TissuGlu is currently approved for sale in the EU for the approximation of tissue layers where subcutaneous dead space exists between the tissue planes in large flap surgical procedures such as abdominoplasty and is being utilized in Europe to eliminate drains or reduce complications in patients undergoing large flap surgical procedures such as abdominoplasty, mastectomy, ventral hernia repair, decubitus and latissimus dorsi flap procedures.
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Patient positioning is essential to the success of the procedure and can affect how the anesthetic spreads following administration. There are 3 different positions which are used: sitting, lateral decubitus, and prone. The sitting and lateral decubitus positions are the most common. Sitting- The patient sits upright at the edge of the exam table with their back facing the provider and their legs hanging off the end of the table and feet resting on a stool.
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The standard abdominal X-ray protocol is usually a single anteroposterior projection in supine position. Special projections include a PA prone, lateral decubitus, upright AP, and lateral cross-table (with the patient supine). A minimal acute obstructive series (for the purpose of ruling out small bowel obstruction) includes two views: typically, a supine view and an upright view (which are sufficient to detect air-fluid levels), although a lateral decubitus could be substituted for the upright. Coverage on the x-ray should include from the top of the Liver (or diaphragm) to the pubic symphysis.
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Most hip fractures are treated surgically by implanting a prosthesis. Surgical treatment outweighs the risks of nonsurgical treatment which requires extensive bedrest. Prolonged immobilization increases risk of thromboembolism, pneumonia, deconditioning, and decubitus ulcers. Regardless, the surgery is a major stress, particularly in the elderly.
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Aside from scratching, decubitus ulcer and tissues near the shunt site are also leading pathways for infection susceptibility. It is also common to give patients seven days of anti-seizure medications post operatively. Traditionally this has been phenytoin, but now is increasingly levetiracetam as it has a lower risk of drug-drug interactions.
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Anaerobic bacteria are often found in oesteomyelitis of the long bones especially after trauma and fracture, osteomyelitis associated with peripheral vascular disease, and decubitus ulcers and osteomyelitis of the facial and cranial bones.Brook I. Microbiology and management of joint and bone infections due to anaerobic bacteria. J Orthop Sci. 2008; 13:160–9.
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A large bubble of air in the heart (as can follow certain traumas in which air freely gains access to large veins) will present with a constant "machinery" murmur. It is important to promptly place the patient in Trendelenburg position (head down) and on their left side (left lateral decubitus position). The Trendelendburg position keeps a left-ventricular air bubble away from the coronary artery ostia (which are near the aortic valve) so that air bubbles do not enter and occlude the coronary arteries (which would cause a heart attack). Left lateral decubitus positioning helps to trap air in the non-dependent segment of the right ventricle (where it is more likely to remain instead of progressing into the pulmonary artery and occluding it).
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Another option for a free muscle transfer is the latissimus dorsi muscle. A disadvantage is that it can only be harvested with the patient in lateral decubitus or prone position. Therefore, the patient has to be turned during the operation. Advantages of the latissimus dorsi muscle are its reliable anatomy and relatively simple dissection.
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He faced many life-threatening medical problems including the possibility of respiratory failure, urinary tract infection, injury to the urethra or bladder, decubitus ulcers, clots in the leg veins, and malnutrition. Eleanor's nursing care was responsible for Roosevelt's survival. Most of the symptoms resolved themselves, but he was left permanently paralyzed from the waist down.
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The patient is first placed in the right lateral decubitus position. Percussion starts at the midpoint of the left costal margin and is continued upward perpendicular to the left costal margin. Normally, the level of dullness does not extend more than 8 cm above the costal margin and splenomegaly is diagnosed if the dullness extends beyond 8 cm.
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Patients should roll their shoulders and upper back forward. Lateral decubitus- In this position, the patient lays on their side with their back at the edge of the bed and facing the provider. The patient should curl their shoulder and legs and arch out their lower back. Prone- The patient is positioned face down and their back facing upwards in a jackknife position.
