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Lipid-Lowering Agents HMG-CoA reductase inhibitors (statins) These agents inhibit the rate-limiting step in cholesterol biosynthesis by competitively inhibiting HMG-CoA reductase. Note the following: Low-density lipoprotein (LDL) reduction of 25%-60% Examples include Atorvastatin, fluvastatin, lovastatin, pitavastatin, pravastatin, rosuvastatin, simvastatin Contraindications include hypersensitivity, active liver disease, pregnancy, lactation, coadministration with strong CYP3A4 inhibitors (selected statins) Vitamin B3 Vitamin B3 inhibits very-low-density lipoprotein (VLDL) synthesis. Note the following: LDL reduction of 10% High-density lipoprotein (HDL) increase of 20% Example includes Niacin (nicotinic acid) Contraindications include hypersensitivity, liver disease, active peptic ulcer, severe hypotension, arterial bleeding Fibrates Fibrates enhance lipoprotein lipase, resulting in increased VLDL catabolism, fatty acid oxidation, and triglycerides elimination. They decrease hepatic extraction of free fatty acids. Note the following: LDL reduction of 15% Triglyceride reduction of 35% Examples include Gemfibrozil, fenofibrate, fenofibrate (micronized), fenofibric acid Contraindications include active liver disease, renal disease, primary biliary cirrhosis, gallbladder disease 2-Azetidiones These agents inhibit sterol transporter at brush border and, consequently, intestinal absorption of cholesterol. LDL reduction of 15% Example includes Ezetimibe Contraindications include hypersensitivity, coadministration with statins (if active liver disease) Bile acid sequestrants These agents lower cholesterol and LDL via bile duct sequestration. Note the following: LDL reduction of 15% Examples include Cholestyramine, colesevelam, colestipol Contraindications include biliary/bowel obstruction, serum triglycerides >300-500 mg/dL, history of hypertriglyceridemia-induced pancreatitis
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Caesarean section is the most common way to deliver a breech baby in the USA, Australia, and Great Britain. Like any major surgery, it involves risks. Maternal mortality is increased by a Caesarean section, but still remains a rare complication in the First World. Third World statistics are dramatically different, and mortality is increased significantly. There is remote risk of injury to the mother’s internal organs, injury to the baby, and severe hemorrhage requiring hysterectomy with resultant infertility. More commonly seen are problems with noncatastrophic bleeding, postoperative infection and wound healing problems. It should be added that the increase in maternal mortality rates could be slightly skewed due to the fact that Caesarean sections are often used during high-risk pregnancies and/or when mortality is already a strong possibility.
One large study has confirmed that elective cesarean section has lower risk to the fetus and a slightly increased risk to the mother, than planned vaginal delivery of the breech however elements of the methodology used have undergone some criticism.
The same birth injuries that can occur in vaginal breech birth may rarely occur in Caesarean breech delivery. A Caesarean breech delivery is still a breech delivery. However the soft tissues of the uterus and abdominal wall are more forgiving of breech delivery than the hard bony ring of the pelvis. If a Caesarean is scheduled in advance (rather than waiting for the onset of labor) there is a risk of accidentally delivering the baby too early, so that the baby might have complications of prematurity. The mother’s subsequent pregnancies will be riskier than they would be after a vaginal birth (uterine rupture). The presence of a uterine scar will be a risk factor for any subsequent pregnancies.
Aortoiliac occlusive disease (AIOD) occurs commonly in patients with PAD. Significant lesions in the aortoiliac arterial segment are exposed easily by palpation of the femoral pulses. Any diminution of the palpable femoral pulse indicates that a more proximal obstruction exists. Obstructive lesions may be present in the infrarenal aorta, common iliac, internal iliac (hypogastric), external iliac, or combinations of any or all of these vessels. Occasionally, degenerated nonstenotic atheromatous disease exists in these vessels and may manifest by atheroembolism to the foot, the "blue toe" or "trash foot" syndrome. Generally, patients with aortoiliac PAD have a poorer general prognosis than those with more distal PAD.
The Arthrex® Achilles SpeedBridge™ repair is a surgical technique system that combines fully threaded SwiveLock® anchors with FiberTape® suture. The surgeon may use the Achilles SpeedBridge to reattach the Achilles tendon to the heel bone after repairing the damaged portion of the Achilles tendon. The Achilles tendon connects the two large muscles at the back of the calf to the heel. Insertional Achilles tendinitis is a painful and disabling condition where the tendon attaches to the heel bone causing redness, pain and swelling. Patients who do not respond to the initial treatment may require surgical treatment.
Biceps tenodesis surgery is performed when the biceps tendon is damaged, or the rotator cuff tendon or cartilage ring in the shoulder is torn. The biceps tendon is a strong rope‐like structure connecting the upper end of the biceps muscle to the bones in the shoulder. In biceps tenodesis surgery, the biceps tendon is separated from the shoulder and reattached to the humerus, or the upper arm bone.
An unnamed Russian scientist has introduced the concept of a device that attaches to the wall of the artery. It would first stop blood flow to the area to prevent breakaway plaque. A drill would then scrape the plaque from the artery wall. The procedure of treating plaque buildup could include bypass surgery, stent replacement and balloon angioplasty. Since the plaques are of different types and locations in the body, the inventor proposed using different types of cutting mills.
Frontotemporal dementia is the name for a range of conditions in which cells in the frontal and temporal lobes of the brain are damaged. These lobes control behaviour, emotional responses and language. This means that people will experience changes in personality and behaviour, or may struggle with language – for example, in finding the right word. Frontotemporal dementia is a less common form of dementia which is more likely to affect younger people – those under 65.
http://www.mediplus.co.uk A new and safer method of inserting a Foley catheter suprapubically. The technique allows the insertion to be carried out in an Outpatient setting, thus saving time, cost and effort. By using the Seldinger technique, the product reduces the chances of bowel or bladder perforation and resultant morbidity.
The product has been chosen by The NHS National Technology Adoption Centre to help facilitate adoption of the product.
The term subarachnoid hemorrhage (SAH) refers to extravasation of blood into the subarachnoid space between the pial and arachnoid membranes. SAH constitutes half of all spontaneous atraumatic intracranial hemorrhages; the other half consists of bleeding that occurs within the brain parenchyma. Subarachnoid hemorrhage occurs in various clinical contexts, the most common being head trauma. However, the familiar use of the term SAH refers to nontraumatic (or spontaneous) hemorrhage, which usually occurs in the setting of a ruptured cerebral aneurysm or arteriovenous malformation (AVM).