Eventration of the diaphragm
Mark Davenport, James D. Geiger, Nigel J. Hall, Steven S. Rothenberg in Operative Pediatric Surgery, 2020
Diaphragm eventration may be discovered incidentally as an elevated hemidiaphragm on a chest radiograph, or it may be the cause of severe symptoms such as respiratory failure or pneumonia. Small eventrations with minimal compromise of lung volume may be monitored by serial radiographs. Recurrent symptoms or respiratory distress that requires mechanical ventilation are indications for surgical correction. When the possibility of reversible phrenic nerve injury exists, such as that due to birth trauma or operative injury, a period of observation is indicated in the symptomatic patient. If there is no improvement in diaphragm function, diaphragm plication is performed after a reasonable period of observation (2–4 weeks). Some function may eventually return to the previously paralyzed diaphragm, but this may require many months. Operative plication does not preclude some recovery of diaphragm function.
The Affordable Care Act
Kant Patel, Mark Rushefsky in Healthcare Politics and Policy in America, 2019
The Hobby Lobby case (2014), the second of three major Supreme Court decisions regarding the Affordable Care Act, invoked values issues, including freedom of religion and women’s access to contraceptives. Recall that the Affordable Care Act requires that insurance plans covered under the law contain ten essential benefits. The tenth benefit is preventive services, such as screening and payments for contraceptives for women. Contraceptives can be expensive, depending on the method and the income of the person. For example, looking at 2012 figures, the pill can cost between $160 and $600 a year. The initial cost of a diaphragm is between $15 and $75 plus the cost of a doctor’s visit. An IUD (intrauterine device) has an upfront cost of $500 to $1,000. Female sterilization can cost between $1,500 and $6,000 (Palmer 2012).
Adolescent contraception
Joseph S. Sanfilippo, Eduardo Lara-Torre, Veronica Gomez-Lobo in Sanfilippo's Textbook of Pediatric and Adolescent GynecologySecond Edition, 2019
Diaphragms are used in conjunction with spermicide, which should be placed in the cup of the diaphragm before intercourse; additional spermicide should be placed in the vagina with each additional act of intercourse. The diaphragm can be placed up to 2 hours before intercourse and must remain in place for a minimum of 6 hours and a maximum of 24 hours after intercourse.178,186 Efficacy is decreased with frequent coitus, numerous partners, younger age, use of oil-based lubricants, poor instructions for use, prior failure of contraceptive, and ambivalence about pregnancy.16 Some studies have indicated that diaphragms are associated with a decreased risk of STIs. However, this may not be due to the method itself, but may be more related to the fact that it is often used in association with spermicide and that many diaphragm users are older, well educated, and in monogamous relationships.178
Is there a relationship between respiratory function and trunk control and functional mobility in patients with relapsing–remitting multiple sclerosis?
Published in Neurological Research, 2023
Melike Sumeyye Ozen, Ebru Calik-Kutukcu, Yeliz Salci, Ecem Karanfil, Asli Tuncer, Kadriye Armutlu
Loss of strength in the respiratory muscles, especially in the expiratory muscles, along with decreases in functional mobility, trunk control, and lung capacity, were found from the early period in the MS patients. The diaphragm, which is an inspiratory muscle, should not be ignored because it is affected in the later stages of the disease. Furthermore, the functional relationship between core stability and respiratory muscles is very important in terms of mobility. For this reason, we think that these parameters should be monitored closely during physiotherapy evaluations from the early stages of the disease, and training to increase lung capacity and strengthen respiratory and trunk muscles should be included in treatment programs. Future studies in which a large number of MS patients of all clinical types are included and comparisons are made according to the EDSS scores are required.
Management of pulmonary arterial hypertension during pregnancy
Published in Expert Review of Respiratory Medicine, 2023
Kaushiga Krishnathasan, Andrew Constantine, Isma Rafiq, Ana Barradas Pires, Hannah Douglas, Laura C Price, Konstantinos Dimopoulos
Several contraceptive options are available, and collaborative decision-making should be based on patient preference and clinical efficacy and safety profiles. Oral contraceptives include the combined pill and the progesterone-only pill. The latter is preferred due to the greater risk of venous and arterial thromboembolism associated with estrogen in the combined oral contraceptive pill. Progesterone is also available as a subcutaneous implant, inserted under local anesthesia [1,7,48]. Intrauterine devices such as copper and levonorgestrel-coated coils are available. Insertion of such devices is associated with a small risk of a vasovagal response, which can be pronounced in patients with PAH and therefore insertion is usually arranged in a hospital setting [3]. Barrier contraception, such as condoms and diaphragms, can protect from sexually transmitted disease but are not considered reliable forms of contraception in PAH due to contraceptive failure rates and the risk of unplanned pregnancy [1,7].
Prospective analysis of a surgical algorithm to achieve ventilator weaning in cervical tetraplegia
Published in The Journal of Spinal Cord Medicine, 2022
Matthew R. Kaufman, Thomas Bauer, Stuart Campbell, Kristie Rossi, Andrew Elkwood, Reza Jarrahy
For the most severe cases of neuromuscular degeneration, muscle replacement may be considered for the potential to wean to a pacemaker. Diaphragm replacement using vascularized muscle flaps is based on the work of Barnhart et al.19 and others, who reported the successful use of abdominal muscle flaps to repair large congenital diaphragmatic hernias.8,9 In the current study both of the patients receiving this treatment had failed prior pacemaker attempts. One of these patients had a pre-operative EMG with evidence of severe neuromuscular degeneration, and the second patient was 48 months post-injury. Both have achieved PW at 2-year follow-up. The application of diaphragm muscle replacement in this patient population is novel and further investigation is necessary to validate these early results.
Related Knowledge Centers
- Birth Control
- Spermicide
- Toxic Shock Syndrome
- Urinary Tract Infection
- Cervix
- Vagina
- Bacterial Vaginosis
- Sexually Transmitted Infection
- Silicone
- Natural Rubber