Bora Rhim, DPM

• Clinical Instructor, VA Medical Center
• Staff Physician, University Foot and Ankle Institute
• Los Angeles, California

This distinction may be important in that IgG 4 thyroiditis has been associated with severe lymphoplasmacytic infiltration acne marks order betnovate 20 gm, marked fibrosis skin care 40s buy cheap betnovate 20gm on-line, and lymphoid follicle formation in contrast to nonIgG 4 thyroiditis skin care quotes safe 20 gm betnovate, which exhibits more mild histopathological changes (Li skin care ingredients buy online betnovate. Thus acne 5 days past ovulation safe 20gm betnovate, this classification might be helpful in assessing the severity of the disease and could be used in determining the most appropriate treatment options for patients acne map betnovate 20gm on-line. The appropriate choice depends on disease presentation and extent of gland involvement. In some instances, patients may present without symptoms, and may not require immediate intervention. Recently, studies have shown that prophylactic treatment in euthyroid patients can slow the progression of the disease and significantly reduce levels of antithyroid antibodies; however, the long term benefits of this approach have not yet been confirmed (Padberg etal 2004). Furthermore, ultrasound studies have shown that thyroid size diminishes in response to thyroid hormone replacement, even in euthryoid patients (Hegedus et al. Moreover, reversibility in the progression of the disease appears to be quicker and more pronounced in younger patients than in more mature patients. This difference may be attributable to the extent of glandular involvement and increased degree of fibrosis in older populations, making reversibility of the underlying pathology less feasible. Thyroid hormone replacement is also indicated in the presence of a goiter, if the goiter is small in size and is causing minimal pressure symptoms or disfigurement. External supplementation of thyroid hormone will not only correct the metabolic status of the person but it is also postulated to modify the course of the disease. Long term follow up of patients treated with thyroxine has shown reduced antithyroid peroxidase antibodies after a mean time of 50 months, with a small number of patients being reported as seronegative (Schmidt et al. In addition, a few studies have shown that if patients recover normal thyroid gland function, they might remain euthyroid, despite not taking hormone therapy, for a mean period of approximately 8 years (Takasu et al. The rationale for using this nutrient stems from the discovery that the enzymes iodothyronine deiodinase, glutathione peroxidase and thioredoxin reductase, which maintain thyroid gland homeostasis, are selenium dependant. Further decline in antibody levels was observed when the therapy was continued, with antibody levels increasing after therapy was terminated. Surgical therapy is indicated in patients suffering from severe, painful goiter or experiencing pressure symptoms resulting from tracheal encroachment, which include dysphasia or dyspnea. In an attempt to create guidelines for thyroid resection, the following factors have been found to play a major role in determining when to pursue surgical resection (Thomas & Rutledge, 1981): 1. Thyroidectomy has been proven to be effective in 60 A New Look at Hypothyroidism these patients as treatment with thyroid hormone replacement or corticosteroids will not alleviate their symptoms (Kon & Degroot, 2003). These cases do not respond to the regular anti inflammatory agents, which have been found to be effective in controlling pain associated with other forms of thyroiditis. Moreover, prophylactic removal of a nodular thyroid gland is done in selected cases to prevent the development of thyroid cancer, which would be typically diagnosed at a later stage. It should be noted that the effectiveness of this approach has been widely debated and remains a point of research interest. In cases with documented thyroid cancer, removal of the gland followed by radiotherapy or chemotherapy, depending on the type of tumor, is the definitive therapy. Briefly summarized; thyroid hormone status, pressure symptoms associated with an enlarged gland, and presence of associated symptoms or other autoimmune disorders should be considered in making an accurate treatment choice. Studies attempting to describe the pathophysiological mechanisms behind this condition have suggested the possible role of autoimmune processes. The literature indicates that the initial clinical presentation can be classified either as a vasculitic type, with predominantly stroke like symptoms and mild cognitive impairment, or a diffuse progressive type with predominant cognitive impairment (Kothbauer Marggreiter et al. Serum titers of antithyroid antibodies will be elevated and cerebrospinal fluid analysis will show increased protein