Lewis, and others, the drug was gradually recognized as specific for treatment of atrial fibrillation. Only subsequently was the value of digitalis for treatment of CHF established. Cardiac glycosides enhance cardiac contractility and slow conduction through the atrioventricular (AV) junction by increasing vagal tone.[3] (See Etiology.) Cardiac glycoside toxicity has been known to result from ingestion of some plants, including yellow oleander (Thevetia peruviana) and foxglove, and a similar toxidrome has been associated with the use of herbal dietary supplements that contain cardiac glycosides. Digoxin is among the top 50 prescribed drugs in the United States.[4] In 2011, the American Association of Poison Control Centers reported 1601 single exposures to cardiac glycoside drugs.[5] Cardiac glycosides account for 2.6% of toxic plant exposures in the United States.[6, 7] Most of these exposures are in children.[7] (See Epidemiology.) Digoxin-specific fragment antigen-binding (Fab) antibody fragments have contributed significantly to the improved morbidity and mortality of toxic patients since their approval in 1986 by the US Food and Drug Administration (FDA). (See Prognosis, Treatment, and Medication.)

How to Insert a Tampon

A drug allergy is the abnormal reaction of your immune system to a medication. Any medication — over-the-counter, prescription or herbal — is capable of inducing a drug allergy. However, a drug allergy is more likely with certain medications. The most common signs and symptoms of drug allergy are hives, rash or fever. A drug allergy may cause serious reactions, including anaphylaxis, a life-threatening condition that affects multiple body systems. A drug allergy is not the same as drug side effects, the known possible reactions that are listed on a drug label. A drug allergy is also distinct from drug toxicity caused by an overdose of medication.

A disease of the immune system due to infection with HIV. HIV destroys the CD4 T lymphocytes (CD4 cells) of the immune system, leaving the body vulnerable to life-threatening infections and cancers. Acquired immunodeficiency syndrome (AIDS) is the most advanced stage of HIV infection. To be diagnosed with AIDS, a person with HIV must have an AIDS-defining condition or have a CD4 count less than 200 cells/mm³ (regardless of whether the person has an AIDS-defining condition).

Premature ejaculation occurs when a man ejaculates sooner during sexual intercourse than he or his partner would like. Premature ejaculation is a common sexual complaint. Estimates vary, but as many as 1 out of 3 men say they experience this problem at some time. As long as it happens infrequently, it's not cause for concern. However, you may meet the diagnostic criteria for premature ejaculation if you: Always or nearly always ejaculate within one minute of penetration Are unable to delay ejaculation during intercourse all or nearly all of the time Feel distressed and frustrated, and tend to avoid sexual intimacy as a result Both psychological and biological factors can play a role in premature ejaculation. Although many men feel embarrassed to talk about it, premature ejaculation is a common and treatable condition. Medications, counseling and sexual techniques that delay ejaculation — or a combination of these — can help improve sex for you and your partner.

Why We French Kiss

An estimated 90% of men who have sex with men and as many as 5% to 10% of sexually active women engage in receptive anal intercourse. Often referred to simply as anal sex, anal intercourse is sexual activity that involves inserting the penis into the anus. People may engage in anal intercourse, which has health risks, because the anus is full of nerve endings, making it very sensitive. For some recipients of anal sex, the anus can be an erogenous zone that responds to sexual stimulation. For the giving partner, the anus may provide a pleasing tightness around the penis. While some people find anal sex enjoyable, the practice has downsides and requires special safety precautions. Is Anal Sex Safe? There are a number of health risks with anal sex, and anal intercourse is the riskiest form of sexual activity for several reasons, including the following: The anus lacks the natural lubrication the vagina has. Penetration can tear the tissue inside the anus, allowing bacteria and viruses to enter the bloodstream. This can result in the spread of sexually transmitted infections including HIV. Studies have suggested that anal exposure to HIV poses 30 times more risk for the receptive partner than vaginal exposure. Exposure to the human papillomavirus (HPV) may also lead to the development of anal warts and anal cancer. Using lubricants can help some, but doesn't completely prevent tearing. The tissue inside the anus is not as well protected as the skin outside the anus. Our external tissue has layers of dead cells that serve as a protective barrier against infection. The tissue inside the anus does not have this natural protection, which leaves it vulnerable to tearing and the spread of infection. The anus was designed to hold in feces. The anus is surrounded with a ring-like muscle, called the anal sphincter, which tightens after we defecate. When the muscle is tight, anal penetration can be painful and difficult. Repetitive anal sex may lead to weakening of the anal sphincter, making it difficult to hold in feces until you can get to the toilet. However, Kegel exercises to strengthen the sphincter may help prevent this problem or correct it. The anus is full of bacteria. Even if both partners do not have a sexually-transmitted infection or disease, bacteria normally in the anus can potentially infect the giving partner. Practicing vaginal sex after anal sex can also lead to vaginal and urinary tract infection

