India’s ‘healing’ herb-dyed cloth

Cloth infused with the herbs of traditional Indian medicine is becoming increasingly popular as the country's stressed urban workers seek cures for conditions such as insomnia and eczema.

Wearing a special shirt is claimed to cure itchy or sore skin, while sleepless nights can be taken care of by putting a herb-infused sheet over your mattress.

The herbs are selected according to the traditional Indian medicine known as ayurvedia, with the infused cloth known as ayurvastra.

"We have selected 28 medicinal plants based on ayurvedic texts and theory - then we dip the natural cotton into it to make sleeping cloths," the chief dyeing technician of the ayurvastra project, Rajan Kay, told BBC World Service's Culture Shock programme.

"For skin problems we select a plant like indigo, and mix with the plant turmeric."

Proper effect

The main centre for ayurvedic practices is Kerala, where it has existed alongside Western medicine for two centuries.

The Keralan government is set to release a report on a local clinical trial that claims the clothes do indeed have health benefits.

And cloth which calms the nerves is certainly proving popular with stressed-out IT consultants from nearby Bangalore.

But Catherine Stubberfield, who has worked with textile manufactures all over the world before moving to work with ayurvastra, warned that the clothes must be combined with the right lifestyle to have the proper effect.

"I believe that wearing natural cotton, wool or silk which has been dyed naturally is going to obviously help your skin, but I think as far as the healing goes ayurvedia is a way of life," she said.

"Wearing a T-shirt made of ayurvedic dyeing is not going to cure you. What the government report will say is if you take it with ayurvedic medicine, it is OK. But it is very difficult for people from the West to understand this."

Meanwhile Dr K Ravi, who established the project, outlined that health benefits of ayurvastra cloth are only part of the story - he began the project not to promote health, but to sustain the traditional industries of rural Kerala.

"The tradition of the handloom is part and parcel of this land - and ayurvedia also," he said.

He pointed out that people in the area traditionally get only 35 rupees - $0.6 - per day to live on. But the ayurvedia sheets will allow them to get more money in domestic and international markets.

"The major part of that that will be transferred to these poor people," he added.
This is a part of article India’s ‘healing’ herb-dyed cloth Taken from "Generic Allegra (Fexofenadine) Detailed Reviews" Information Blog

Assessing Outcomes From the Sleep Disturbance Associated With Rhinitis.

Performance Testing

Although poor control of allergic rhinitis symptoms can lead to sedation, nonprescription and prescription medications used to treat symptoms can cause drowsiness and impair performance in everyday tasks. Some H1-antihistamine receptor antagonists are documented to cause drowsiness and decreased mental performance. Participants treated with placebo and fexofenadine demonstrated similar driving abilities in the Iowa Driving Simulator. Coherence was significantly better after taking fexofenadine and even alcohol as compared with diphenhydramine.[64,65]  Printer- Friendly Email This

Curr Opin Allergy Clin Immunol.  2007;7(3):249-256.  ©2007 Lippincott Williams & Wilkins
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Aids study halted over high risks

A major international study of a new way of treating HIV has been stopped because researchers found it was doubling the risk of illness or death.

More than 5,000 people in 33 countries were given anti-retroviral drugs only when their immune systems weakened.

But they were twice as likely to die or suffer illness as patients on the drugs full-time, said the National Institute of Allergy and Infectious Diseases.

It had been hoped the treatment would minimise side-effects, and save money.

'Cost-cutting'

Investigators from the institute, NIAID, said that as well as the higher risk of death or illness, those taking part in the study also experienced "an increase in major complications such as cardiovascular, kidney and liver diseases".

NIAID recommended that doctors participating in the international study should resume full-time anti-retroviral therapy (ART) for all patients.

The findings by the US government are a blow to advocates of the study, who were trying to reduce the huge cost of ART, especially in poor countries where Aids is most widespread.

Some earlier small-scale studies had indicated that carefully monitored breaks in ART could keep Aids at bay.

The trial, known as Strategies for Management of Anti-Retroviral Therapy, has been running since 2002.

Nick Partridge, chief executive of the HIV charity Terrence Higgins Trust, said: "This trial has given us a crucial insight into how HIV should be treated in future.

"However, the results will be a disappointment for many people with HIV.

"Continuous treatment is complex, can cause side effects and can be difficult to stick with.

"At the moment, many people take a ¿treatment break¿ to improve their quality of life.

"It's essential that the information from this trial is disseminated as soon as possible.