levels. Early diagnosis and prompt intervention are of critical importance in effectively treating this condition, and significantly reducing its morbidity and mortality. The first line of treatment is usually corticosteroids, and in cases where steroids are contraindicated, other immunosuppressive agents have been employed with good efficacy. In steroid unresponsive cases, administration of plasmapheresis has been shown effective in controlling symptoms (Nagpal & Pande, 2004). Periodic intravenous exchange may also be used for steroid non responders, but no superiority has been established when compared to plasmapheresis. The duration of the treatment is highly variable, however approximately 90% of the cases will remain in remission after treatment. We have also discussed potential complications including other autoimmune diseases and neoplasms. Our understanding of how a genetic predisposition can be modified by environmental exposure is expanding. Our grasp of how aggressive immune suppression can alter disease course is growing. As with many subjects in medicine, with knowledge comes more questioning of what we know. Just as in other disease states, we must eagerly seek out both the questions and the answers. Correlation of Thyroid Antibodies and Cytologic Features in Suspected Autoimmune Thyroid Disease. Identification of a Thyroxine Containing Self Epitope of Thyroglobulin Which Triggers Thyroid Auto reactive T Cells. Evidence for a Restricted Idiotypic and Epitope Specificity of Anti thyroglobulin Auto antibodies in Patients with Autoimmune Thyroiditis. Differential Regulation of Fas Mediated Apoptosis in Both Thyrocyte and Lymphocyte Cellular Compartments Correlates with Opposite Phenocytic Manifestations of Autoimmune Thyroid Disease. Serum Thyroglobulin and the Response to Thyrotropin Releasing Hormone in Symptomless Autoimmune 64 A New Look at Hypothyroidism Thyroiditis and in Borderline and Overt Hypothyroidism. Histocompatability Leukocyte Antigens and Closely Linked Immunomodulatory Genes in Autoimmune Thyroid Disease. Apoptosis: Life Though Planned Cellular Death Regulating Mechanisms, Control Systems and Relations with Thyroid Disease. T Cells and Human Autoimmune Thyroid Disease: Emerging Data Show Lack of Need to Invoke Suppressor T Cell Problems. Antigenic Determinants of Human Thyroglobulin Differentiated Using Antigen Fragments.

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Doctors and past porn users have found that leaving porn and can crowd out maps linking sexual excitement to a real behind can fx erectile dysfunction problems skin care lotion generic betnovate 20gm otc. Researchers have found that even moderate porn use was correlated with having a lowered response to sexual cues in the brain acne face chart order betnovate 20gm. They found that their brains showed reduced grey matter in the reward center (which means reduced dopamine signaling) and the sexual centers of the hypothalamus acne topical medications cheap 20gm betnovate overnight delivery. Kuhn study showed that even moderate porn use correlated with having reduced grey matter delex acne buy generic betnovate 20 gm line. Studies have found that porn use is correlated with Negatively anxiety as well as an increased likelihood for angry overreaction acne 5 pocket jeans cheap 20gm betnovate. Studies have found that porn use is correlated with to focus and lack of motivation acne removal tool purchase betnovate 20 gm otc. A study looking at Internet addicts (pornography was a with depression, anxiety, stress, and social problems. A study done in China looked at students, some of whom had never been exposed to the internet before entering university. They evaluated the students before internet use and then evaluated them a second time after a year had passed. Of the students that had never used the Internet before, 59 of them had developed an Internet addiction by the end of their frst year. Internet addiction disorder may bring some pathological problems to the addicts in some ways. Researchers in Taiwan found that there is a correlation between teens attempting suicide and Internet addiction, even after they controlled for depression, self esteem, family support, and demographics. In a study looking at 2,293 7th graders in China, researchers measured subjects for depression, hostility, social anxiety, and Internet addiction two times, a year apart. Those who developed Internet addiction displayed increases in depression and hostility compared to those who were not addicted. Those who had been Internet addicts but were no longer at the end of the year had decreased in depression, hostility, and social anxiety compared to those who were still addicted. Even moderate porn use is correlated with damage to parts of the brain involved with motivation and decision making. They are obviously essential brain cells for social representations of sexual