Thalassemia is an inherited blood disorder characterized by less hemoglobin and fewer red blood cells in your body than normal. Several types of thalassemia exist, including alpha-thalassemia, beta-thalassemia intermedia, Cooley's anemia and Mediterranean anemia. Hemoglobin is the substance in your red blood cells that allows them to carry oxygen. The low hemoglobin and fewer red blood cells of thalassemia may cause anemia, leaving you fatigued. If you have mild thalassemia, you may not need treatment. But, if you have a more severe form of thalassemia, you may need regular blood transfusions. You can also take steps on your own to cope with fatigue, such as choosing a healthy diet and exercising regularly.

Inflammation of the uvula is known as uvulitis. Your uvula will appear red, puffy, and larger than normal. Other symptoms of uvulitis may include: itching burning a sore throat spots on your throat snoring difficulty swallowing trouble breathing If you have a swollen uvula along with a fever or abdominal pain, consult with your doctor right away. In rare cases, the uvula can swell enough to block your airway. Swelling of the throat is a life-threatening event. If this happens, seek immediate medical attention. What causes a swollen uvula? Causes Inflammation is your body’s response when it’s under attack. Triggers for inflammation include: environmental and lifestyle factors an infection trauma genetics Environmental and Lifestyle Factors The most common food allergies are peanuts tree nuts milk eggs wheat soy fish, including shellfish You could be having an allergic reaction to something you touched, swallowed, or breathed in. Some common allergens include: food irritants , such as dust, animal dander, or pollen medication exposure to chemicals or other toxic substances, including tobacco Infection You can get viral infections or bacterial infections. Examples of viral infections include: the common cold the flu mononucleosis chickenpox measles croup The most common bacterial infection is strep throat, which occurs due to Streptococcus pyogenes, which is a type of group A Streptococcus. If you have infected tonsils, or tonsillitis, severe inflammation can cause them to push against and irritate your uvula. Trauma Trauma to the uvula can happen if you need an intubation, such as during surgery. Your uvula can also be injured during a tonsillectomy. This is a procedure to remove your tonsils, which are located on both sides of your uvula. Your throat and uvula can also become irritated if you have acid reflux disease or if you vomit frequently. Genetics A condition called hereditary angioedema (HAE) can cause swelling of the uvula and throat, as well as swelling of the face, hands, and feet. Other symptoms include nausea, vomiting, and abdominal pain. It’s an uncommon genetic mutation that occurs in 1 in 10,000 to 1 in 50,000 people. It’s rare, but there are case reports of individuals who have an elongated uvula, which can also interfere with breathing. What are the risk factors for a swollen uvula? Risk Factors Anyone can get uvulitis, but adults get it less often than children do. You’re at increased risk if you: have allergies use tobacco products are exposed to chemicals and other irritants in the environment have a weakened immune system, making you more susceptible to infections How is a swollen uvula diagnosed? Diagnosis If you have fever or swelling of your throat, see your doctor. Be prepared to give a complete medical history. Tell your doctor: about all the over-the-counter and prescription medications you take if you’re a smoker or you chew tobacco if you’ve recently tried new foods if you’ve been exposed to chemicals or unusual substances about your other symptoms, such as abdominal pain, fever, or dehydration Your doctor may be able to make a diagnosis through a physical exam. It’s likely you’ll also need a throat swab to evaluate for strep or to obtain secretions for culture to determine if you have another bacterial or fungal infection. This test is known as the rapid strep test. You may also need a nasal swab to test for influenza. Blood testing can help identify or rule out some other infectious agents. If those tests are inconclusive, you may need to see an allergist. Blood and skin tests can help identify foods or other substances that cause a reaction. Learn more: Allergy testing » If necessary, imaging tests can provide a more detailed view of your throat and the surrounding area. What’s the treatment for a swollen uvula? Treatment When you have something like the common cold, swelling usually clears up on its own without treatment. Otherwise, treatment will depend on how severe your symptoms are, as well as what’s causing the inflammation. Infection Viral infections tend to clear up without treatment. The only upper respiratory infection for which an antiviral medication is available is influenza. Antibiotics can treat bacterial infections. Even after symptoms clear up, take all the medication as