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Figure 3. Fluoroscopic picture showing a mild amount of distraction of the hip before insertion of any instruments The procedure is performed with the patient asleep (general anaesthetic) or under spinal anaesthesia. There are two widely used methods, one with the patient on their back (supine) and the other on their side (lateral decubitus). Which is used is down to the surgeon's preference.
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Subjects are examined with and without water contrast. Water contrast imaging is performed by having adult subjects take at least one liter of water prior to examination. Patients are examined in the supine, left posterior oblique, and left lateral decubitus positions using the intercostal and subcostal approaches. The liver, gall bladder, spleen, pancreas, duodenum, colon, and kidneys are routinely evaluated in all patients.
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Symptoms of an acute stroke may also be seen. Echocardiography can be used to visualize air that has become trapped in the chambers of the heart. If a large air embolism is suspected, a syringe can be attached to the catheter cap and pulled pack in an attempt to remove the air from circulation. The patient can also be placed in the left lateral decubitus position.
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Skin involvement in subcutaneous tissue infections includes: cutaneous and subcutaneous abscesses,Meislin HW, Lerner SA, Graves MH, et al. Cutaneous abscesses: anaerobic and aerobic bacteriology and outpatient management. Ann Intern Med 1977; 97:145–50. breast abscess, decubitus ulcers, infected pilonidal cyst or sinus, Meleney's ulcer infected diabetic (vascular or trophic) ulcers, bite wound,Brook I. Management of human and animal bite wound infection: an overview.
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Nosocomial FUO refers to pyrexia in patients that have been admitted to hospital for at least 24 hours. This is commonly related to hospital- associated factors such as surgery, use of a urinary catheter, intravascular devices (i.e. "drip", pulmonary artery catheter), drugs (antibiotic-induced Clostridium difficile colitis, drug fever), and/or immobilization (decubitus ulcers). Sinusitis in the intensive care unit is associated with nasogastric and orotracheal tubes.
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A skin ulcer is often visible in the event of exposure to heat or cold, irritation, or a problem with blood circulation. They can also be caused due to a lack of mobility, which causes prolonged pressure on the tissues. This stress in the blood circulation is transformed to a skin ulcer, commonly known as bedsores or decubitus ulcers. Ulcers often become infected, and pus forms.
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A morning dose of caffeine can also be effective. In mild cases, where the patient is still responsive, laying the person in dorsal decubitus (lying on the back) position and lifting the legs increases venous return, thus making more blood available to critical organs in the chest and head. The Trendelenburg position, though used historically, is no longer recommended. Hypotensive shock treatment always follows the first four following steps.
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Painting of a lying woman Lying, also called recumbency or prostration, or decubitus in medicine (from the Latin verb decumbere 'to lie down'), is a type of human position in which the body is more or less horizontal and supported along its length by the surface underneath. Lying is the most common position while being immobilized (e.g. in bedrest), while sleeping, or while being struck by injury or disease.
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It is best heard at the cardiac apex with the patient in the left lateral decubitus position and holding his breath. The combined presence of S3 and S4 is a quadruple gallop, also known as the "Hello-Goodbye" gallop. At rapid heart rates, S3 and S4 may merge to produce a summation gallop, sometimes referred to as S7. Atrial contraction must be present for production of an S4.
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Patient positioning is of utmost importance to ensure safety of the fetus during the procedure. This is especially important during the third trimester due to the potential of compression of the inferior vena cava leading by the enlarged uterus. Placing the patient in a 30-degree left lateral decubitus position alleviates this pressure and prevents fetal distress. One area of concern related to the LA during pregnancy is pneumoperitoneum.