behavior. You automatically have There is convincing behavioral evidence linking media empathy for me. Marco Iacoboni, neuroscientist at the University of California, Los Angeles, What should we do about it Researchers have been studying the impact of violence in that even infants imitate behaviors they see others perform. Mayberg, Yonglin structure critically involved in learning the association between Pu, Frank Zamarripa, Yijun Liu, Marty G. Dysfunction in the more primitive system within his or her brain (amygdala, neural circuitry of emotion regulation: A possible prelude to violence. Proceedings of the National Academy of murderers indicated by positron emission tomography. Altruistic helping in human infants and that the human brain does not distinguish between real life young chimpanzees. Well, to begin with, they after every interaction, we update a built in neurochemical are the reason happy people make others smile, and tense and profle of the world. As the monkey watched the event, researchers middle, context recognition; and the bottom, recognition saw his brain respond in exactly the same way it would if he of intention. Mirror neurons in area F5 of the Macaque outside of our conscious control, are what allow for empathy, inferior frontal cortex fred both when the monkey grasped the understanding, and culture building. Neurophysiological mechanisms underlying the understanding and imitation of action. The social ripple efect of mirror neurons explain our ability to learn through seeing; how culture is established Iacoboni, M. Since every thought neurons and sneak under the conscious rational radar of and action is emotionally primed automatically in the brain, potential consumers is nothing new. The great advertising video games become one of the best methods of teaching genius Leo Burnett, who created the Marlboro man, the Jolly through direct simulation. Andrews in Scotland enabled by mirror neurons acts as an emotional scafold shows the frst phenomenon. The mirror neuron system and its of getting the prize, by frst tapping and inserting a stick role in interpersonal relations. When chimps could not see inside the box, they followed the ritual to retrieve the reward. Instead motivation to cultural diferences, from dysfunctional mirror they overimitated, following the ritual for its own sake, and systems to prior experience and skill development. Causal knowledge and imitation/emulation switching in chimpanzees (Pan troglodytes) and children (homo sapiens). Mirror neurons in our brains produce automatic can and do build up cognitive resistance to our empathetic imitative infuences of which we are often unaware and that neurophysiological responses. If their options how we respond to what we see may lie simply in carefully for dealing with confict are limited to violence as a resolution, choosing what we see and in attempting to build a visual world they will generally turn to violence themselves.

Palpebral subconjunc infiltrative process acne 7dpo discount 20gm betnovate otc, while the dendriform tival hemorrhages in herpes zoster ophthalmicus acne 40 year old woman buy betnovate amex. Superior orbital present because of a cosmetic concern acne hoodie buy betnovate 20 gm free shipping, mild anterior segment inflammation acne quizzes buy betnovate 20gm. Herpes zoster keratouveitis and inflammatory ocular hypertension 8 years after varicella vaccina such as pain or tenderness are uncom gia skin care products online buy 20 gm betnovate fast delivery, topical steroid) with the addition of tion acne xarelto buy generic betnovate on line. This colorless, tent erythema, hypo or hyperpigmenta of plasma lipids into the dermis due to mildly pungent liquid agent has both tion, scarring and ectropion. Biomed Pap Med Fac Univ Palacky increased serum lipid fractions in about pharmacy or purchased as part of a com Olomouc Czech Repub. Xanthelasma palpe incidence of hypertension, ischemic heart depigmentation in individuals with darker brarum with arcus cornea: a clinical and biochemical study. If the presentation is atypical, or if the these individuals should be evaluated 11. Ultrapulse carbon dioxide laser ablation of xanthelasma palpebrarum: a case series. Br J ommended for all patients who are newly consisting of only fresh papaya or pine Ophthalmol. The key to managing Nevus of Ota, also known as congenital dominant multisystem connective tissue patients is recognizing its appearance, and melanosis bulbi and oculodermal melanosis, disorder resulting from mutations in referring for the proper medical workup. Bevacizumab treat 35 ment for subfoveal choroidal neovascularization from causes bengal green light procedures. Methods Mol solutions and ointments, topical cyclospo with blue sclera should be monitored for Med. Marfan syndrome cycloplegia, topical and oral steroids, topi esis imperfecta and blue sclera. Presenting signs and