Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0344329 (collapse)
 28,634 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Obstructive sleep apnea is a serious medical problem producing both physical and behavioral derangement. It is essential to provide a thorough workup and evaluation of all patients seeking care for snoring or OSA. Polysomnography is the standard for evaluation and assessment of the severity of OSA in every patient. The evaluation and workup for surgical intervention should include a thorough history, complete head and neck evaluation, nasopharyngeal laryngoscopy with a flexible fiberoptic endoscope, and appropriate imaging (e.g., cephalometrics). This workup allows pathologic entities of the upper airway (e.g., neoplasia, cysts) to be ruled out and regions of disproportionate anatomy (e.g., large soft palate, uvula, base of tongue, and a hypoplastic mandible) to be documented. Treatment of site-specific based on the finding of the evaluation. Treatment of snoring is often addressed by more conservative palatal procedures such as LAUP, RVTR, or electrocautery of the soft palate. The more aggressive palatal procedures such as UPPP are generally reserved for OSA. Nasal airway reconstruction may aid in the treatment of OSA, because increased nasal resistance and obstruction may significantly increase the negative pressure of the upper airway, leading to collapse of the velopharyngeal, base-of-tongue, and hypopharyngeal regions. Children with OSA usually respond well to adenotonsillectomy. Occasionally, uvulopalatopharyngeal procedures may be necessary. Craniofacial anomalies and significant skeletal anomalies such as severe mandibular hypoplasia have historically been problematic. Tracheostomies were at one time the only way to secure the airway in these patients. New developments in distraction osteogenesis have enabled mandibular lengthening and airway improvement, leading to earlier decannulation of these patients. The combined phase I and phase II treatment has a success rate of greater than 90%. Phase I treatment may include nasal reconstruction, uvulopalatopharyngeal, base-of-tongue, and hypopharyngeal surgery. Phase I surgery has a documented success rate of about 70% to 80%. Phase II surgery (MMA) has a success rate approaching 100%. In certain cases, MMA may be used as the primary treatment of OSA.
 ...
PMID:Surgical management for snoring and sleep apnea. 1169 45

US policy on refugees was developed as an ad hoc response to the problem of displaced persons in Europe following the Second World War and quickly became a foreign policy tactic to be manipulated in the context of the Cold War political struggle. It was not until 1980 that the US formally adopted an asylee policy in legislative forum. That policy, too, was affected by the Cold War. The dismantlement of the Berlin Wall in 1989 and the subsequent collapse of the Soviet Union in 1991, however, have radically changed the dynamics of refugee and asylee issues. Refugee and asylee pressures are increasingly being linked with the broader worldwide issues of population growth, unbalanced economic development, and migration pressures. New refugee and asylum policies are required in the new world order which are not predicated upon the need to respond to communism. These policies must be reserved for truly persecuted individuals. The author discusses the creation of an asylum policy, mass asylum, and pending policy reforms. The refugee system provides a means of access for many people looking to escape the poverty, unemployment, and destitution of their homeland. Asylum policy is the most vulnerable element of refugee policy for exploitation. To alleviate the economic forces which lie at the core of asylum abuse will require more fundamental policies than the procedural changes currently under consideration by Congress or those proposed by President Clinton. Among them must be policies which promote family planning and provide the means for its practice; expand commitments to economic development assistance; and link trade access to the US marketplace and the receipt of foreign aid to the strict adherence of internationally specified human rights practices.
 ...
PMID:U.S. asylum policy and the New World Order. 1234 56

In 1891, Paul Ehrlich began investigating the possible antimalarial effects of methylene blue. His studies prompted other such studies with antimalarials, including pheno-thiazine analogues of the dye. One of these analogues, fenethazine, was found to be a potent antihistamine, and was well received by clinicians as an antiallergic drug. Homologues of fenethazine, although found to be weak antihistamines, had pronounced anticholinergic effects and were used successfully in the treatment of Parkinson's disease. Henri Laborit's search to find a drug that would be of value in preventing the traumatic consequences of shock caused by circulatory collapse during surgery led him to discover the important effects that antihistamines, particularly promethazine, had on the central nervous system. Investigations of centrally acting phenothiazines suitable to Laborit's requirements, with more sedating properties, eventually led to the development of chlorpromazine and its use as an antipsychotic drug. (c) 2002 Prous Science. All rights reserved.
 ...
PMID:The 50th Anniversary of Chlorpromazine. 1267 84

