Persius/hicric huggingface dataset:
Divalproex sodium overdosage

# Overdosage
Overdosage with valproate may result in somnolence, heart block, and deep coma. Fatalities have been reported; however patients have recovered from valproate levels as high as 2,120 mcg/mL.
In overdose situations, the fraction of drug not bound to protein is high and hemodialysis or tandem hemodialysis plus hemoperfusion may result in significant removal of drug. The benefit of gastric lavage or emesis will vary with the time since ingestion. General supportive measures should be applied with particular attention to the maintenance of adequate urinary output.
Naloxone has been reported to reverse the CNS depressant effects of valproate overdosage. Because naloxone could theoretically also reverse the antiepileptic effects of valproate, it should be used with caution in patients with epilepsy.
Intracranial dolichoectasias
The term dolichoectasia means elongation and distension.  It is used to characterize arteries throughout the human body which have shown significant deterioration of their tunica intima (and occasionally the tunica media), weakening the vessel walls and causing the artery to elongate and distend.

# Etiology
Most commonly caused by hypertension, continued stress on the walls of the artery will degrade the vessel wall by damaging and loosening the collagen and elastin meshwork which comprises the intima. Similarly, hypercholesterolemia or hyperlipidemia can also provide sufficient trauma to the vessel wall resulting in dolichoectasia. As the arrangement of connective tissue is disturbed, the vessel wall is no longer able to hold its original conformation and begins to unravel due to the continued hypertension. High blood pressure mold and force the artery to now take on an elongated, tortuous course to better withstand the higher pressures.

# Pathophysiology
Most commonly affected is the Vertebral Basilar Artery (Vertebral Basilar Dolichoectasia or Vertebrobasillar Dolichoectasia). The Internal Carotid Artery is also at high risk to be affected. Patients with Autosomal Dominant Polycystic Kidney Disease (ADPKD) are more likely to be subject to dolichoectasias. Dolichoectasias are most common in eldery females.
In cases involving the Basilar Artery (VBD), the pathogenesis arises from direct compression of different cranial nerves.
Additionaly, ischemic effects on the brain stem and cerebellar hemispheres as well as symptoms related to hydrocephalus are common. Direct cranial nerve compression can lead to isolated cranial nerve dysfunction, usually associated with a normal-sized basilar artery that is tortuous and elongated. Cranial nerve dysfunction most commonly involves the VII cranial nerve and the V cranial nerve. Multiple cranial nerve dysfunction is far more likely to occur if there is dilation (ectasia) associated with a tortuous and elongated basilar artery. Cranial nerves affected in descending order of frequency include: VII, V, III, VIII, and VI.
Internal Carotid Artery dolichoectasia is particularly interesting because the artery normally already contains one hairpin turn. Seen in an MRI as two individual arteries at this hairpin, a carotid artery dolichoectasia can progress so far as to produce a second hairpin turn and appear as three individual arteries on an MRI. In the case of a dolichoectasia of the Internal Carotid Artery (ICD), the pathogenesis is primarily related to compression of the Optic Nerves at the Optic Chiasma (see Fig. 1 and 2).

# Signs and Symptoms
VBD
- Hemifacial Spasm
- Paresis
- Trigeminal Neuralgia
ICD
- Progressive Visual Field Defect

# Treatment
A combination of lifestyle modifications and medications can be used for the treatment of dolichoectasias.
- Antihypertensive medications such as Thiazides, Beta Blocker, ACE Inhibitor
- Trental or other Pentoxifylline drugs
- Dietary changes
- Weight Loss
- Regular Exercise
WikiDoc foundation donations
WikiDoc Foundation is a non-profit 509 (a) 1 organization. Your donations are tax deductible.

# Overview
WikiDoc depends upon the charitable contributions of our viewership.  We do not accept monies from the pharmaceutical or device industries.

# Where Does The Money Go?
At present, the money goes to support bandwidth of the site (the servers).  There are no employee salaries at present.  Efforts are purely voluntary.

# Donate by Credit Card or PayPal
Your credit card donation will be processed by PayPal. The charge will appear as "WikiDoc Foundation" on your credit card statement. You will be able to print out a receipt of your donation for your records and tax returns.

