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Neuro myelomeningocele search myelomeningocele, severe spina bifida epidemiology occurs in 1 per thousand live births risk factors maternal folate deficiency prior history of child with myelomeningocele (4% risk) valproic acid (1-2% risk if taken during pregnancy) pathophysiology severe form of spinal dysraphism affects lumbosacral region in 75% of cases associated with dysfunction of multiple organ systems signs flaccid paralysis of lower extremities deep tendon reflexes absent associated conditions hydrocephalus (80% of cases) arnold chiari ii malformation neurogenic bladder urinary incontinence stool incontinence management supportive care may be appropriate in severe cases surgery in first few days of life surgical repair of myelomeningocele csf shunt for hydrocephalus frequent bladder catheterization for neurogenic bladder reduces risk of pyelonephritis and hydronephrosis prognosis mortality with aggressive treatment: 10-15% by age 4 normal intelligence in 70% of survivors complications see ventriculoperitoneal shunt malfunction see arnold-chiari ii malformation urinary tract infections related to neurogenic bladder urine may be difficult to interpret (due to chronically dirty urine, especially if prior intestinal graft) symptoms may be difficult to assess (due to cognition, differential diagnosis including shunt malfunction) treat symptomatic urinary tract infections skin infections sensory deficits below myelomeningocele allow for skin breakdown and infection undress and fully examine all spina bifida patients for fever source prevention folic acid supplementation started before conception references majoewsky (2012) em:rap-c3 2(9): 5 behrman (2000) nelson pediatrics, saunders, p. best place to buy viagra online 1804 goetz (1999) neurology, saunders, p. viagra for sale 515-16 type your search phrase here top nicu neuro please see the terms and conditions. cheap generic viagra This page was written by scott moses, md. viagra daily dose generic This page was last revised on 10/7/2012 and last published on 10/7/2012. much cost viagra canada â©2011, family practice notebook, llc. cheap viagra 2012 icd-9-cm volume 2 index > 'm' words > myelomeningocele... taking viagra20 To myoclonus... can you get samples viagra > myelomeningocele (spinal cord) (see also spina bifida) 741. order viagra online usa 9 myelopathic - see conditionmyelopathy (spinal cord) 336. generic viagra sales 9 myelophthisis 284. Viagra for daily use canadian pharmacy 2 myeloproliferative disease (m9960/1) 238. taking viagra20 79 myeloradiculitis (see also polyneuropathy) 357. Viagra on women 0 myeloradiculodysplasia (spinal) 742. viagra for sale 59 myelosarcoma (m9930/3) 205. generic viagra india reviews 3 myelosclerosis 289. buy viagra online 89 myelosis (m9860/3) (see also leukemia, myeloid) 205. Cheapest 20 mg viagra 9 myesthenia - see myastheniamyiasis (cavernous) 134. 0 myoadenoma, prostate 600. generic viagra no rx 20 myoblastoma myocardial - see conditionmyocardi. generic viagra from us pharmacy viagra price saudi arabia
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