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Middle cerebral artery syndrome is a condition whereby the blood supply from the middle cerebral artery (MCA) is restricted, leading to a reduction of the function of the portions of the brain supplied by that vessel: the lateral aspects of frontal, temporal and parietal lobes, the corona radiata, globus pallidus, caudate and putamen. The MCA is the most common site for the occurrence of ischemic stroke.[1] Depending upon the location and severity of the occlusion, signs and symptoms may vary within the population affected with MCA syndrome. More distal blockages tend to produce milder deficits due to more extensive branching of the artery and less ischemic response. In contrast, the most proximal occlusions result in widespread effects that can lead to significant cerebral edema, increased intracranial pressure, loss of consciousness and could even be fatal.[1] In such occasions, mannitol (osmotic diuretic) or hypertonic saline are given to draw fluid out of the oedematus cerebrum to minimise secondary injury. Hypertonic saline is better than mannitol, as mannitol being a diuretic will decrease the mean arterial pressure and since cerebral perfusion is mean arterial pressure minus intracranial pressure, mannitol will also cause a decrease in cerebral perfusion. Contralateral hemiparesis and hemisensory loss of the face, upper and lower extremities is the most common presentation of MCA syndrome.[1] Lower extremity function is more spared than that of the faciobrachial region.[2] The majority of the primary motor and somatosensory cortices are supplied by the MCA and the cortical homunculus can, therefore, be used to localize the defects more precisely.it is important to note that middle cerebral artery lesions mostly affect the dominant hemisphere i.e. the left cerebral hemisphere.
Surgeons at The Children’s Hospital of Philadelphia were the first to perform a bilateral hand transplant on a child. Our research and work in this groundbreaking field of medicine led us to establish the Hand Transplantation Program. Combining the expertise of the Penn Transplant Institute and the Hospital’s Division of Plastic and Reconstructive Surgery and Division of Orthopedics, the program aims to improve quality of life for children who may benefit from this procedure.
The liver regulates most chemical levels in the blood and excretes a product called bile. ... Production of bile, which helps carry away waste and break down fats in the small intestine during digestion. Production of certain proteins for blood plasma.
Epidermoid cysts, also called sebaceous, keratin, or epithelial cysts, are small, hard lumps that develop under the skin. These cysts are common. They grow slowly. They do not cause other symptoms and are nearly never cancerous. Epidermoid cysts are often found on the face, head, neck, back, or genitals
Acute leukaemias develop quickly and need to be treated urgently. Chronic leukaemias develop more slowly and may not need to be treated for some time after they are diagnosed. Some forms may not require any treatment. Myeloid leukaemias arise from myeloid stem cells and are characterised by the accumulation of cancerous myeloid cells. Lymphoid leukaemias arise from lymphoid stem cells and are characterised by the accumulation of cancerous lymphoid cells such as B-cells and T-cells. The most common forms of leukaemia in adults are CLL and AML, and the common cancer in children is ALL. Leukaemia is more common in adults.
Lumbar puncture is a common emergency department procedure used to obtain information about the cerebrospinal fluid (CSF) for diagnostic and, less commonly, therapeutic reasons. Please refer to the full article on Lumbar Puncture for more details on the lumbar puncture procedure. Lumbar puncture is typically performed via “blind” surface landmark guidance. The surface landmark technique is reported to be successful in a high percentage of attempted lumbar punctures; however, surface landmark identification of underlying structures has been shown to be accurate only 30% of the time. [1] Unsuccessful identification of proper landmarks often leads to increased difficulty in obtaining CSF, if the procedure is performed, and a higher rate of complications. Few alternatives are available in these cases. If available, fluoroscopic-guided lumbar puncture may be performed. If not, treatment is sometimes initiated empirically without obtaining CSF. Disadvantages of using fluoroscopy include limited availability or necessary transport of the patient outside of the emergency department, inability to directly visualize the spinal canal, and inherent radiation exposure
A pheochromocytoma (fee-o-kroe-moe-sy-TOE-muh) is a rare, usually noncancerous (benign) tumor that develops in cells in the center of an adrenal gland. You have two adrenal glands, one above each kidney. Your adrenal glands produce hormones that give instructions to virtually every organ and tissue in your body. If you have a pheochromocytoma, an adrenal gland releases hormones that cause persistent or episodic high blood pressure. If left untreated, a pheochromocytoma can result in severe or life-threatening damage to other body systems, especially the cardiovascular system. Most people with a pheochromocytoma are between the ages of 20 and 50, but the tumor can develop at any age. Surgical treatment to remove a pheochromocytoma usually returns blood pressure to normal.
When oral medications do not relieve knee pain, but you're not to the point of pursuing knee surgery, one of the following injections or procedures may help. Hyaluronic acid supplements – Although not technically medications, these substances are injected into knee joints to supplement naturally occurring hyaluronic acid. In healthy joints hyaluronic acid acts as a shock absorber and lubricant, allowing joints to move smoothly over each other. However, the acid appears to break down in people with osteoarthritis. Injecting it into a joint may lessen pain and inflammation. The injections are given weekly for three or five weeks, depending on the product (examples are Synvisc and Hyalgan). A small amount of joint fluid is removed first to make room for the hyaluronic acid. 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. Read a report from the British Medical Journal on corticosteroid injections for knee osteoarthritis. Arthrocentesis – Also called joint fluid aspiration, arthrocentesis is removal of joint fluid through a hollow needle inserted into the joint space of the knee. Although the purpose of removing joint fluid from the knee is usually so that it can be tested in the lab, removing excess fluid can also quickly ease pain and swelling. Often after withdrawing fluid, doctors use the same puncture site where the fluid was removed to inject a corticosteroid preparation and/or anesthetic into the knee joint to further relieve pain and inflammation.
Emphysema gradually damages the air sacs (alveoli) in your lungs, making you progressively more short of breath. Emphysema is one of several diseases known collectively as chronic obstructive pulmonary disease (COPD). Smoking is the leading cause of emphysema. Your lungs' alveoli are clustered like bunches of grapes. In emphysema, the inner walls of the air sacs weaken and eventually rupture — creating one larger air space instead of many small ones. This reduces the surface area of the lungs and, in turn, the amount of oxygen that reaches your bloodstream. When you exhale, the damaged alveoli don't work properly and old air becomes trapped, leaving no room for fresh, oxygen-rich air to enter. Treatment may slow the progression of emphysema, but it can't reverse the damage.
What is a mole? Many people refer to a mole as any dark spot or irregularity in the skin. Doctors use different terms. But the following types of skin marks such as these are not treated the same way moles are and are not discussed here: Birthmarks Abnormal formations of blood vessels (hemangiomas) Keratoses (benign or precancerous spots, which appear after about age 30 years)
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