Persius/hicric huggingface dataset:
Post-vasectomy pain syndrome
Steven C. Campbell, M.D., Ph.D.
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# Overview
Post-Vasectomy Pain Syndrome (PVPS, PVP, CPTP, CPVSP) is a chronic pain condition, marked by severe and unremitting pain, that affects between 5% to 33% of vasectomized men.
  The pain syndrome is caused by a combination of testicular backpressure, chronic inflammation, fibrosis, sperm granulomas, nerve entrapment, and electrical activity changes in the vas deferens. When pain in the epididymides is the primary symptom, Post-Vasectomy Pain Syndrome is also known as congestive epididymitis.

# Mechanisms of Pain

## Backpressure and Distension
There is a marked increase in pressure within the vas on the testicular side following vasectomy.  The epididymides of vasectomized men are often swollen and distended from backpressure effects.  The efferent ducts and seminiferous tubules of the testes are also impacted by backpressure, leading to an increase in area and thickness. 

## Inflammation and Fibrosis
As part of the reaction of the body to the injury of vasectomy, the body produces hard scar-like tissue. Simply clamping the vas deferens can produce muscle disruption and fibrosis.  As the diameter of the vas lumen is less than the thickness of the wall, the thick muscle layers can easily become disrupted, leading to sperm accumulation and extravasation. Cysts often form from the fluid that spreads between the muscle layers. 

## Escaping Sperm and Sperm Granulomas
Sperm leak from the vas deferens and epididymides of vasectomized men, forming lesions in the scrotum known as sperm granulomas. Some sperm granulomas can be painful.  Interestingly, sperm granulomas can actually reduce the likelihood of PVPS by serving as a pressure valve. 

## Nerve Entrapment
Nerves can become trapped in the fibrous tissue caused by vasectomy. This pain is often heightened during  intercourse and ejaculation because, with arousal and ejaculation, muscles elevate the testis. A large number of nerves that run parallel to the vas are easily cut or damaged during vasectomy. 

## Electrical Activity Changes
The vas deferens has two forms of electrical activity, pacesetter potentials and action potentials. After vasectomy, while the action potentials are completely diminished, the pacesetter potentials on the testicular side exhibit an irregular rhythm, or vasoarrhythmia .
Coronary artery irregularity

# Overview
The appearence of irregular lesions with intraluminal filling defects and contrast staining is detected by coronary angiography and may indicate a fissuredatherosclerotic plaque with adherent thrombus.

# Definition
A stenosis is classified as having irregular contour if the vascular margin is rough or has a jigged appearance and is characterized by ulceration, intimal flap, aneurysmal dilation, or sawtooth pattern.

# Pathophysiology
The pathophysiology of lesion irregularity is represented by pre-existing intimal disruption and/or increased turbulence and shear stresses, which lead to platelet activation evidenced by a large transcardiac gradient of serotonin (5-hydroxy-tryptamine). The irregular endothelial surfaces may serve as foci of platelet aggregation with subsequent thrombus formation and vasospasm induced by release of thromboxane A2 (TXA2). The resulting endothelial damage and lesion instability are associated with an increased risk of thrombotic occlusion and distal embolization.

# Grading of Lesion Irregularity
- Grade 0: Smooth  no irregularity.
- Grade 1: Mildly Irregular  lesion has an indistinct lumen edge.
- Grade 2: Sawtoothed/Grossly Irregular  lesion has defined jagged or sawtoothed lumen edges.

# Clinical Significance
- The degree of irregularity is correlated with the risk of clinical instability in the next 10 days once the unstable features partially resolve over 5 to 10 days.
- Greater irregularity of lesions are more likely to appear in the infarct-related artery than in lesions in other coronary arteries of patients with acute infarction and they are also related to the appearence of unstable angina.
- The lesion irregularity is the second most important risk factor of diameter stenosis as a predictor of future infarction.
- Greater lesion complexity is associated with worse epicardial flow characteristics and decreased myocardial perfusion at 60 minutes and after percutaneous coronary intervention and with a higher risk of shock and mortality rate within 30 days.