tions and oral antimetabolite medications have increased risk for glaucoma or exhibit clinical diagnosis in individuals referred to rule out Marfan syn drome. Clinical study of hereditary disorders of thickness is lower in osteogenesis imperfecta and negatively can be treated using any topical anti connective tissues in a Chilean population: joint hypermobil correlates with the presence of blue sclera. Medical testing is required to genetics and osteogenesis imperfecta classification With concurrent conjunctivitis, pes virus migrates along local nerves to to trifluridine. Additionally, ganciclovir dem dyes have been reported as part of the rence, stimuli postulated by other reports onstrates greatly reduced corneal toxicity, syndrome. The disease is generally Vision may or may not be affected, While many of the ocular manifesta self limiting and can be managed with depending upon the amount of watery tions related to the herpes simplex virus palliative therapies such as artificial tear discharge and presence of corneal epithe are immune (delayed hypersensitivity drops and ointments along with oral over liopathy. Delayed type hyper sensitivity in the pathogenesis of recurrent herpes stromal kerati tis. Pediatric herpes simplex cal medications used, atopic disease or a of the anterior segment: characteristics, treatment, and out ing, burning, scratchiness or other irrita history of immunosuppression can signifi comes. For example, if symblepharon may simply be a matter of degree and Finally, membranes and pseudomem develops and the conjunctival fornices intensity of inflammation. This tight adherence causes greater Plasminogen deficiency (both congeni difficulty with removal, and results in an tal and acquired) has also been associated Management increased likelihood and volume of bleed with the formation of membranes and Appropriate management of membranous ing upon their extraction. Hyperacute conjunctivitis, is often necessary despite primary care such a product is not available commer if associated with N. Topical tranilast for gous serum tears after haematopoietic progenitor cell transplan in the management of such disorders. Bacterial conjunctivitis: a review for of ligneous conjunctivitis with topical fresh frozen plasma in an infant. Iatrogenically induced Stevens coalesced blood between the bulbar con Johnson syndrome after a car accident. Pseudomembranous disease (ligneous inflammation) of the female genital tract, peritoneum, gingiva, and paranasal sinuses associated with plasminogen deficiency. Ligneous gingivitis associated with plasminogen deficiency: a challenge in diagnosis. Ligneous conjunctivitis in a patient of juvenile colloid milia: a rare association. Even a small drop of ketchup (blood) can temic conditions are usually the causative 2008;36(6):581 2. Valsalva retinopathy in preg mon household items nearly always helps nancy: a case report. It should only be considered in cases and the tortuosity of vessels of the bulbar conjunctiva. Subconjunctival hemorrhages: cant ophthalmic morbidity to adjacent presenting sign for hereditary hemochromatosis. Subconjunctival hemor ecchymosis and petechial hemorrhages rhage in a patient on dabigatran (Pradaxa). Recent causes of sub making: hyposphagma prior to intravenous tissue plasminogen nant tumors of the conjunctiva may conjunctival hemorrhage. The condition may also most notably herpes simplex and syphilis, ingly difficult to culture. Predictors of recurrent ophthalmia syndrome, glaucoma, optic 29 31 herpes simplex virus keratitis. Bevacizumab as a for the development of secondary open demonstrates a substantially more rapid potent inhibitor of inflammatory corneal angiogenesis and lym angle, primary angle closure and second phangiogenesis. Successful diagnosis and treatment of a single case of bilateral necrotizing kera Pathophysiology 2. Incidence of ocular complications in patients with multibacillary leprosy after com eter at birth measures between 9. American Academy of measuring less than 10mm in either the identified as a unique syndrome, associ Ophthalmology. Acyclovir for the preven of microcornea often present with normal from microphthalmos, also referred to tion of recurrent herpes simplex virus eye disease. Oral acyclovir for herpes ocular and systemic complications such describes a condition in which the entire simplex virus eye disease: effect on prevention of epithelial kera titis and stromal keratitis. Arch Ophthalmol and a malignant (ciliary block) Since microcorneas also possess the 1953; 49(2):220 1. Some cases demonstrate properties of being flatter or steeper than other anomalies. Systemic and ocular manifestations of the rubella Management microphthalmos can enjoy improved syndrome. Cornelia de Lange syndrome with optic disk pit: Novel association and fusion averse with potential amblyopia the fit of any contact lens is influenced review of