Female pattern hair loss is a common form of hair loss in women that increases in incidence with age. The etiology is unknown with numerous factors identified that influence its onset. Female pattern hair loss may be viewed as a marker for an increased risk of cardiovascular and metabolic disease. New treatments include microneedling, low-level laser therapy, and autologous fat transfer. This article focuses on the pathophysiology, diagnosis, systemic associations, and current treatments for female pattern hair loss, which is the most common cause of alopecia in women.
Background Adams-Oliver syndrome is characterized by the combination of congenital scalp defects and terminal transverse limb defects. In some instances, cardiovascular malformations and orofacial malformations have been observed. Little is written with regards to the anesthetic management and airway concerns of patients with Adams-Oliver syndrome. Case presentation A five-year-old female with Adams-Oliver syndrome presented for repeat lower extremity surgery. Airway exam was significant for dysmorphic features, such as hypertelorism, deviated jaw, and retrognathia. Video laryngoscope was utilized for intubation due to the patients retrognathic jaw, cranial deformities, and facial dysmorphism. A vein finder with ultrasound guidance was needed to place the peripheral intravenous line due to her history of difficult intravenous access. The patient was successfully intubated with slight cricoid pressure applied to direct the endotracheal tube smoothly. Surgery and recovery were both unremarkable. Conclusions Due to varying presentations of Adams-Oliver syndrome, anesthetic and airway management considerations should be carefully assessed prior to surgery. Anesthesiologists must take into consideration possible orofacial abnormalities that may make intubation difficult. Amniotic band syndrome and other limb defects could potentially impact intravenous access as well.
Background Spinal arteriovenous malformations in children are extremely rare and pose great risk for intraoperative hemorrhage. Congenital syphilis sometimes presents with vascular symptoms, however, there is little published on patients with a history of congenital syphilis presenting with spinal arteriovenous malformations. Case presentation A 15-month-old female with a history of congenital syphilis presented with urinary retention, fever, and subacute onset of paraplegia. MRI showed a lesion at T8-L1, angiogram was performed which confirmed the presence of a complex type IVc arteriovenous malformation and fistula from Artery of Adamkiewicz at L1-L2. It also showed peri medullary dilated veins and a pseudoaneurysm that compressed the spinal cord at T8-T10. Somatosensory evoked potentials and motor-evoked potentials were not recordable on the bilateral lower extremities prior to surgery. Once the patient was optimized for surgery, osteoplastic laminotomies from T6-T12 were performed. The dura was opened and the intradural, intramesenchymal hematoma was evacuated. There were two episodes of brisk arterial bleeding with hypotension during resection of the hematoma. The patient was taken to the angiography suite from the OR to successfully coil the large aneurysm. Intraoperative spinal cord monitoring remained undetectable in the bilateral lower extremities. The patient’s paraplegia remained unchanged from preoperative presentation. Conclusion Congenital syphilis may present with vascular changes that might impact surgical approaches and treatment outcomes in patients with spinal arteriovenous malformations. Preparation for massive transfusion and intraoperative monitoring are imperative in ensuring a safe perioperative experience.
Schlüsselwörter: Arterie, Stenose, Doppier, Ultraschall, Roboter Es wird eine Methode zur Erkennung klinisch stummer Stenosen vorgestellt. Sie basiert auf einem mehrkanaligen, gepulsten Dopplerultraschallgerät mit einer Frequenz von 4,1 MHz. Pulsrepetitionsfrequenz, zeitliche und örtliche Auflösung des Gerätes sind in einem begrenzten Rahmen wählbar. Ein computergesteuerter Roboter positioniert den Ultraschallwandler und erleichtert die Erfassung des Gefäßverlaufes, der Gefäßgeometrie und der Dopplerdaten. An Göttinger Miniaturschweinen werden in der A. femoralis rechts mittels Plastik-Konstriktoren Stenosen mit Lumeneinschränkungen von 30, 50 und 65 % erzeugt. Für den proximalen und distalen Bereich der stenosierten und der gesunden kontralateralen A. femoralis werden aus dem Doppler-Signal die Frequenzspektren, die Gschwindigkeit und der Fluß berechnet. Aus den Resultaten geht hervor, daß die Geschwindigkeitsprofile als Funktion des Ortes die zuverlässigste Basis bilden für die Erkennung von Stenosen mit Lumeneinschränkung ^30%. Die normierte Spektralbreite des Doppier-Signals aus der Gefäßmitte ermöglichte die Erkennung von Stenosen mit Lumeneinschränkung i?50 %. A method for detecting presymptomatic arterial stenoses is presented. It is based on a multichannel pulsed doppler ultrasound Instrument employing a frequency of 4.1 MHz. Pulse repetition frequency, spatial and temporal resolution of the Instrument can be varied within certain limits. A computer-assisted robot positions the transducer and facilitates the acquisition of vessel axis and vessel geometry, äs well äs the doppler signal. Plastic constrictors were placed around the femoral arteries of Göttinger minipigs in order to produce lumen area reductions of 30, 50 and 65 %. The doppler Information obtained from the proximal and distal part of the stenosed femoral artery and from the healthy contralateral femoral artery was used to calculate the doppler spectra, the velocity and the volume flow rate. The results show that the velocity profiles äs a function of the location along the vessel axis provides the most reliable basis for the detection of stenoses =30 %. The normalized width of the doppler spectrum from the center of the lumen permits the detection of stenoses ^50 %.
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