prescribed. If your condition may be contagious, stay home until your doctor tells you that you’re no longer at risk of spreading it to others. Allergy If you test positive for an allergy, try to avoid the allergen in the future. Doctors usually treat allergies with antihistamines or steroids. Anaphylaxis is a severe allergic reaction. Doctors use epinephrine to treat this reaction. Hereditary angioedema Your doctor may treat HAE with any of the following: anabolic steroids, or androgens antifibrinolytics C1 inhibitors, such as C1 esterase inhibitor (Berinert) or C1 esterase inhibitor (recombinant) (Ruconest) a plasma kallikrein inhibitor, such as ecallantide (Kalbitor) bradykinin receptor antagonist, such as icatibant injection (Firazyr) Tell your doctor if you have new or worsening symptoms, and follow up as necessary. Tips for relief home treatment If you have a swollen uvula or sore throat, it’s your body’s way of telling you that something is wrong. A few home remedies can help keep you strong and soothe your irritated throat. Make sure you’re getting enough fluids. If your throat hurts when you drink, try drinking small amounts throughout the day. Your urine should be light in color. If it’s dark yellow or brown, you’re not drinking enough and may be dehydrated. Additional tips include the following: Cool your throat by sucking on ice chips. Frozen juice bars or ice cream may also do the trick. Gargle with warm salt water to ease your dry, scratchy throat. Aim for a full night’s sleep, and nap during the day if you can. What’s the outlook? Outlook A swollen uvula isn’t a common occurrence. Most of the time it clears up without treatment. If you have an infection, prompt treatment should take care of the problem within a week or two. If you have allergies that lead to swelling of the uvula or throat, do your best to avoid that allergen. You should also be prepared to deal with an attack if you come into contact with the substance again. If you’ve ever had anaphylaxis, ask your doctor if you should carry injectable epinephrine (EpiPen) in case of emergency. People with HAE must learn to recognize triggers and early warning signs of an attack. Talk to your doctor about how to manage HAE. 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Vertigo is a sensation of spinning. If you have these dizzy spells, you might feel like you are spinning or that the world around you is spinning. Causes of Vertigo Vertigo is often caused by an inner ear problem. Some of the most common causes include: BPPV. These initials stand for benign paroxysmal positional vertigo. BPPV occurs when tiny calcium particles (canaliths) clump up in canals of the inner ear. The inner ear sends signals to the brain about head and body movements relative to gravity. It helps you keep your balance. BPPV can occur for no known reason and may be associated with age. Meniere's disease. This is an inner ear disorder thought to be caused by a buildup of fluid and changing pressure in the ear. It can cause episodes of vertigo along with ringing in the ears (tinnitus) and hearing loss. Vestibular neuritis or labyrinthitis. This is an inner ear problem usually related to infection (usually viral). The infection causes inflammation in the inner ear around nerves that are important for helping the body sense balance

Epley maneuver: Step 1 You will sit on the doctor's exam table with your legs extended in front of you. The doctor will turn your head so that it is halfway between looking straight ahead and looking directly to the side that causes the worst vertigo. Without changing your head position, the doctor will guide you back quickly so that your shoulders are on the table but your head is hanging over the edge of the table. In this position, the side of your head that is causing the worst vertigo is facing the floor. The doctor will hold you in this position for 30 seconds or until your vertigo stops. Epley maneuver: Step 2 Then, without lifting up your head, the doctor will turn your head to look at the same angle to the opposite side, so that the other side of your head is now facing the floor. The doctor will hold you in this position for 30 seconds or until your vertigo stops. Epley maneuver: Step 3 The doctor will help you roll in the same direction you are facing so that you are now lying on your side. (For example, if you are looking to your right, you will roll onto your right side.) The side that causes the worst vertigo should be facing up. The doctor will hold you in this position for another 30 seconds or until your vertigo stops. Epley maneuver: Step 4 The doctor will then help you to sit back up with your legs hanging off the table on the same side that you were facing. This maneuver is done with the assistance of a doctor or physical therapist. A single 10- to 15-minute session usually is all that is needed. When your head is firmly moved into different positions, the crystal debris (canaliths) causing vertigo will move freely and no longer cause symptoms.