literature. Corneal diameter in childhood carbonate lenses should be used if there is toricity, corneal asphericity, sagittal depth, aphakic glaucoma. Oculodentodigital dysplasia syndrome with angle tion between the eyes in order to protect design and material, water content, edge closure glaucoma. Digital evaluation of Congenital glaucomas require surgi host of hereditary conditions. Snellen to the basal cell layer of the corneal epi acterized by the insidious onset of super acuity of 20/30 or better is seen in about thelium, the subepithelial nerve plexus, ficial corneal inflammation, with a long 80% of individuals at presentation. Understanding the response to topical corticosteroids during and other secondary scar forming pathol nature of the disease course as well as the acute episodes. Viral isolates in super order is its potential to heal without scar intraocular pressure in susceptible patients. Graefes Arch Clin while others involved subsequent develop has been used successfully in the man Exp Ophthalmol. Patients may report visual acuity reduction though in many instances choroidal folds themselves are asymptomatic. Hypotony secondary to an ing acquired hyperopia and choroidal the posterior pole of the fundus. Dilated and choroidal fold development and increased Choroidal folds are not a diagnosis, but a hyperpermeable choroidal vessels may intracranial pressure. Choroidal neovascularization or chronic central brought about by prolonged microgravity folds are likely to develop in association serous chorioretinopathy. Choroidal folds in acute stage Vogt Koyanagi Harada disease patients with rela the majority of choroidal folds occur if neuroimaging is unremarkable for an tively short axial length. Choroidal folds and refractive errors tion of chorioretinal folds related maculopathy. Clinicopathologic choroidal folds from an epiretinal mem correlation of choroidal folds: secondary to massive cranio 37. Risk factors for While subluxation of the crystalline lens 42 hypotony maculopathy. Aetiology and man 1 5 roidal folds resolve though there may be agement of choroidal folds. Ethmoid sinus oste syndrome, hyperlysinemia, sulfite oxidase oma presenting as epiphora and orbital cellulitis: case report nosis of exclusion. Furthermore, since the zonules remain attached to the lens capsule, some degree of accommodation persists. Open angle glaucoma appears to be slightly more common than known as simple ectopia lentis) and ectopia is also possible in cases of crystalline lens lens displacement associated with underly lentis et pupillae, both forms of hereditary subluxation, with the primary mechanisms ing systemic disorders. Using eye is compressed in an anterior posterior ally and symmetrically dislocated superior direct illumination, this is seen as an intra direction (such as with impact by a fist or temporally, while the iris and pupil remain pupillary dark crescent against the convex other projectile) and the subsequent dis normal and intact. Dislocation (not ated with congenital disorders varies in include enlarged corneal diameters, micro true subluxation) of the lens may be up pathophysiologic mechanism depend spherophakia and corectopia. About 60% of these individuals of firm apposition between the lens and and/or iridodonesis (tremulousness of the demonstrate ectopia lentis. Spontaneous dislocation of a transparent lens to the anterior chamber a case report. Bilateral spontaneous crystalline lens disloca tion to the anterior chamber: a case report. Anterior axial lens subluxation, pro gressive myopia, and angle closure glaucoma: recognition and uncovers 25% to 50% of the dilated pupil; Marfan syndrome. Reverse pupillary lens edge uncovers greater than 50% of of zonular adherence (often in cases of block following anterior crystalline lens dislocation. Late Management tends to be conserva risk of dislocation into the anterior cham onset lens particle glaucoma in Marfan syndrome. The primary goal is optimization of avoided until surgical consultation can be Subluxation of the lens: etiology and results of treatment. Bilateral posterior dislocation of advanced glaucoma and corneal endothelial dysfunction: a case sidered when functional visual acuity the crystalline lens after a head injury sustained during a seizure. Surgical manage of crystalline lens dislocation into the anterior chamber in a vic ment of lens subluxation in Marfan syndrome. Intraocular ment of pupillary block glaucoma associated with anterior lens subluxation in Marfan syndrome. Management of traumatic crys a rare disease: ectopia lentis and homocystinuria, a Pakistani talline lens subluxation and dislocation. Emergency use of pilo Comparison with the fellow eye in unilat nuclear cataracts. Evaluation of the ent with significantly reduced vision, yet by a dense, milky nuclear opalescence that modified capsular tension ring in cases of traumatic lens sublux ation.