Alveolar recruitment represents a challenging issue in ALI/ARDS patients. Multiple techniques have been compared: intermittent sighs, sustained application of high pressure in single or multiple episodes, use of progressive higher PEEP and lower tidal volumes (VT), with a fixed upper limit, and increase of PEEP, without modifying VT. Encouraging results emerge also from the use of prone position, that allows a better distribution of transalveolar forces, thus reducing ventilator induced lung injury. Moreover the use of spontaneous breathing, such as Bi-PAP mode, enhances re-expansion of dorsal lung regions and intriguing, but still uncertain results derive from biological variability of ventilatory pattern. Finally, a pressure-volume (P-V) curve of respiratory system can be employed to set appropriate PEEP level, to prevent collapse of new recruited alveoli. To monitor alveolar recruitment we can use P-V curves, continuous intra-arterial gas analysis, electrical impedence tomography. It is worth noting that different recruiting techniques are characterised by different efficacy and adverse hemodynamic effects. In conclusion, The "Open lung" approach should not be applied to every patient; it should be reserved to restore lung volume if deterioration occurs, by means of adequate PEEP level and lowest acceptable FiO(2).
 ...
PMID:How to recruit the injured lung. 1276 7

This review focuses on possible pathophysiology of exercise-associated hyponatraemia and its implication on evaluation and treatment of collapsed athletes during endurance events. Rehydration guidelines and field care have traditionally been based on the belief that endurance events create a state of significant fluid deficit in athletes, which must be corrected by liberal hydration. Beliefs in the necessity of liberal hydration may have contributed to cases of hyponatraemia. Assumptions that fluid loss accounts for the entire weight loss during exercise and that fluid ingestion is the only source of water gain during exercise may lead to an overestimation of the degree of volume depletion and the amount of fluid needed for replacement. Increasing evidence suggests that hyponatraemic athletes are fluid overloaded; ingestion of large amount of hypotonic fluid in combination with inappropriate or inadequate physiological responses leads to excessive retention of free fluid. Risk factors include hot weather, female sex, slower finishing time, and possibly the use of nonsteroidal anti-inflammatory medications. Symptoms of hyponatraemia can be subtle and can mimic those of other exercise-related illnesses, thereby complicating its diagnosis and leading to possible inappropriate treatment. Most athletes who collapse at the finish line experience exercise-associated collapse, a benign and transient form of postural hypotension that can be treated simply by continued ambulation after finishing or elevation of legs while in a supine position for those who cannot walk. Care providers should consider the use of intravenous hydration with normal saline carefully since it is not needed by most collapsed athletes and may worsen the condition of patients with unsuspected hyponatraemia. Historic information and clinical signs of volume depletion should be elicited prior to its use. Most hyponatraemic athletes will recover uneventfully with careful observation while awaiting spontaneous diuresis. Use of hypertonic saline should be reserved for patients with severe symptoms. Moderate consumption of carbohydrate-electrolyte solution during exercise may allow the maintenance of adequate hydration and the prevention of hyponatraemia.
 ...
PMID:Recommendations for treatment of hyponatraemia at endurance events. 1504 15

Surgical therapies for the treatment of pulmonary arterial hypertension typically are reserved for patients who are deemed to be refractory to medical therapy and have evidence of progressive right-sided heart failure. Atrial septostomy, a primarily palliative procedure, may stave off hemodynamic collapse from right-sided heart failure long enough to permit a more definitive surgical treatment such as lung or combined heart-lung transplantation. This article discusses indications for and results of atrial septostomy and lung and heart-lung transplantation in patients who have pulmonary arterial hypertension.
 ...
PMID:Surgical therapies for pulmonary arterial hypertension. 1733 35