# Donate by Check
Please mail your check or money order to:
WikiDoc Foundation
423 Brookline Avenue
Box # 309
Boston, MA 02215-5410
If your donation exceeds $250.00 US dollars and if you would like a receipt, please provide your address so that we may send confirmation of your donation.

# Donate using an IRA
An IRA owner over 70 1/2 years of age can directly transfer tax free up to $100,000 per year to an eligible charitable organization. This is a new law and is a good way to donate to a good cause and avoid taxes on money the IRS would normally make you withdraw and pay taxes on.  For more information, please see the following: 
Contact us for help with this kind of donation 

# Donate using a Charitable Remainder Trust (CRT)
CRTs and GRATs allow owners of property (buildings/land/equipment/etc.) and high net worth individuals to transfer assets to the WikiDoc foundation and provides significant reductions in the tax burden to heirs. Contact us for help with this kind of donation
Dorland's Medical Dictionary
Dorland's is the brand name of several different medical dictionaries and ancillary products, chiefly Dorland's Illustrated Medical Dictionary (currently in its 31st edition) and Dorland's Pocket Medical Dictionary (currently in its 27th edition). The principal dictionary was first published in 1890 as the American Illustrated Medical Dictionary, including 770 pages. The pocket edition, called the American Pocket Medical Dictionary, was first published in 1898, consisting of just over 500 pages.
With the death of the editor William Alexander Newman Dorland, AM, MD in 1956, the dictionaries were retitled to incorporate his name, which was how they had generally come to be known.  The illustrated dictionary has grown to 2208 pages for the 31st edition.

# List of products in the Dorland's family (past and present)
- American Illustrated Medical Dictionary (until 1956)
- American Pocket Medical Dictionary (until 1956)
- Dorland's Illustrated Medical Dictionary (currently in its 31st edition)
- Dorland's Illustrated Medical Dictionary on CD-ROM
- Dorland's Illustrated Medical Dictionary online
- Dorland's Pocket Medical Dictionary (currently in its 27th edition)
- Dorland's Pocket Medical Dictionary on CD-ROM
- Dorland's Medical Speller (1992)
- Dorland's Medical Abbreviations (1992)

# Publisher
Dorland's was published for over a century by the W.B. Saunders Company, which was an independent medical publisher during most of that time. In the 1980s and 1990s, W.B. Saunders was acquired first by CBS and then by Harcourt. Today the company has been absorbed into Elsevier, where the name Saunders (without the W.B. ) is used as an imprint name.
The most recent edition of Dorland's Illustrated, the 31st, is available in electronic format.
Dorsal branch of ulnar nerve
The dorsal branch of ulnar nerve arises about 5 cm. above the wrist; it passes backward beneath the Flexor carpi ulnaris, perforates the deep fascia, and, running along the ulnar side of the back of the wrist and hand, divides into two dorsal digital branches; one supplies the ulnar side of the little finger; the other, the adjacent sides of the little and ring fingers.
It also sends a twig to join that given by the superficial branch of the radial nerve for the adjoining sides of the middle and ring fingers, and assists in supplying them.
A branch is distributed to the metacarpal region of the hand, communicating with a twig of the superficial branch of the radial nerve.

# Additional images
- Cutaneous nerves of right upper extremity. Posterior view.
- Diagram of segmental distribution of the cutaneous nerves of the right upper extremity. Posterior view.
Dynamin-like 120 kDa protein
Dynamin-like 120 kDa protein, mitochondrial is a protein that in humans is encoded by the OPA1 gene. This protein regulates mitochondrial fusion and cristae structure in the inner mitochondrial membrane (IMM) and contributes to ATP synthesis and apoptosis, and small, round mitochondria. Mutations in this gene have been implicated in dominant optic atrophy (DOA), leading to loss in vision, hearing, muscle contraction, and related dysfunctions.

# Structure
Eight transcript variants encoding different isoforms, resulting from alternative splicing of exon 4 and two novel exons named 4b and 5b, have been reported for this gene. They fall under two types of isoforms: long isoforms (L-OPA1), which attach to the IMM, and short isoforms (S-OPA1), which localize to the intermembrane space (IMS) near the outer mitochondrial membrane (OMM). S-OPA1 is formed by proteolysis of L-OPA1 at the cleavage sites S1 and S2, removing the transmembrane domain.