"People living with HIV and their consultants need the latest information in order to make educated choices about future treatment regimes."
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Pulmonary Medicine, October 2005

In This Journal ScanThe New England Journal of MedicineThoraxChestAmerican Journal of Respiratory and Critical Care Medicine

Pulmonary Medicine, October 2005 Journal Scan

FromThoraxOctober 2005  ( Volume 60, Number 10 )

Pepsin Like Activity in Bronchoalveolar Lavage Fluid Is Suggestive of Gastric Aspiration in Lung AllograftsWard C, Forrest IA, Brownlee IA, et al 
Thorax.  2005;60(10):872-874

Bronchiolitis obliterans (BO), the pathologic correlate of chronic allograft rejection, is the entity that is the most common cause of a patient's demise beyond the first post-lung transplant year. This remains 1 of the major reasons why outcomes after lung transplantation continue to lag behind that of other solid organ transplants. As yet, there are no proven effective therapies for BO. Any intervention that might reduce the incidence of BO might have a significant impact on survival. Similarly, early identification of treatable risk factors could have significant long-term benefits. One such risk factor appears to be chronic aspiration. For a number of reasons lung transplant recipients might be at higher risk for aspiration. Specifically, vagal innervation might be disrupted as a result of the surgery and the calcineurin inhibitors are known to reduce gastric motility. Most of the work highlighting the potential association of BO with gastroesophageal reflux disease has come from the group at Duke.[1-4] It is therefore gratifying that another group has produced data consistent with that of the Duke groups, which lends further credence to the association.

In this article, from the British group at Newcastle upon Tyne, the authors looked at levels of pepsin in the bronchoalveolar lavage samples of 13 lung transplant recipients. These patients were 3-87 months out from their transplants. All of them were on standard triple immunotherapy, 10 were taking prophylactic proton pump inhibitors, and all were free from any symptoms suggestive of gastroesophageal reflux disease. They compared the pepsin levels of these patients to those of 4 normal nonsmoking controls (who they somehow talked into undergoing bronchoscopy!). These controls were invaluable as they underscore the importance of the results found in the patients, specifically the levels of pepsin in the controls were < 1 ng/mL vs 109 ng/mL in the patients (range, 35-1375). Small numbers perhaps, big difference definitely, and a P value of .003 to underscore this.

The scary implication of this study is that all lung transplant recipients aspirate and can remain symptom-free, acid-free, and still potentially suffer the deleterious consequences of proteolytic activity in the lungs. This study raises a number of questions. First, is it possible that enzymatic activity precipitates an exaggerated or ongoing immune response? Could it be that BO is not an immunologic injury after all? What is needed to validate these findings is a study showing a correlation between bronchoalveolar lavage pepsin levels and the subsequent development of BO. A retrospective study showing that fundoplication halts or reverses BO has already been performed by the group at Duke[4]. .. food for thought indeed!ReferencesDavis RD, Lau CL, Eubanks S, et al. Improved lung allograft function after fundoplication in patients with gastroesophageal reflux undergoing lung transplantation. J Thorac Cardiovasc Surg. 2003;125:533-542.Lau CL, Paler SM, Howell DN, et al. Laparoscopic antireflux surgery in the lung transplant population. Surg Endosc. 2002;16:1674-1678.O'Halloran EK, Reynolds JD, Lau CL, et al. Laparoscopic Nissen Fundoplication for treating reflux in lung transplant recipients. J Gastrointest Surg. 2004;8:132-137.Cantu E, Appel JZ, Hartwig MG, et al. Early fundoplication prevents chronic allograft dysfunction in patients with gastroesophageal reflux disease. Ann Thor Surg. 2004;78:1142-1151.

Abstract

This is a part of article Pulmonary Medicine, October 2005 Taken from "Erectile Disfunction Medication" Information Blog

Cardiovascular Outcomes Among Sildenafil Users

Conclusions

The results of the IMHS constitute a valuable contribution to the literature on real-world data on users of sildenafil. Instead of evaluating CVD events in men enrolled in clinical trials, the IMHS included men in the general population who were prescribed sildenafil. The results are consistent with previous analyses, suggesting that the incidence of CVD events in men prescribed sildenafil for ED was low and similar to those in clinical trials and the UK PEM study. The results also support previous reports that ED and CVD share risk factors and that men with ED are at greater risk for CVD events than those without ED.