Diseases

• Arthrogryposis multiplex congenita
• Methylmalonicaciduria with homocystinuria, cbl F
• Mitral atresia
• Boomerang dysplasia
• Fibromuscular dysplasia
• Achondroplasia Swiss type agammaglobulinemia
• Sclerosing mesenteritis
• Hypopituitary dwarfism

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This procedure is normally (American English: performed as an emergency intervention when a patient is suffering Appendectomy) from inflammation of the appendix (appendicitis). The proteins embedded in the cell membrane which regulate the Aquaporins flow of water. A polyunsaturated fatty acid present in the membranes of body Arachidonic acid cells. A false object or test result, eg when faulty preparation of a Artefact specimen for microscopic examination allows contamination and a misleading result. The surgical joining together of two arteries (or one artery that has Arterial anastomosis been severed). It is conventionally described by two figures eg 120/70, where the 120 Arterial blood is the pressure at maximum contraction of the heart ventricles pressure (systolic pressure) and the 70 the pressure at the moment of greatest relaxation (diastolic pressure). A hollow tube passed through the skin into an artery in order to Arterial line sample blood, measure pressure and/or deliver injectable material. Aspartate An enzyme normally present in body serum and other tissue, aminotransferase particularly in that of the heart and liver. The star shaped glial cells in the brain and spinal cord which Astrocyte perform many functions including repair of the brain and spinal cord. A muscle relaxant of short to intermediate duration used by anaesthetists in surgery or intensive care. It is used to relax stomach muscles and the diaphragm to permit surgery within the abdominal cavity. A wasting away of an organ or part or a failure to grow to normal Atrophy size in consequence of disease. A drug, prepared originally from the plant Belladonna, which relaxes muscles not under conscious control, particularly those of the intestines, bladder and stomach. It was used as premedication before an anaesthetic but is now rarely used for that purpose. It increases heart rate so may be used to oppose certain other anaesthetic drugs having the opposite effect. It combines amoxicillin, a Augmentin derivative of penicillin and clavulinic acid which enhances its effectiveness. A post mortem assessment or examination of the body to determine Autopsy the cause of death. A drug prescribed to transplant recipients to inhibit rejection of the Azathioprine transplanted tissue. A wide cavity where the arachnoid (a layer of membranes that Basal cistern contain the central nervous system) extends between the two temporal lobes. Situated at the base of the forebrain and strongly connected with the cerebral cortex, Basal ganglia thalamus and other brain areas, they are associated with a variety of functions, including voluntary motor control and procedural learning. Fundal haemorrhage is a sign of trauma or damage to the blood Bilateral fundal vessels at the back of the eye. It is indicative of a lack of oxygen or haemorrhages a catastrophic fall in blood pressure. A device used to measure the partial pressures of oxygen and carbon dioxide in a blood sample. It also measures the acidity of Blood gas analyser blood and gives an indication of the concentrations of electrolytes (chemicals such as sodium) and haemoglobin. A blood test analysing chemicals and providing information about Bone profile the quality of bones. Brain stem death A series of tests performed by two doctors, some hours apart, to test confirm brain stem death. An intravenous catheter most often used for the administration of medication and the withdrawal of blood for analysis. Broviac lines Broviac line may remain in place for extended periods and are used when long term intravenous access is required. The deposit of calcium salts in the body tissue, normally the bones Calcification and teeth. A short, narrow hollow tube which can be inserted into a blood vessel and used to take samples or deliver medication. If a cannula Cannula becomes dislodged allowing fluids to escape and enter tissue outside a blood vessel, then it must be removed and replaced. The terminal vessels uniting the arterial with the venous systems of Capillary the body. It may be measured by holding the hand higher than the heart and pressing the soft pad Capillary refill of a finger until it turns white and noting the time to re colour once pressure is released. A sudden cessation of cardiac function resulting in loss of effective Cardiac arrest circulation. An emergency procedure involving external cardiac massage and Cardiac artificial respiration in an attempt to restore circulation of the blood resuscitation and so prevent death or brain damage from lack of oxygen. One of two paired arteries (left and right) supplying the head and Carotid artery neck with oxygenated blood. Hollow tubes, longer than cannulas, which are inserted into the body, eg cardiac catheters which are passed along a vein into the heart, suprapubic catheters which are inserted above the pubic Catheter bone into the bladder to drain urine, urethral catheters passed into the urethra, ureteric catheters which are passed from the bladder up the ureters to inject material or sample urine from the kidney. Cefotaxime sodium An antibiotic used in the treatment of infections of the respiratory (Claforan) tract. The line can be used to judge heart and circulation function by measuring pressures. A measure of the pressure of blood in one of the main veins draining into the heart (superior or inferior vena cava). A rounded lobule on the under surface of each cerebellar Cerebellar tonsil hemisphere. A region of the brain having an important role in motor