# Example

# Treatment
A continued anticoagulation is already known as responsible for restabilize the coronary plaque after thrombolysis and so substantially reduce the risk of reinfarction. Due to these findings the anticoagulants may be used in patients in whom particularly irregular lesions are demonstrated by coronary angiography.
Coronary computed tomography

# Overview
In meta-analyses CTA has demonstrated a high diagnostic accuracy to identify patients with 50% stenoses by QCA, with a pooled AUC of 0.99. (1,2)   Multicenter studies yielded AUCs of 0.93 and 0.96 for 64-slice detector technology. (3-6) However, assessment of stenosis severity in individual coronary arterial lesions is more limited. In the study by Meijboom et al. (5) sensitivity for detecting 50% stenoses by QCA decreased from 99% on a patient level to 88% on a segment-based analysis and positive predictive value fell from 86% to 47%.
Using the presence or absence of obstructive and nonobstructive coronary artery disease, extensive data has accumulated demonstrating the prognostic information of CTA. Several studies examined the positive predictive value of CTA. (7,8)Bamberg et al report on the predictive value of the presence and the extent of CAD by CTA in their meta-analysis of 11 studies enrolling 7,335 patients. In patients with 1 significant coronary stenosis, annualized event rate (including revascularization) and hazard ratio were 11.9% and 10.74, respectively. (8)
More importantly, several studies demonstrate a low incidence of myocardial infarction or CAD-related death in patients after a normal CTA over a period of at least 2 years and possibly >5 years. (10-13)
In a meta-analysis of 9,592 patients from 17 studies, Hulten et al reported a sensitivity of 99% (95% CI 0.93-1.00, P < .001) to exclude adverse cardiovascular events at follow up. During the median follow-up period of 20 months, myocardial infarction or death occurred in 0.15% per year, which is comparable to healthy low-risk populations adjusted for age. (7) The CONFIRM international registry reported an annualized death rate of 0.28% after a normal CTA in 24,775 patients. (14)
Because of the high negative predictive value, CTA is suitable for clinical situations in which the exclusion of significant proximal disease is required.
-       Several studies describe the negative predictive value of CT in patient presenting to the ED with chest pain. (15-18)
-       This could include preoperative coronary evaluation before non-cardiac surgery.
Corpus cavernosum clitoridis

# Overview
The corpus cavernosum clitoridis is homologous to the corpus cavernosum penis in the male. The body of the clitoris contains erectile tissue in a pair of corpora cavernosa with a recognisably similar structure.
In some circumstances, release of nitric oxide precedes relaxation of the clitoral cavernosal artery and nearby muscle, in a process similar to male arousal. More blood flows in through the clitoral cavernosal artery, the pressure in the corpora cavernosa clitoridis rises, and the clitoris is engorged with blood. This leads to extrusion of the glans clitoridis and enhanced sensitivity to physical contact.
The female anatomy has no corpus spongiosum, but instead two vestibular bulbs beneath the skin of the labia minora (at the entrance to the vagina), which expand at the same time as the glans clitoris to cap the ends of the corpora cavernosa.
DREB box gene transcriptions
It "is likely that the present OsDREBL may preferably bind to other elements such as the ethylene responsive element GCC box (AGCCGCC), rather than the CRT/DREB box (TACCGACAT), since the two boxes were very similar."
"Based on DNA-binding data, this group  has been subdivided into dehydration-responsive element-binding (DREB)-like proteins, which interact with the dehydration-responsive, or cold-repeat, element (consensus sequence TACCGACAT) (Liu et al. 1998; Stockinger et al. 1997) and the EREBP-like (ethylene responsive element binding protein) proteins binding the GCC box (consensus sequence AGCCGCC) (Ohme-Takagi and Shinshi 1995; Sakuma et al. 2002)."

