The American journal of medicine
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Widespread use of improved measurements for serum thyroid hormones and thyroid-stimulating hormone (TSH) has resulted in characterization of the syndromes of subclinical hypothyroidism, characterized by normal free T4 estimate and raised serum TSH, and subclinical hyperthyroidism, in which patients have normal serum free T4 estimate and decreased serum TSH. Therapy for these two disorders in generally recommended but must be individualized according to the patient's general medical condition. ⋯ This report reviews subclinical hypothyroidism and subclinical hyperthyroidism, describing their causes, diagnostic criteria, complications, and indications for treatment. A brief review of testing for thyroid function is presented, and each of the subclinical disorders is compared with the classic syndromes of hypothyroidism and hyperthyroidism.
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To determine the demographics, clinical presentations, pathological findings, and the effectiveness of treatment in 110 patients with thoracic endometriosis syndrome (TES). ⋯ There is a significant association between the presence of pelvic endometriosis and TES, with the latter occurring approximately 5 years later. Pneumothorax is the most common manifestation. The most plausible explanation for pathogenesis involves peritoneal-pleural movement of endometrial tissue through diaphragmatic defects and microembolization through pelvic veins. Diagnosis is established on clinical grounds in most cases. Surgical pleural abrasion is superior to hormonal treatment in the long-term management of pneumothorax. Earlier diagnosis and effective therapy of TES can decrease the morbidity of this disease in women during their reproductive period.
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Randomized Controlled Trial Multicenter Study Comparative Study Clinical Trial
Nebulized bronchodilators for outpatient management of stable chronic obstructive pulmonary disease.
The bronchodilator efficacy, safety, and persistence of effect of the anticholinergic agent ipratropium bromide and the beta-adrenergic agonist albuterol, both given by nebulization, were compared in 223 patients with stable, severe chronic obstructive pulmonary disease (COPD). The study was a randomized, double-blind, parallel group trial conducted over 85 days. Patients took the study drugs (either 500 micrograms of ipratropium bromide or 2.5 mg of albuterol) three times daily on an outpatient basis throughout the study. ⋯ Patients receiving ipratropium bromide scored higher on a quality-of-life questionnaire evaluating dyspnea, fatigue, emotional function, and mastery. Side effects were relatively infrequent and generally mild for both study drugs. These results show that ipratropium bromide, given by nebulization, is safe and effective in the outpatient treatment of COPD.
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Randomized Controlled Trial Clinical Trial
Addition of anticholinergic solution prolongs bronchodilator effect of beta 2 agonists in patients with chronic obstructive pulmonary disease.
A randomized, double-blind placebo-controlled clinical trial was designed to assess the safety, efficacy, and duration of the bronchodilation resulting from the addition of 500 micrograms of ipratropium bromide (Atrovent; Boehringer Ingelheim, CT) inhalation solution to standard small volume nebulizer treatments with 2.5 mg albuterol inhalation solution. A total of 195 patients (63% men, average age 64 years) with > 10 pack-year smoking histories and stable, moderate-to- severe chronic obstructive pulmonary disease (COPD; forced expiratory volume in 1 second [FEV1] 1.02 liter, 38.8% predicted) from eight university-affiliated chest clinics in seven U. S. cities were enrolled into the study. ⋯ Similar increases were seen in FVC and FEF25-75%. The peak improvements in FEV1 and FVC with the addition of ipratropium bromide to albuterol were maintained on test days 43 and 85. Considering the safety and efficacy profiles of this combination, the data would suggest that ipratropium bromide inhalation solution should be considered first-line therapy for those patients with COPD requiring small volume nebulizer treatments.