control and Cerebellum cognitive function. Cerebral An adaptive mechanism that plays an important role in maintaining autoregulation an appropriate blood pressure within vessels supplying brain tissue. Because the brain is within a rigid skull, any increase in its volume in consequence of oedema causes increased pressure on the brain which in turn, restricts the amount Cerebral oedema of venous blood draining from the brain and further increases the oedema. The eventual result is that parts of the brain are forced by the pressure down through the foramen magnum, the hole in the base of the skull, impairing blood supply to the brainstem and leading to loss of control over the heart, blood pressure and breathing. An umbrella term encompassing a group of non progressive, non Cerebral palsy contagious motor conditions which cause physical disability in human development. A rare form of stroke that results from thrombosis (a blood clot) of Cerebral venous the dural venous sinuses, which drain blood from the brain. Cerebrovascular A group of conditions affecting the circulation of blood to the brain. A sensory receptor that converts chemical signals into electrical Chemoreceptor potential. In more general terms, chemoreceptors detect certain chemical stimuli in the environment. An abnormal pattern of breathing characterized by progressively deeper and sometimes faster breathing, followed by a gradual Cheyne Stokes decline and then a temporary stop called an apnea. The pattern is respiration repeated with each cycle taking between 30 seconds and 2 minutes. A malformation of the brain consisting of a downward displacement Chiari malformation of the cerebellar tonsils through the foramen magnum (the opening at the base of the skull). A part of the brain situate in the medial aspect of the cerebral cortex Cingulate gyrus and considered part of the limbic lobe. The circulating nurse can also assess or measure the amount of blood or other fluids draining from catheters etc. An antibiotic used in the treatment of severe infection of the lung, Claforan throat, ear or urinary tract. A succession of intermittent muscular contractions and relaxations Clonus usually resulting from a sustained stretching stimulus and often a sign of brain or spinal cord disease. The formation of a jellylike substance within a blood vessel causing Clotting a stoppage of the blood flow, also called coagulation. A standard set of blood tests performed in a haematology laboratory Coagulation screen to detect abnormality in the blood clotting system. The tension in a muscle which gives way in little jerks when the Cogwheel rigidity muscle is passively stretched. If a tissue is kept cold, it can withstand ischaemia for longer than at body temperature. It is therefore important when Cold ischaemic time performing a transplant operation to keep the donor organ cold. A substance evenly and microscopically dispersed throughout Colloid another substance. Common iliac Two large arteries originating from the aortic bifurcation at the level th arteries of the 4 lumbar vertebra. The left and right common iliac veins lie on either side of the pelvis, and meet in the lower back, at the level of the fifth lumbar vertebra, Common iliac vein to form the inferior vena cava, the main vein returning blood from the legs & lower trunk to the heart. The presence of one or more disorders (or diseases) in addition to Co morbidity a primary disease or disorder or the effect of such additional disorders or diseases. Congenital A generic term for several conditions characterised by abnormally nephrotic syndrome functioning glomeruli in the kidneys and which are present at birth. Any condition present at birth in which drainage of urine from the Congenital kidney is obstructed at a point between the kidney pelvis and obstructive uropathy urethra. An involuntary contraction or series of contractions of the voluntary Convulsion muscles, also called a seizure. A wide, flat bundle of neural fibres beneath the cortex connecting Corpus callosum the left and right cerebral hemispheres and facilitating inter hemispheric communication. The higher the blood creatinine (and the lower the urinary Creatinine creatinine) the poorer the kidney function. A substance that in solution can pass through a semipermeable membrane and be crystallized. The physical opposite of a Crystalloid crystalloid is a colloid, which does not dissolve and does not form true solutions. It is usually seen in the terminal stages of acute head injury and may indicate imminent brain herniation. The appearance of a blue or purple coloration of the skin or mucous Cyanosis membranes due to reduced oxygen levels within the tissues close to the skin surface. In peritoneal dialysis, fluid is run into the peritoneal cavity (inside of Cycles of dialysis the abdomen) left for a time and then run out again. Morphine belongs to Cyclimorph a group of strong painkilling medicines called opioids and cyclizine is an anti sickness medicine. An immunosuppressant drug used in organ transplantation to Cyclosporine prevent rejection. A protein which when measured in a blood sample provides an Cystatin C accurate assessment of kidney function. To determine if a transplant donor or recipient has been infected, the concentration of antibody to the virus can be measured. If the cerebrum is not functioning adequately as a result of disease, Decerebrate toxin, seizures etc. Inability of the heart to maintain adequate circulation, manifested by Decompensation difficulty in breathing, venous engorgement and oedema. White matter carries information between the nerve cells in the brain and Deep white matter the spinal cord. A deficiency of fluid in the body caused by insufficient intake, excessive output or both.

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