# Function
This gene product is a nuclear-encoded mitochondrial protein with similarity to dynamin-related GTPases. It is a component of the mitochondrial network. The OPA1 protein localizes to the inner mitochondrial membrane, where it regulates mitochondrial fusion and cristae structure. OPA1 mediates mitochondrial fusion in cooperation with mitofusins 1 and 2 and participates in cristae remodeling by the oligomerization of two L-OPA1 and one S-OPA1, which then interact with other protein complexes to alter cristae structure. Its cristae regulating function also contributes to its role in oxidative phosphorylation and apoptosis, as it is required to maintain mitochondrial activity during low-energy substrate availability. Moreover, stabilization of mitochondrial cristae by OPA1 protects against mitochondrial dysfunction, cytochrome c release, and reactive oxygen species production, thus preventing cell death. Mitochondrial SLC25A transporters can detect these low levels and stimulate OPA1 oligomerization, leading to tightening of the cristae, enhanced assembly of ATP synthase, and increased ATP production.  Stress from an apoptotic response can interfere with OPA1 oligomerization and prevent mitochondrial fusion.

# Clinical significance
Mutations in this gene have been associated with optic atrophy type 1, which is a dominantly inherited optic neuropathy resulting in progressive loss of visual acuity, leading in many cases to legal blindness. Dominant optic atrophy (DOA) in particular has been traced to mutations in the GTPase domain of OPA1, leading to sensorineural hearing loss, ataxia, sensorimotor neuropathy, progressive external ophthalmoplegia, and mitochondrial myopathy. As the mutations can lead to degeneration of auditory nerve fibres, cochlear implants provide a therapeutic means to improve hearing thresholds and speech perception in patients with OPA1-derived hearing loss.
Mitochondrial fusion involving OPA1 and MFN2 may be associated with Parkinson's disease.

# Interactions
OPA1 has been shown to interact with:
- Adenonucleotide transporters,
- ATP synthase,
- CHCHD3,
- Mitofilin,
- Prohibitin,
- SAMM50, and
- SLC25A.
Dysuria history and symptoms
Please help WikiDoc by adding more content here.  It's easy!  Click  here  to learn about editing.

# History and Symptoms

## Symptoms
- Pain may be felt right where the urine passes out of the body. Or, it may be felt inside the body, behind the pubic bone, or in the bladder or prostate.
- Pain on urination is a fairly common problem. People who have pain with urination also may have the urge to urinate more often.
Echogenic intracardiac focus

# Overview
Echogenic intracardiac focus (EIF) is a small bright spot seen in the babys heart on an ultrasound exam.  This is thought to represent mineralization, or small deposits of calcium, in the muscle of the heart. EIFs are a found in about 3-5% of normal pregnancies and cause no health problems.
EIFs themselves have no impact on health or heart function. Often the EIF is gone by the third trimester. If there are no problems or chromosome abnormalities, EIFs are considered normal changes, or variants.

# Association with birth defects
Researchers have noted an association between an EIF and a chromosome problem in the baby. Types of chromosome problems that are occasionally seen include Trisomy 18 or Trisomy 21 (Down syndrome). In the case of an isolated EIF, and no other ultrasound findings, some studies show that the risk for a chromosome abnormality is approximately two times a womans background risk.  Other studies report up to a 1% risk for Down syndrome when an EIF is seen on a second trimester fetal ultrasound exam.

# A clue to chromosome problems
An EIF is one clue, which contribute to the chances of finding a chromosome problem. Generally the risks are low if there are no other risk factors. Many babies with chromosome problems do not show any signs on ultrasound. Other factors are discussed in counseling include:
- Mother's age at the expected date of delivery
- The results of the Expanded AFP blood triple test
- Evidence of other "fetal findings" seen at on the ultrasound that suggest a chromosome problem.

# Options
Genetic counseling is recommended to give you more information about the EIF, to answer your questions and concerns, and go over the options available to you.
Amniocentesis is a test to check a baby's chromosomes. A small amount of amniotic fluid, which contains some fetal cells, is removed and tested. Amniocentesis is very accurate; however, there is a risk of miscarriage of 1 in every 200 amniocentesis tests performed. Results take about two weeks.  A normal amniocentesis result means the EIF is not significant and there would be no other concerns about it.

