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This chapter sets out the most promising modern directions of research in the field of magnetic resonance imaging. These include multinuclear studies aimed at the exploration of magnetic resonance (MR) image contrast induced by exogeneous (fluorine-19, hyperpolarized noble gases) and “built-in” (phosphorus-31, sodium-23) contrast agents for potential clinical benefits. The chapter covers electrodynamic elements of MR scanners that increase signal-to-noise ratio in low-field magnetic resonance imaging (MRI), hyperpolarization techniques that allow several orders of magnitude improved sensitivity in low-field MRI, as well as MRI methods to study dynamics of pharmaceuticals introduced into the body. Special attention is given to MRI methods based upon magnetization transfer aimed at the detection of myelination defects of axons in the brain and functional MRI characterizing brain dynamic response to external stimuli.
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Fluid compartments in the human body are divided between the intracellular and extracellular spaces. The extracellular space constitutes about one-third of total body water, which is further divided into intravascular plasma volume (25%) and the extravascular interstitial space (75%). The fluid balance between these compartments is maintained by hydrostatic pressures and oncotic pressures described by Starling. The other two factors that play an important role in fluid balance are vessel wall permeability and the lymphatic system. The lymphatic system collects fluid and filtered proteins from the interstitial space and returns that back to the vasculature. Any disturbance in this delicate homeostasis that results in net filtration out of the vascular space or impaired return of fluid by lymphatics leads to the accumulation of fluid in the interstitial space that is called edema. Edema can affect any part of the body and ranges from local swelling to full-blown anasarca, depending on the underlying pathology. A classic example of local swelling is an insect bite. An example of anasarca can be seen in nephrotic syndrome.[1] Edema, other than localized edema, does not become clinically apparent until the interstitial volume has increased by 2.5 to 3 liters because the tissues constituting the interstitium can easily accommodate several liters of fluid. Therefore, a patient's weight may increase by nearly 10% before pitting edema is evident.
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Lipedema is a condition where there is abnormal, increased deposition of adipose tissue in the subcutaneous tissues. This distinct clinical entity was initially described by Allen and Hines, affecting the lower limbs. The longstanding and progressive nature of this disease condition often results in discomfort, pain, and disfiguration, which can affect an individual’s quality of life.There is a preponderance of women compared to men and most frequently affecting the age groups from puberty to mid-30s. Lipedema can affect both lower and upper limbs (in 30% of cases) with symmetrical bilateral distribution. One particular distinguishing feature is sparing of the hands and feet which is seen in lipedema as compared to lymphedema. Due to the misdiagnosis of lipedema as obesity or lymphedema, the true prevalence is significantly under-reported. Although the precise prevalence is evasive, it is estimated that 1 in 10 women can develop lipedema.As such by the time the diagnosis has been obtained, chronic irreversible changes such as pain, tightness, bruising tendency are already present, which result in significant challenges to effective treatment.
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The thigh lift procedure is one of the 5 most requested procedures associated with skin excess from massive weight loss (MWL). The procedure also has the highest reported complication rate amongst MWL procedures. The complication rate is most commonly associated with regional blood flow, higher bacterial involvement associated with proximity to the perineal region and poor-quality dermal thickness to support closure. Technical aspects of ideal management of the region include proper use of lipoplasty, skin excision, multi-layer tissue approximation and suspension. The following chapter reviews the regional anatomy, analysis, and the range of surgical techniques associated with this challenging procedure.
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One of the most common breast malformations is tuberous breast anomaly. Being prevalent in adolescence, few patients know about this condition and the options of treatment.