# DREB box sampling of A1BG promoters
Consensus sequence for the dehydration-responsive element-binding (DREB) box is 3'-TACCGACAT-5'.
For the Basic programs (starting with SuccessablesDREB.bas) written to compare nucleotide sequences with the sequences on either the template strand (-), or coding strand (+), of the DNA, in the negative direction (-), or the positive direction (+), the programs are, are looking for, and found:
- negative strand in the negative direction (from ZSCAN22 to A1BG) is SuccessablesDREB--.bas, looking for 3'-TACCGACAT-5', 0,
- negative strand in the positive direction (from ZNF497 to A1BG) is SuccessablesDREB-+.bas, looking for 3'-TACCGACAT-5', 0,
- positive strand in the negative direction is SuccessablesDREB+-.bas, looking for 3'-TACCGACAT-5', 0,
- positive strand in the positive direction is SuccessablesDREB++.bas, looking for 3'-TACCGACAT-5', 0,
- complement, negative strand, negative direction is SuccessablesDREBc--.bas, looking for 3'-ATGGCTGTA-5', 0,
- complement, negative strand, positive direction is SuccessablesDREBc-+.bas, looking for 3'-ATGGCTGTA-5', 0,
- complement, positive strand, negative direction is SuccessablesDREBc+-.bas, looking for 3'-ATGGCTGTA-5', 0,
- complement, positive strand, positive direction is SuccessablesDREBc++.bas, looking for 3'-ATGGCTGTA-5', 0,
- inverse complement, negative strand, negative direction is SuccessablesDREBci--.bas, looking for 3'-ATGTCGGTA-5', 0,
- inverse complement, negative strand, positive direction is SuccessablesDREBci-+.bas, looking for 3'-ATGTCGGTA-5', 0,
- inverse complement, positive strand, negative direction is SuccessablesDREBci+-.bas, looking for 3'-ATGTCGGTA-5', 0,
- inverse complement, positive strand, positive direction is SuccessablesDREBci++.bas, looking for 3'-ATGTCGGTA-5', 0,
- inverse, negative strand, negative direction, is SuccessablesDREBi--.bas, looking for 3'-TACAGCCAT-5', 0,
- inverse, negative strand, positive direction, is SuccessablesDREBi-+.bas, looking for 3'-TACAGCCAT-5', 0,
- inverse, positive strand, negative direction, is SuccessablesDREBi+-.bas, looking for 3'-TACAGCCAT-5', 0,
- inverse, positive strand, positive direction, is SuccessablesDREBi++.bas, looking for 3'-TACAGCCAT-5', 0.
Increasing the number of nts from A1BG to ZNF497 from 958 to 4445 has yielded no DREB boxes.

# Acknowledgements
The content on this page was first contributed by: Henry A. Hoff.
Initial content for this page in some instances came from Wikiversity.
Sexually transmitted disease
Synonyms and keywords: Sexually transmissible disease; STD; VD; STI; sexually transmitted infection; venereal disease.

# Overview
Sexually transmitted diseases (or STDs) are bacterial, viral, fungal, or protozoal infections that are transmitted via sexual contact. Sexual contact may entail non-penetrative contact of the genitalia, performing or receiving oral sex (cunnilingus, anilingus, or fellatio), and insertive or receptive vaginal or anal sexual intercourse. Sexually transmitted infections may have a variety of clinical presentations including dermatological manifestations, generalized symptoms, or urogenital tract symptoms such as discharge and dysuria. Some infectious agents may be transmitted primarily through sexual contact while others may less frequently be transmitted sexually.
The CDC reported updated Surveillance data on sexually transmitted diseases from 2018 in the United States, which included chlamydia, gonorrhea, and syphilis. Complications of STDs depend on the causative pathogen and may range from genital or oral pruritis and discomfort to more serious complications such as pelvic inflammatory disease, primary CNS lymphoma, cervical cancer, as well as cardiac and neurological complications. If left untreated, some STDs may progress to septic shock and death.
Most STDs have well-established risk factors and preventative measures. If followed appropriately, most STD transmissions can be avoided.

# Classification
Table below provides a concise comparison of various sexually transmitted diseases:

# Differential Diagnosis
Table below provides differential diagnosis of sexually transmitted diseases:

# Treatment
- To view the treatment of chlamydia infection click here.
- To view the detailed treatment of gonorrhea click here.
- To view the detailed treatment of herpes simplex click here.
- To view the detailed treatment of mycoplasma genitalium infection click here.
- To view the detailed treatment of syphilis click here.
- To view the detailed treatment of trichomoniasis click here.
- To view the detailed treatment of bacterial vaginosis click here.
- To view the detailed treatment of human papillomavirus click here.
Deep circumflex iliac artery
The deep circumflex iliac artery (or deep iliac circumflex artery) is an artery in the pelvis that travels along the iliac crest of the pelvic bone.