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Bacteria that are members of the 'normal flora' of the region of the infection are often also isolated from lesions involving anaerobic bacteria. Specimens obtained from wounds and subcutaneous tissue infections and abscesses in the rectal area (perirectal abscess, decubitus ulcer) or that are of gut flora origin(i.e. diabetic foot infection) often to yield colonic flora organisms.Brook I. The role of anaerobic bacteria in cutaneous and soft tissue abscesses and infected cysts. Anaerobe.
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Many of these bone infections are polymicrobial in nature. Cranial and facial bones anaerobic osteomyelitis often originates by the spread of the infection from a contiguous soft-tissue source or from dental, sinus, or ear infection. The high concentration of anaerobic bacteria in the oral cavity explains their importance in cranial and facial bone infections. The high number of gut anaerobes in pelvic osteomyelitis is generally caused by their spread from decubitus ulcers sites.
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Renal biopsy is typically performed by a nephrologist or interventional radiologist. The biopsy is planned with the assistance of ultrasound or CT scanning to visualise the location and depth of the kidneys immediately before the biopsy. In the case of a native kidney biopsy, the procedure will be performed with the patient lying on their stomach (prone) or on their side (lateral decubitus position). For transplant renal biopsy, the patient lies on their back (supine).
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MMP7 is found to potentially involved in tumor metastasis and inflammatory processes. The upregulation of MMP7 is associated with many malignant tumors including esophagus, stomach, colon, liver, pancreas, and renal cell carcinomas. High MMP7 expression facilitates cancer invasion and angiogenesis by degrading extracellular matrix macromolecules and connective tissues. These degradations are associated with many mechanisms including embryogenesis, postpartum uterine involution, tissue repair, angiogenesis, bone remodeling, arthritis, decubitus ulcer, and tumor metastasis/invasion.
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The Charles Mingus composition "Hora Decubitus" initially appeared on the album Mingus Mingus Mingus Mingus Mingus. "Upon A Veil of Midnight Blue" would be recorded by the posthumous Charles Mingus Orchestra, initially written for rhythm and blues singer Charles Brown. "Speak Darkly My Angel" was written for Anne Sofie von Otter and the Brodsky Quartet, while "Put Away Forbidden Playthings" was his contribution to a concert commemorating the death of Henry Purcell.Costello, liners, passim.
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Tissue gas is the name given to the action of the bacteria Clostridium perfringens (formerly known as C. welchii) in dead bodies. Its effect on the deceased is that of an extremely accelerated decomposition. It is only halted by embalming the body using special additive chemicals. It most commonly occurs in the bodies of people who have died of gangrene, large decubitus ulcers, necrotising fasciitis or who have had soil, faeces or water forced into wounds.
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Animal studies conducted in 2004-2005 have demonstrated the effectiveness of TCOT on Rabbit ear wounds. A recently published study documented two prevented amputations which have shown TCOT to be highly effective on diabetic foot ulcers, venous stasis and decubitus ulcers and a study completed in 2010 by Dr. Gary Sibbald documented the effectiveness of TCOT on 9 diabetic foot ulcer patients. Manufacturers of devices used in TCOT have published several additional cases whereby treatment using TCOT prevented previously scheduled amputations.
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The presence of the gastric bubble on the left with an abnormalagm of more than 2 cm can also suggest the diagnosis. Lateral decubitus views, with the patient lying on their side, can confirm the effusion as it will layer along the lateral chest wall. Subpulmonic space refers to the space below the lungs in which the subpulmonic fluid fills. Subpulmonic fluid is common particularly in trauma cases where the apparent hemidiaphragm appears defieted and the apex is displaced laterally.
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Treatment consists primarily of supportive care including providing bowel rest by stopping enteral feeds, gastric decompression with intermittent suction, fluid repletion to correct electrolyte abnormalities and third-space losses, support for blood pressure, parenteral nutrition, and prompt antibiotic therapy. Monitoring is clinical, although serial supine and left lateral decubitus abdominal X-rays should be performed every six hours. As an infant recovers from NEC, feeds are gradually introduced. "Trophic feeds" or low- volume feeds (<20 ml/kg/day) are usually initiated first.