# Summary
An EIF in the fetal heart may increase the chance for the baby to have a chromosome problem. It does not affect the development of the baby or the function of the heart. If the baby has normal chromosomes, there would be no associated problems to be concerned about. No special treatment or tests are needed at delivery.
It is important to remember that chances are strongly in your favor of a normal outcome in this pregnancy, but with this additional clue, you are entitled to further counseling and testing options.
Effective circulating volume
Effective Circulating Volume (ECV):
ECV is the volume of arterial blood (vascular extracellular fluid) effectively perfusing tissue.  ECV is dynamic and not a measurable, distinct compartment.  ECV is about 0.7 L in a 70 kg individual.  This concept is useful for discussion of cardiovascular and renal physiology.
Though ECV normally varies with extracellular fluid, it is uncoupled in diseases, such as congestive heart failure (CHF) or hepatic cirrhosis.  Here decreased ECV may lead to volume-depletion responses and edema.
Decreased ECV can stimulate renin secretion or stimulate a sympatheic nervous system response or prostaglandin release (all of which help mediate renal blood flow and glomerular filtration rate among other things).
Reference:  John Bullock, Michael B. Wang, Joseph Boyle.  NMS Physiology. 4th ed., Lippincott Williams & Wilkins, 2001. pp 337-339.
Egomania (UK TV Documentary)
"Egomania" was an episode of a 3-part documentary series on Channel 4 made by Firecracker Films about people who are diagnosed with what psychiatrists call Narcissistic personality disorder (NPD).
The other two parts of the series, called Mania, were called Erotomania and Pyromania.
The film was directed by Mark Soldinger, narrated by actor Bernard Hill.
The film was not well received by some critics.
Sam Wollaston from the Guardian referred to it as "an excuse to show some really nasty people and their behaviour on the television" and asked of the Brian Blackwell murder reenactment, "Is that really necessary?". Though he does feel the documentary improves towards the end: "When a contributor who has featured throughout, Dr Sam Vaknin, reveals that he is not just an expert on the condition, but also a sufferer. And then we get to see him in action, the out-takes of the making of the film, in which he's trying to run the show, demanding retakes, trying to write the script, direct it, do everything, because he believes he can do it better. He's a rare thing - a self-aware egomaniac, and it's absolutely fascinating to watch".
In his review, Paul Whitelaw felt that it "typified the shallow, brassy, stylised approach which taints so many factual-based programmes" and went on to suggested the reconstructions of the murder: "must have been upsetting for the family concerned. Still, I'm sure it satisfied the ego of the director".
Ejaculatory duct obstruction

# Overview
- Ejaculatory duct obstruction may be either congenital or acquired. Because the hypothalamic pituitary gonadal axis is intact, serum hormone levels are normal.

# Classification
Ejaculatory duct obstruction may be complete or partial.
- Complete form: patients have a total absence of sperm in the ejaculate
- Partial form: sperm are found in the semen but exhibit reduced numbers, reduced motility, on both. Ejaculate volume is consistently decreased.

# Causes
- Causes include idiopathic, transurethnal endoscopic procedures, urethral catheterization, and urethritis.

# Diagnosis
Diagnosis of ejaculatory duct obstruction is suggested by the presence of a cyst posterior to the prostatic urethra, with on without dilatation of the seminal vesicles.
MR images demonstrate left ejaculatory duct obstruction
Electrocardiogram technician
An electrocardiogram technician (also known as cardiographic technician, ECG tech or EKG tech) is a member of the health care team whose primary duty is the performance of electrocardiograms on patients.  An electrocardiogram (often abbreviated EKG or ECG) measures the electrical activity of the heart and can be used to diagnose a range of heart diseases.
The process of taking an ECG involves attaching a series of electrodes to the patient's chest and limbs, and printing a recording on the ECG machine for interpretation.  It takes approximately 5 minutes to record a diagnostic ECG.