# Course
The deep circumflex iliac artery arises from the lateral aspect of the external iliac artery nearly opposite the origin of the inferior epigastric artery.
It ascends obliquely lateralward behind the inguinal ligament, contained in a fibrous sheath formed by the junction of the transversalis fascia and iliac fascia, to the anterior superior iliac spine, where it anastomoses with the ascending branch of the lateral femoral circumflex artery.
It then pierces the transversalis fascia and passes along the inner lip of the crest of the ilium to about its middle, where it perforates the transversus abdominis muscle, and runs backward between that muscle and the internal oblique, to anastomose with the iliolumbar artery and the superior gluteal artery.
Opposite the anterior superior spine of the ilium it gives off a large branch, which ascends between the internal oblique and transversus abdominis muscles, supplying them, and anastomosing with the lumbar arteries and inferior epigastric artery.

# Additional images
- The ven cav and azygos veins, with their tributaries.
- The veins of the right half of the male pelvis.
Stent thrombosis definitions

# Most commonly used definitions
There have been different definitions in different studies.

# Definition based on timing of stent thrombosis (ST)
- Acute	     < 24 hrs
- Subacute    24 hrs  30 days and
Evidence of ST by way of one or more of
angiographic vessel occlusion with TIMI 0-1 flow
new Q-wave MI in an area supplied by the stented vessel,
unexplained death from a cardiac cause
- Evidence of ST by way of one or more of
angiographic vessel occlusion with TIMI 0-1 flow
new Q-wave MI in an area supplied by the stented vessel,
unexplained death from a cardiac cause
- angiographic vessel occlusion with TIMI 0-1 flow
- new Q-wave MI in an area supplied by the stented vessel,
- unexplained death from a cardiac cause
Some studies looked at clinical events from soon after procedure to a few days after the procedure. One of the reasons for this method was that a significant proportion of clinical events in this time period was proceudure related.
- Late ST     30 d  - 360 days
 30 d following stent implantation and new myocardial infarction (MI) with occlusion of the stented artery on angiography.
- > 30 d following stent implantation and new myocardial infarction (MI) with occlusion of the stented artery on angiography.
Some studies had a definition of  late after the 6th month.
- Very Late ST	> 360 days
- ( > 4 yrs ) At the moment there is only sparse data beyond four years.

# Definition based on certainty of ST
In order to standardize and semi-quantify the certainty of ST, the academic research consortium (ARC) recommended the following classification (ref )
- Definite ST
Angiographic confirmation of thrombus, with or without vessel occlusion, associated with
clinical or ECG signs of acute ischemia or
elevation of serum creatinine kinase (CK) to twice the normal value within 48 hours of angiography.
- Angiographic confirmation of thrombus, with or without vessel occlusion, associated with
clinical or ECG signs of acute ischemia or
elevation of serum creatinine kinase (CK) to twice the normal value within 48 hours of angiography.
- clinical or ECG signs of acute ischemia or
- elevation of serum creatinine kinase (CK) to twice the normal value within 48 hours of angiography.
- Probable ST
Unexplained death occurring within 30 days after the index procedure or
if a myocardial infarction, occurring at any time after the index procedure, was documented in an area supplied by the stented vessel in the absence of angiographic confirmation of stent thrombosis or other culprit lesion.
- Unexplained death occurring within 30 days after the index procedure or
- if a myocardial infarction, occurring at any time after the index procedure, was documented in an area supplied by the stented vessel in the absence of angiographic confirmation of stent thrombosis or other culprit lesion.
- Possible ST
Unexplained death occurring more than 30 days after the index procedure.
NOTE : Events occurring after repeat target lesion revascularization would be included.