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Both agents are administered by lumbar puncture (also referred to as a spinal tap or cisternal puncture), at the cervicocranial junction. The human patient is rolled from the lateral decubitus (lying on the side) to prone. Ankles are strapped to the end of a hard X-ray, CT, or MRI table. To obtain images of the cervical region the patient is then carefully tilted in the Trendelenberg position (head down) so the contrast agent (particularly Pantopaque) can enter the neck region.
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Fear of eating is commonly seen among those with the chronic form of SMA syndrome. For many, symptoms are partially relieved when in the left lateral decubitus or knee-to- chest position, or in the prone (face down) position. A Hayes maneuver, which corresponds to applying pressure below the umbilicus in cephalad and dorsal direction, elevates the root of the SMA, also slightly easing the constriction. Symptoms can be aggravated when leaning to the right or taking a face up position.
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Mitral stenosis typically presents as a diastolic low-pitched decrescendo murmur best heard at the cardiac apex in the left lateral decubitus position. It may be associated with an opening snap. Increasing severity will shorten the time between S2(A2) and the opening snap. (i.e. In severe MS the opening snap will occur earlier after A2) Tricuspid valve stenosis presents as a diastolic decrescendo murmur at the left lower sternal border, and signs of right heart failure may be seen on exam.
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A subpulmonic effusion is excess fluid that collects at the base of the lung, in the space between the pleura and diaphragm. It is a type of pleural effusion in which the fluid collects in this particular space, but can be "layered out" with decubitus chest radiographs. There is minimal nature of costophrenic angle blunting usually found with larger pleural effusions. The occult nature of the effusion can be suspected indirectly on radiograph by elevation of the right diaphragmatic border with a lateral peak and medial flattening.
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The left lateral decubitus position also prevents the air from passing through a potentially patent foramen ovale (present in as many as 30% of adults) and entering the left ventricle, from which it could then embolise to distal arteries (potentially causing occlusive symptoms such as stroke).Brunicardi, F. Schwartz's Principles of Surgery, 9th Ed, McGraw Hill, 2009. p. 144 Administration of high percentage oxygen is recommended for both venous and arterial air embolism. This is intended to counteract ischaemia and accelerate bubble size reduction.
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Foreign body aspiration of a coin If foreign body aspiration is suspected, finger sweeping in the mouth is not recommended due to the increased risk of displacing the foreign object further into the airway. Most patients receive a chest x-ray to determine the location of the foreign body. However, a negative chest x-ray cannot rule out foreign body aspiration. Lateral neck, chest, and bilateral decubitus end-expiratory chest x-rays should be obtained in patients suspected of having aspirated a foreign body.
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For example, the Waterlow score and the Braden scale deals with a patient's risk of developing a Pressure ulcer (decubitus ulcer), the Glasgow Coma Scale measures the conscious state of a person, and various pain scales exist to assess the "fifth vital sign". The use of medical equipment is routinely employed to conduct a nursing assessment. These include, the otoscope, thermometer, stethoscope, penlight, sphygmomanometer, bladder scanner, speculum, and eye charts. Besides the interviewing process, the nursing assessment utilizes certain techniques to collect information such as observation, auscultation, palpation and percussion.
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Methods in preventing amputation, limb-sparing techniques, depend on the problems that might cause amputations to be necessary. Chronic infections, often caused by diabetes or decubitus ulcers in bedridden patients, are common causes of infections that lead to gangrene, which would then necessitate amputation. There are two key challenges: first, many patients have impaired circulation in their extremities, and second, they have difficulty curing infections in limbs with poor vasculation (blood circulation). Crush injuries where there is extensive tissue damage and poor circulation also benefit from hyperbaric oxygen therapy (HBOT).