CLICK HERE for subscription information about this journal.  Printer- Friendly Email ThisFunding Information

The study was sponsored by Pfizer Inc. Murray A. Mittleman has served as a consultant to Pfizer Inc., Lily ICOS LLC and Bayer Healthcare, and has previously received research funding from Pfizer Inc. Statistical support was provided by Xiaofeng Zhou of Pfizer Inc. Editorial support was provided by Carl Clay, PhD, and Deborah M. Campoli-Richards, BSPHA, RPh, at Complete Healthcare Communications, Inc., and was funded by Pfizer Inc.Reprint Address

Dr Murray A. Mittleman, Cardiovascular Division, Beth Israel Deaconess Medical Center, 330 Brookline Ave - MASCO 423, Boston, MA 02215, USA, Tel.: + 617 632 7694, Fax: + 617 632 7698, Email: mailto:mmittlem@hsph.harvard.edu

Int J Clin Pract.  2008;62(3):367-373.  ©2008 Blackwell Publishing
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Viagra: the hard sell

Viagra - it is the drug that has transformed the lives of millions and changed the way we think about sex forever.

The rise and rise of Viagra has created a £1.5bn worldwide market in anti-impotence pills.

Now rivals are fighting for a share of the spoils and it is becoming a recreational drug of choice for some in the party generation.

Last week, Pfizer's chief executive Henry McKinnell warned that Chinese made counterfeits posed a threat to its business and urged the country's authorities to clamp down on the copycats.

New research

Pfizer, the world's biggest pharmaceutical company, stumbled on the drug by accident at their research labs in Sandwich, Kent.

In the late 1980s, they had been developing a new treatment for angina, but noticed a strange side-effect in trials - increased erections among volunteers.

The effect on their sex lives was so marked that once the angina trails were over the volunteers wanted to keep on taking the medication.

Pfizer decided to commission some new research.

In 1989 they approached Clive Gingell, one of Britain's top Urological Surgeons, based in Bristol.

He had spent his whole career trying to treat and improve the lives of thousands of men suffering from impotence.

In those days, commonly used treatments included the fitting of implants directly into the penis, a vacuum pump and self injection.

Most sufferers were thoroughly put off and consigned themselves to a life without sex.

Viagra arrives

Mr Gingell ran a new series of trials, and the results impressed him.

He describes Viagra as "a wonder drug".

"The thought of having a pill that would cure impotence was amazing to me," he says.

"I never thought I would see it in my lifetime."

"There has been a kind of Holy Grail idea associated with curing impotence," Pfizer's Mariann Caprino tells the Money Programme.

"And here it was in a little blue pill."

Colossal market

When Viagra was launched in 1998, Pfizer's share price doubled. It was apparent that there was a huge previously untapped market out there.

Doctors claim that half of all men over 40 become impotent at some point in their lives.

That is more than 150 million worldwide, with two million sufferers in Britain alone, so the potential market for drugs like Viagra is colossal.

Overnight Viagra made Pfizer famous. "We discovered the mass production of penicillin, yet it was Viagra that put Pfizer on the map," says Ms Caprino.

Embarrassing subject

Nevertheless, despite the highly successful launch, the company faced a huge potential problem in selling Viagra.

Men were simply not willing to talk about impotence, they were ashamed.

If they were not prepared to discuss their impotence, how could they be persuaded to ask their doctor for a prescription?

Ray Reynolds, who suffered from impotence for 30 years, had simply given up hope of ever being able to have sex again.

"I thought well, I'll just put it to one side and remain a eunuch for the rest of my life," he says.

Celebrity endorsement

To overcome the problem, Pfizer came up with a series of marketing ploys.

Firstly, they asked the Vatican, and other world religious leaders, for their blessing. This headed off possible moral and religious objections.

Secondly, they employed big name celebrities to encourage men to seek treatment for impotence.

Pele, the legendary footballer, headed a men's health campaign about erection problems, and 75 year old former US Presidential candidate Bob Dole went public for Pfizer about his own impotence problem.

American men rushed to their doctors.

Leon Steinberg, an 84-year-old impotence sufferer living in a retirement community in Florida, was impressed by Mr Dole's courage in coming forward.

"When I saw it on TV, I admired him for it," he says.

"You might say he was my idol."

Withdrawal of campaign

Pfizer decided not to use the term "impotence" in the advertisements, instead replacing it with a more bland technical term "erectile dysfunction".

Pfizer's Mike Suesserman says the new term "allowed us to make the condition a household name".

Pfizer reasoned that few men may admit to impotence, which employs a complete loss of ability, but a lot more may own up to erectile dysfunction, which suggests a much broader range of symptoms.