This video: Pericarditis is swelling and irritation of the pericardium, the thin sac-like membrane surrounding your heart. Pericarditis often causes chest pain and sometimes other symptoms. The sharp chest pain associated with pericarditis occurs when the irritated layers of the pericardium rub against each other. Pericarditis usually begins suddenly but doesn't last long (acute). When symptoms develop more gradually or persist, pericarditis is considered chronic. Most cases are mild and usually improve on their own. Treatment for more-severe cases may include medications and, rarely, surgery. Early diagnosis and treatment may help to reduce the risk of long-term complications from pericarditis.

Homocystinuria is an inherited disorder that affects the metabolism of the amino acid methionine. Amino acids are the building blocks of life. Causes Homocystinuria is inherited in families as an autosomal recessive trait. This means that the child must inherit a non-working copy of the gene from each parent to be seriously affected. Homocystinuria has several features in common with Marfan syndrome, including joint and eye changes. Symptoms Newborn infants appear healthy. Early symptoms, if present, are not obvious. Symptoms may occur as mildly delayed development or failure to thrive. Increasing visual problems may lead to diagnosis of this condition. Other symptoms include: Chest deformities (pectus carinatum, pectus excavatum) Flush across the cheeks High arches of the feet Intellectual disability Knock knees Long limbs Mental disorders Nearsightedness Spidery fingers (arachnodactyly) Tall, thin build

Absence seizures involve brief, sudden lapses of consciousness. They're more common in children than adults. Someone having an absence seizure may look like he or she is staring into space for a few seconds. This type of seizure usually doesn't lead to physical injury. Absence seizures usually can be controlled with anti-seizure medications. Some children who have them also develop other seizures. Many children outgrow absence seizures in their teens.

Whereas it is true that no operation has been profoundly affected by the advent of laparoscopy than cholecystectomy has, it is equally true that no procedure has been more instrumental in ushering in the laparoscopic age than laparoscopic cholecystectomy has. Laparoscopic cholecystectomy has rapidly become the procedure of choice for routine gallbladder removal and is currently the most commonly performed major abdominal procedure in Western countries.[1] A National Institutes of Health consensus statement in 1992 stated that laparoscopic cholecystectomy provides a safe and effective treatment for most patients with symptomatic gallstones and has become the treatment of choice for many patients.[2] This procedure has more or less ended attempts at noninvasive management of gallstones. The initial driving force behind the rapid development of laparoscopic cholecystectomy was patient demand. Prospective randomized trials were late and largely irrelevant because advantages were clear. Hence, laparoscopic cholecystectomy was introduced and gained acceptance not through organized and carefully conceived clinical trials but through acclamation. Laparoscopic cholecystectomy decreases postoperative pain, decreases the need for postoperative analgesia, shortens the hospital stay from 1 week to less than 24 hours, and returns the patient to full activity within 1 week (compared with 1 month after open cholecystectomy).[3, 4] Laparoscopic cholecystectomy also provides improved cosmesis and improved patient satisfaction as compared with open cholecystectomy. Although direct operating room and recovery room costs are higher for laparoscopic cholecystectomy, the shortened length of hospital stay leads to a net savings. More rapid return to normal activity may lead to indirect cost savings.[5] Not all such studies have demonstrated a cost savings, however. In fact, with the higher rate of cholecystectomy in the laparoscopic era, the costs in the United States of treating gallstone disease may actually have increased. Trials have shown that laparoscopic cholecystectomy patients in outpatient settings and those in inpatient settings recover equally well, indicating that a greater proportion of patients should be offered the outpatient modality

Corticosteroid Injections – Doctors sometimes inject corticosteroids directly into the knee joint for quick relief of pain and inflammation. Their benefits may last anywhere from a few days to more than six months. While the injections bring targeted relief to the joint and lack many of the side effects of oral corticosteroid medications, they are not without risks. Repeated knee injections may actually contribute to cartilage breakdown. For that reason your doctor will likely put a limit on the number of injections you can receive.