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An S3 heart sound is best heard with the bell-side of the stethoscope (used for lower frequency sounds). A left-sided S3 is best heard in the left lateral decubitus position and at the apex of the heart, which is normally located in the 5th left intercostal space at the midclavicular line. A right-sided S3 is best heard at the lower- left sternal border. The way to distinguish between a left and right-sided S3 is to observe whether it increases in intensity with inhalation or exhalation.
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Anaerobic gram-positive cocci and microaerophilic streptococci are often recovered in polymicrobial skin and soft tissue infections, such as gangrene, fasciitis, ulcers, diabetes-related foot infections, burns, human or animal bites, infected cysts, abscesses of the breast, rectum, and anus. Anaerobic gram-positive cocci and microaerophilic streptococci are generally found mixed with other aerobic and anaerobic bacteria that originate from the mucosal surface adjacent to the infected site or that have been inoculated into the infected site. Peptostreptococcus spp. can cause infections such as gluteal decubitus ulcers, diabetes-related foot infections, and rectal abscesses.
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This cycle, which is controlled by the autonomic nervous system, has a mean duration of two and a half hours. He further observed and documented that the turbinates in the dependent nasal fossa fill when the patient is in the lateral decubitus (lying down on your side) position. Some postulate that this alternating positional obstruction has the purpose of causing a person to turn from one side to the other while sleeping in order to prevent bedsores. Others note that the asymmetric airflow may have some benefit to overall olfactory sensitivity.
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In the US, chest radiography includes a PA and Lateral with the patient standing or sitting up. Special projections include an AP in cases where the image needs to be obtained stat and with a portable device, particularly when a patient cannot be safely positioned upright. Lateral decubitus may be used for visualization of air-fluid levels if an upright image cannot be obtained. Anteroposterior (AP) Axial Lordotic projects the clavicles above the lung fields, allowing better visualization of the apices (which is extremely useful when looking for evidence of primary tuberculosis).
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Queckenstedt's maneuver is a clinical test, formerly used for diagnosing spinal stenosis. The test is performed by placing the patient in the lateral decubitus position, thereafter the clinician performs a lumbar puncture. The opening pressure is measured. Then, the clinician's assistant compresses both jugular veins (if increased intracranial pressure is not suspected then one may exert pressure on both external jugular veins but usually pressure is first exerted on the abdomen, this pressure causes an engorgement of spinal veins and in turn rapidly increases cerebrospinal fluid pressure), which leads to a rise in the intracranial pressure.
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Though early use focused on burns and surgical wounds, wider use of wounds treated with TCOT have become more common in diabetic foot ulcers, venous stasis and decubitus ulcers(pressure sores). TCOT involves inserting a thin tube which delivers the oxygen above the wound bed of a cleaned wound. An absorbent dressing is then placed above the tube and an occlusive or semi occlusive dressing is placed over the entire wound site. The far end of the tube is connected to an oxygen delivery unit, often portable, which delivers oxygen at a slow rate, typically 3ml per hour.
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In medicine, shifting dullness refers to a sign elicited on physical examination for ascites (fluid in the peritoneal cavity).Murray Longmore, Ian B. Wilinson, Edward H. Dawvidson, Alexander Foulkes and Ahmad R. Mafi Oxford Handbook of Clinical Medicine 8thEdition Oxford University Press 2010 The two steps of shifting dullness. Percussion of the green section shifts from a dull note to a tympanic note after the patient changes from supine to lateral decubitus position. The test is performed by first percussing the midline of the abdomen to elicit a resonant note due to gas in the abdomen.
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On 9 September 1967, Kramminger crashed his car into a high voltage mast while driving tired and was thrown twenty metres out of his car. He had compression fractures on his fifth, sixth and seventh thoracic vertebrae and spent eleven months in a hospital in Bietigheim then was moved to five different hospitals in a span of five years. When he arrived at the Vienna General Hospital, he had a decubitus on his buttocks and was transferred to a rehabilitation centre in Tübingen. In 1972, his left leg got amputated followed by his right kidney, bladder, rectum and his right leg in 1985.