# Other definitions

# Return to main Coronary stent thrombosis page
Des-gamma carboxyprothrombin
Des-gamma carboxyprothrombin (DCP), also known as protein induced by vitamin K absence or antagonist-II (PIVKA-II), is an abnormal form of the coagulation protein, prothrombin.  Normally, the prothrombin precursor undergoes post-translational carboxylation by gamma-glutamyl carboxylase in the liver prior to secretion into plasma.  Many hepatocellular carcinoma (HCC) cells however, lack the carboxylation activity and secrete unmodified prothrombin precursor DCP.  DCP lacks thrombotic activity and many clinical research papers have shown that DCP is present in the sera of HCC patients .  
In 1984, Liebman et al. found DCP in high prevalence with high specificity in sera of patients with HCC, and proposed it as a novel serum marker of HCC .  Many clinical studies have since shown that DCP is significantly elevated in HCC patients and that DCP was able to discriminate HCC from nonmalignant hepatopathy (i.e. chronic hepatitis B & hepatitis C and liver cirrhosis) with high specificity  .  DCP level has also been demonstrated to be significantly associated with metastasis of tumor and the development of portal vein invasion (PVI) .
Though DCP has been used extensively in Japan for many years for HCC management, its clinical utility was only recently evaluated in the United States.  Recent US studies reported that DCP is indeed effective in discriminating HCC from non-malignant hepatopathy for the North American demographic.  A recently published case-controlled study reported that, DCP was able to differentiate early stage HCC from cirrhosis with high accuracy (at 150 mAU/mL):  92% sensitivity and 93% specificity.  In addition, DCP identified 15 (88%) of 17 patients with early stage HCC that would have been missed utilizing the traditional HCC marker AFP alone during screening .  
The target population to be screened for DCP is similar to that of another HCC marker, Lens culinaris reactive AFP (AFP-L3): patients with chronic hepatitis (CH), and cirrhosis. However, DCP is independently expressed.  DCP therefore, is regarded as an independent and complimentary HCC marker for risk assessment, surveillance and detection of HCC .
Descending perineum syndrome

# Overview
Descending perineum syndrome (also known as Levator plate sagging)  refers to a condition where the perineum "balloons" several centimeters below the bony outlet of the pelvis during strain, although this descent may happen without straining. The syndrome was first described in 1966 by Parks et al.

# Epidemiology
The condition mainly occurs in women, and it is thought by some to be one of the main defects encountered problem in perineology.

# Signs & Symptoms
Abnormal descent of the perineum may be asymptomatic, but otherwise the following may feature:
- perineodynia (perineal pain) 
- Colo-proctological symptoms, e.g. obstructed defecation, dyschesia (constipation), or degrees of fecal incontinence 
- gynaecological symptoms, e.g. cystocele (prolapse of the bladder into the vagina) and rectocele (prolapse of the rectum into the vagina) 
- lower urinary tract symptoms, e.g. dysuria (painful urination), dyspareunia (pain during sexual intercourse), urinary incontinence & urgency 
Other researchers concluded that abnormal perineal descent did not correlate with constipation or perineal pain, and there are also conflicting reports of the correlation of fecal incontinence with this condition.

# Diagnosis
Diagnosis is by rectal examination. A specialized tool called a "Perineocaliper" can be used to measure the descent of the perineum. A retro anal ultrasound scan may demonstrate the condition. "Anti sagging tests", whereby the abnormal descent is corrected temporarily, may help to show whether symptoms are due to descending perineum syndrome or are in fact due to another condition.
Normally, the anal margin lies just below a line drawn between the coccyx (tailbone) and the pubic symphysis. In descending perineum syndrome the anal canal is situated several cm below this imaginary line, or it descends 34 cm during straining.
Defecography may also demonstrate abnormal perineal descent.

# Cause
One of the main causes is suggested to be excessive and repetitive straining during defecation. Other causes include weakness of the pelvic floor muscles (secondary to age related neuropathic degeneration or traumatic injury during pregnancy and labor.

# Treatment
Surgical treatments may be used to treat the condition, and include retro-rectal levatorplasty, post-anal repair, retro-anal levator plate myorrhaphy.
Developmental venous anomaly
Developmental venous anomalies (DVA) are cerebral vascular malformations that consist of dilated intramedullary veins converging into a large draining vein that reaches either the superficial or the deep system in an area in which there is an absence of normal draining veins.
Developmental venous anomalies are known to be associated with other developmental vascular anomalies, especially cavernous malformations.

# Diagnosis
Dilated intramedullary veins converging into a large draining vein producing the Medusa head appearance.

## Diagnostic Findings
(Images courtesy of RadsWiki)
Didanosine contraindications

# Contraindications
These recommendations are based on either drug interaction studies or observed clinical toxicities.

## Allopurinol
Coadministration of didanosine and allopurinol is contraindicated because systemic exposures of didanosine are increased, which may increase didanosine-associated toxicity.

## Ribavirin
Coadministration of didanosine and ribavirin is contraindicated because exposures of the active metabolite of didanosine (dideoxyadenosine 5-triphosphate) are increased. Fatal hepatic failure, as well as peripheral neuropathy, pancreatitis, and symptomatic hyperlactatemia/lactic acidosis have been reported in patients receiving both didanosine and ribavirin.