# Advanced ECG roles
The role of the ECG tech is expanding in the hospital setting.  Cardiographic technicians with advanced training are important in exercise ECG testing and in Holter monitor testing.  The roles of an ECG technician in stress testing involve taking a patient history, obtaining a baseline ECG, taking initial vital sign measurements, and explaining the procedure.  A number of protocols exist for stress testing, and the technician's role involves monitoring vital sign and ECG changes while the patient undergoes protocol with increased exertion.
Holter monitoring, which is a continuous cardiac recording to detect arrhythmias, or disturbances in the rhythm of the heart, also requires advanced training.  The technician's role at the initiation of the test is to place electrodes on the patient's chest and attach them to a portable ECG monitor, that the patient carries.  After a number of hours (24 or more) the patient returns, and the technician removes the recorded material from the ECG monitor for interpretation.  This is usually a tape device.  The technician also checks the quality of the recorded electrical activity and prints a report to be interpreted by the physician.
Technician run open-access stress testing has shown to be useful in resource optimization.  One report has suggested that technician-reported ECG's prevent medical error by house officers in the emergency department setting.

# Qualifications and licensing
The position is generally unlicensed and skills are learned on the job; however, two- and four-year training programs to learn advanced ECG technical skills are available at junior colleges and community colleges.
In the United States in 2004, there were 45,000 employed cardiovascular technicians, with 75% of jobs in the hospital setting.
Eletriptan adverse reactions

# Adverse Reactions
The following adverse reactions are described elsewhere in other sections of the prescribing information:
- Myocardial ischemia and myocardial infarction, and Prinzmetal's angina 
- Arrhythmias 
- Chest, throat, neck, and/or jaw pain/tightness/pressure 
- Cerebrovascular events 
- Other vasospasm reactions 
- Medication overuse headache 
- Serotonin syndrome 
- Increase in blood pressure 
- Hypersensitivity reactions 

### 6.1 Clinical Trials Experience
Because clinical studies are conducted under widely varying conditions, adverse reaction rates observed in the clinical studies of a drug cannot be directly compared to rates in the clinical studies of another drug and may not reflect the rates observed in practice.
Among 4,597 patients who treated the first migraine headache with RELPAX in short-term placebo-controlled trials, the most common adverse reactions reported with treatment with RELPAX were asthenia, nausea, dizziness, and somnolence. These reactions appear to be dose-related.
In long-term open-label studies where patients were allowed to treat multiple migraine attacks for up to 1 year, 128 (8.3%) out of 1,544 patients discontinued treatment due to adverse reactions.
Table 1 lists adverse reactions that occurred in the subset of 5,125 migraineurs who received eletriptan doses of 20 mg, 40 mg and 80 mg or placebo in worldwide placebo-controlled clinical trials.
Only adverse reactions that were more frequent in a RELPAX treatment group compared to the placebo group with an incidence greater than or equal to 2% are included in Table 1.
The frequency of adverse reactions in clinical trials did not increase when up to 2 doses of RELPAX were taken within 24 hours. The incidence of adverse reactions in controlled clinical trials was not affected by gender, age, or race of the patients. Adverse reaction frequencies were also unchanged by concomitant use of drugs commonly taken for migraine prophylaxis (e.g., SSRIs, beta blockers, calcium channel blockers, tricyclic antidepressants), estrogen replacement therapy or oral contraceptives.

### 6.2 Postmarketing Experience
The following adverse reaction(s) have been identified during post approval use of RELPAX. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to drug exposure.
Neurological: seizure
Digestive: vomiting
Eletriptan contraindications

# Contraindications
RELPAX is contraindicated in patients with:
- Ischemic coronary artery disease (CAD) (angina pectoris, history of myocardial infarction, or documented silent ischemia) or coronary artery vasospasm, including Prinzmetal's angina .
- Wolff-Parkinson-White syndrome or arrhythmias associated with other cardiac accessory conduction pathway disorders .
- History of stroke, transient ischemic attack (TIA), or history or current evidence of hemiplegic or basilar migraine because these patients are at a higher risk of stroke .
- Peripheral vascular disease .
- Ischemic bowel disease .
- Uncontrolled hypertension .
- Recent use (i.e., within 24 hours) of another 5-hydroxytryptamine1 (5-HT1) agonist, ergotamine-containing medication, or ergot-type medication such as dihydroergotamine (DHE) or methysergide .
- Hypersensitivity to RELPAX (angioedema and anaphylaxis seen) .
- Recent use (i.e., within at least 72 hours) of the following potent CYP3A4 inhibitors: ketoconazole, itraconazole, nefazodone, troleandomycin, clarithromycin, ritonavir, or nelfinavir .