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Obeng was born in Ghana in 1973. At age 15, he met medical professionals from Operation Smile, who helped a neighbor whose husband had thrown acid on her face by providing her with scar revision therapy. When asked about this experience, Obeng stated " That, coupled with the premature death of my mother and grandmother due to complications of decubitus ulcer, propelled me to seek a career as a physician and a plastic surgeon...". At age 20, Obeng immigrated to the United States with less than $200 to attend undergrad at Midwestern State University in Wichita Falls, Texas.
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The indium white blood cell scan, is a nuclear medicine procedure in which white blood cells (mostly neutrophils) are removed from the patient, tagged with the radioisotope Indium-111, and then injected intravenously into the patient. The tagged leukocytes subsequently localize to areas of relatively new infection. The study is particularly helpful in differentiating conditions such as osteomyelitis from decubitus ulcers for assessment of route and duration of antibiotic therapy. In imaging of infections, the gallium scan has a sensitivity advantage over the indium white blood cell scan in imaging osteomyelitis (bone infection) of the spine, lung infections and inflammation, and in detecting chronic infections.
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It is no longer recommended to administer aspirin, unless advised to do so by medical personnel, as analgesics may mask symptoms. People should be made comfortable and placed in the supine position (horizontal), or the recovery position if vomiting occurs. In the past, both the Trendelenburg position and the left lateral decubitus position (Durant's maneuver) have been suggested as beneficial where air emboli are suspected, but are no longer recommended for extended periods, owing to concerns regarding cerebral edema. The duration of recompression treatment depends on the severity of symptoms, the dive history, the type of recompression therapy used and the patient's response to the treatment.
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The goal of medical treatment for SMA syndrome is resolution of underlying conditions and weight gain. Medical treatment may involve nasogastric tube placement for duodenal and gastric decompression, mobilization into the prone or left lateral decubitus position,Dietz UA, Debus ES, Heuko-Valiati L, Valiati W, Friesen A, Fuchs KH, Malafaia O, Thiede A: Aorto-mesenteric artery compression syndrome. Chirurg 2000;71:1345–51 the reversal or removal of the precipitating factor with proper nutrition and replacement of fluid and electrolytes, either by surgically inserted jejunal feeding tube, nasogastric intubation, or peripherally inserted central catheter (PICC line) administering total parenteral nutrition (TPN). Pro-motility agents such as metoclopramide may also be beneficial.
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Sloughing (pronounced "sluffing") in biology refers to the act of shedding or casting off dead tissue, such as cells of the endometrium, shed during menstruation, or the shedding of skin in amphibians. Skin sloughing is the process of shedding dead surface cells from the skin. In veterinary medicine, it may refer to the process where necrotic surface epithelial cells are discarded from the small intestinal mucosa following various infections which may occur within both monogastrics or ruminants. In medicine, slough may start occurring in pressure ulcers also known as decubitus ulcers or as bed sores at the stage 3, and in stage 4 levels of wound, infection, and damage.
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Fluid in space between the lung and the chest wall is termed a pleural effusion. There needs to be at least 75 mL of pleural fluid in order to blunt the costophrenic angle on the lateral chest radiograph and 200 mL of pleural fluid in order to blunt the costophrenic angle on the posteroanterior chest radiograph. On a lateral decubitus, amounts as small as 50ml of fluid are possible. Pleural effusions typically have a meniscus visible on an erect chest radiograph, but loculated effusions (as occur with an empyema) may have a lenticular shape (the fluid making an obtuse angle with the chest wall).
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Stage IV decubitus Pressure ulcers, also known as pressure sores or bed sores, are localised damage to the skin and/or underlying tissue that usually occur over a bony prominence as a result of usually long-term pressure, or pressure in combination with shear or friction. The most common sites are the skin overlying the sacrum, coccyx, heels, and hips, though other sites can be affected, such as the elbows, knees, ankles, back of shoulders, or the back of the cranium. Pressure ulcers occur due to pressure applied to soft tissue resulting in completely or partially obstructed blood flow to the soft tissue. Shear is also a cause, as it can pull on blood vessels that feed the skin.