Athletes sometimes collapse either during or after exercise. Conditions that cause collapse during exercise may be life-threatening and account for 10-15% of all exercise-related medical encounters at endurance sporting events. These conditions are not always 'sports-specific' and are managed according to the usual clinical care guidelines. The majority (>85%) of exercise-related collapse occurs after athletes have completed the event and key features are that patients are fully conscious and they have no clinical evidence for other serious medical conditions, but they have postural hypotension (blood pressure usually <100mm Hg) with unexpectedly low heart rates (<100 beats per minute). The cause of the postural hypotension appears to be the combination of physiological changes induced by exercise that tend to maintain a state of abnormally low peripheral vascular resistance for some hours after exercise. The most appropriate treatment for these patients is the supine position with the legs and pelvis above the level of the heart. Additional therapeutic interventions should be reserved for those who fail to respond adequately (blood pressure >100mm Hg; normal heart rate) to this simple treatment.
 ...
PMID:Reduced peripheral resistance and other factors in marathon collapse. 1746 14

Recent advancements in barrier membranes, bone grafting substitutes, and surgical techniques have led to a predictable arsenal of treatment methods for clinicians who practice implant dentistry. The contemporary clinician is supplied with proven knowledge, substantiated materials, and instrument inventory that allows implant placement in cases that used to be reserved for the specialist in the past because of their complexity. Nowadays, postextraction alveolar ridge maintenance can be a predictable procedure and can certainly aid the clinician in preventing ridge collapse, thereby allowing for implant placement in a position that satisfies esthetics and function. Extraction socket maintenance for future implant therapy does not rule out immediate implant placement but rather provides an additional option when treatment planning implant patients. This article will focus on the concept of extraction socket preservation using regenerative materials. It will describe a technique suggested by the authors to resist bone resorption and soft tissue shrinkage following tooth extraction.
 ...
PMID:Preserving the socket dimensions with bone grafting in single sites: an esthetic surgical approach when planning delayed implant placement. 1767 82

Upper airway surgery is an important treatment option for patients with obstructive sleep apnea (OSA), particularly for those who have failed or cannot tolerate positive airway pressure therapy. Surgery aims to reduce anatomical upper airway obstruction in the nose, oropharynx, and hypopharynx. Procedures addressing nasal obstruction include septoplasty, turbinectomy, and radiofrequency ablation (RF) of the turbinates. Surgical procedures to reduce soft palate redundancy include uvulopalatopharyngoplasty, uvulopalatal flap, laser-assisted uvulopalatoplasty, and RF of the soft palate with adenotonsillectomy. More significant, however, particularly in cases of severe OSA, is hypopharyngeal or retrolingual obstruction related to an enlarged tongue, or more commonly due to maxillomandibular deficiency. Surgeries in these cases are aimed at reducing the bulk of the tongue base or providing more space for the tongue in the oropharynx so as to limit posterior collapse during sleep. These procedures include genioglossal advancement, hyoid suspension, distraction osteogenesis, tongue RF, lingualplasty, and maxillomandibular advancement. Successful surgery depends on proper patient selection, proper procedure selection, and experience of the surgeon. Most surgeries are done in combination and in a multistep manner, with maxillomandibular advancement typically being reserved for refractory or severe OSA, or for those with obvious and significant maxillomandibular deficiency. Although not without risks and not as predictable as positive airway pressure therapy, surgery remains an important therapeutic consideration in all patients with OSA. Current research aims to optimize the success of these procedures by identifying proper candidates for surgery, as well as to develop new invasive procedures for OSA treatment.
 ...
PMID:Surgical treatment of obstructive sleep apnea: upper airway and maxillomandibular surgery. 1825 Feb 12

Fractures of the talus are rare and generally associated with severe trauma. The mechanism of injury is usually forced dorsiflexion or a fall from a height. Severe talar fractures pose a challenge for surgeons as they are often associated with complications such as avascular necrosis, collapse, malunion, secondary osteoarthritis and pain. This has led some institutions to advocate primary arthrodesis for these injuries. We report an unusual complex fracture of the talus that was successfully managed with open reduction and internal fixation. By restoring a near-normal range of motion and function to a fit, young male, the severely limiting effects of arthrodesis were avoided or at least delayed. We use this case to highlight that primary arthrodesis should only be reserved for cases that fail to respond to open reduction and internal fixation or deteriorate to the point where it is the only reasonable and justifiable alternative.
 ...
PMID:Open reduction and internal fixation for concomitant talar neck, talar body, and medial malleolar fractures: a case report. 1939 7


<< Previous 1 2 3 4 Next >>