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In 1961, Dolphy left Mingus' band and went to Europe for a few months, where he was recorded in Scandinavia and Berlin. (See Berlin Concerts, The Complete Uppsala Concert, Eric Dolphy in Europe Volumes 1, 2, and 3 (1 and 3 were also released as Copenhagen Concert), and Stockholm Sessions.) He was later among the musicians who worked on Mingus Mingus Mingus Mingus Mingus in 1963, and is featured on "Hora Decubitus". In early 1964, he joined Mingus' working band again, along with Jaki Byard, Johnny Coles, and Clifford Jordan. This sextet worked at the Five Spot before playing at Cornell University and Town Hall in New York (both were recorded: Cornell 1964 and Town Hall Concert) and subsequently touring Europe.
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The presence of human burials in the site is attested by the excavation of a small sepulchral cave immediately near the village, in the escarpment of its south-east side, which provided remains of a minimum of four individuals, animal bones and part of the grave goods that are with the buried. On the other side, in its westernmost southern slope, in the space delimited by a wide wall and by different stone courses that follow along the outer slope, a circular grave was excavated that contained another human burial, under a sedimentation of more than of depth. The buried was in fetal position, right lateral decubitus, with the legs folded and the feet crossed. The right arm was elongated behind the back and the hand crushed by a block.
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Povidone- iodine exhibits longer lasting antiseptic effects than tincture of iodine, due to its slow absorption via soft tissue, making it the choice for longer surgeries. Chlorhexidine provides superior results with equivalent adverse events. Consequently, PVP-I has found broad application in medicine as a surgical scrub; for pre- and post-operative skin cleansing; for the treatment and prevention of infections in wounds, ulcers, cuts and burns; for the treatment of infections in decubitus ulcers and stasis ulcers; in gynecology for vaginitis associated with candidal, trichomonal or mixed infections. For these purposes PVP-I has been formulated at concentrations of 7.5–10.0% in solution, spray, surgical scrub, ointment, and swab dosage forms; however, use of 10% povidone-iodine though recommended, is infrequently used, as it is poorly accepted by health care workers and is excessively slow to dry.
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Once a pleural effusion is diagnosed, its cause must be determined. Pleural fluid is drawn out of the pleural space in a process called thoracentesis, and it should be done in almost all patients who have pleural fluid that is at least 10 mm in thickness on CT, ultrasonography, or lateral decubitus X-ray and that is new or of uncertain etiology. In general, the only patients who do not require thoracentesis are those who have heart failure with symmetric pleural effusions and no chest pain or fever; in these patients, diuresis can be tried, and thoracentesis is avoided unless effusions persist for more than 3 days. In a thoracentesis, a needle is inserted through the back of the chest wall in the sixth, seventh, or eighth intercostal space on the midaxillary line, into the pleural space.
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High-voltage pulsed galvanic stimulation (HGVS) has been shown to be of prophylactic benefit, to reduce the incidence of attacks. The patient is usually placed in the left lateral decubitus position and a sterile probe is inserted into the anus. The negative electrode is used and the stimulator is set with a pulse frequency of 80 to 120 cycles per second. The voltage (intensity) is started at 0, progressively raised to a threshold of patient discomfort, and then is decreased to a level that the patient finds comfortable. As the patient's tolerance increases, the voltage can be gradually increased to 250 to 350 Volts. Each treatment session usually lasts between 15 and 60 minutes. Several studies have reported short-term success rates that ranged from 65 to 91%.Sohn N, Weinstein MA, Robbins RD. The levator syndrome and its treatment with high-voltage electrogalvanic stimulation. Am J Surg. 1982;144(5):580-582.
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