But Pfizer's aggressive marketing campaign has recently run into trouble.

A recent television advertisement has been criticized in the United States for suggesting that Viagra might be better and more effective for patients than the clinical experience suggests.

The Food and Drug Administration ordered its withdrawal.

Efficient sex

There are potential problems, too, in the increasing use of Viagra as a recreational drug.

"For a lot of gay people it is just a normal way of life," says Gary Mercado, who runs the Elysium Resort, the largest gay hotel in Fort Lauderdale, Florida.

When Viagra is taken with amphetamines, "you forget about having protective sex, so there are huge capabilities of transmitting all sorts of sexual diseases", he says.

Pfizer says that a very small percentage of people abuse Viagra, but accepts there is great potential in developing the market for sexual pharmaceuticals.

Meika Loe, author of the book The Rise of Viagra, agrees: "In the Viagra era, sexuality is subject to the cult of efficiency. It's become almost McDonald's-ised. Serve it up fast and hot."

The Money Programme: Viagra: The Hard Sell was broadcast at 2200 GMT on Wednesday, 9 February on BBC Two .
This is a part of article Viagra: the hard sell Taken from "Erectile Disfunction Medication" Information Blog

Pulmonary Hypertension, February 2006

In This Journal ScanPediatric ResearchChestCirculation ResearchThe New England Journal of Medicine

Pulmonary Hypertension, February 2006 Journal Scan

FromChestFebruary 2006  ( Volume 129, Number 2 )

Pulmonary Hemodynamic Responses to Brain Natriuretic Peptide and Sildenafil in Patients With Pulmonary Arterial HypertensionKlinger JR, Thaker S, Houtchens J, Preston IR, Hill NS, Farber HW 
Chest.  2006;129(2):417-425

Atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP) are proteins that are expressed in the heart.[1] These peptides raise the intracellular cyclic guanosine monophosphate (cGMP) levels to cause vasorelaxation. Another benefit of these peptides is the inhibition of vascular smooth muscle proliferation.[2] Study results have demonstrated inhibition of pulmonary vasoconstriction in pulmonary arterial rings by these 2 peptides[3] and the development of increased pulmonary artery pressures when the gene for encoding of ANP is disrupted.[4] The exact hemodynamic response to these peptides in patients with pulmonary arterial hypertension (PAH) has not been adequately studied, but the use of natriuretic peptides in patients with left heart disease and chronic hypoxic lung disease has demonstrated a decrease in pulmonary artery pressure (PAP).

This study looks at the effect of BNP acutely on hemodynamics (compared with inhaled nitric oxide [iNO] and epoprostenol) in patients with PAH and then the effect on hemodynamics when the pohsphodiesterase-5 (PDE-5) inhibitor sildenafil is added. This open-label study ran from September 2002 to June 2003 and enrolled 13 patients. Inclusion criteria included mean PAP (mPAP) levels > 25 mm Hg at rest, and a World Health Organization class I PAH group. They also had to be de novo patients. All patients had a Swan-Ganz catheter placed and received epoprostenol and, in addition, 8 patients also received iNO. They then received 2 infusions of the human B-type natriuretic peptide nesiritide. The second infusion of nesiritide occurred 1 hour after a single dose of oral sildenafil.

Hemodynamics were evaluated at various points during each separate drug administration. Plasma BNP levels were also obtained. mPAP was 48.6 ± 3.7 mm Hg and mean pulmonary vascular resistance (PVR) was 698 ± 105 dynes·cm/s². The resultant findings were decreased mPAP with both iNO and epoprostenol and an increase in cardiac index and decrease in PVR with epoprostenol. The BNP infusion on its own did not affect mPAP or PVR. With 1 dose of sildenafil, the mPAP and PVR did drop below baseline, and the addition of BNP after the sildenafil dose resulted in a further decline in mPAP. The decrease in mPAP and PVR in this group remained visible for up to 6 hours after stopping the BNP infusion, signifying the longest duration of response of all the groups. Only 1 patient demonstrated a vasodilator response to epoprostenol or sildenafil alone, but 4 of 12 patients demonstrated a positive vasodilator response to sildenafil with BNP.

Increased circulating BNP levels may help slow right ventricular remodeling and may even inhibit the proliferation of pulmonary vascular smooth muscle. With their effect on endothelin synthesis (inhibition), the natriuretic peptides could improve the effects of endothelin receptor antagonists. What is uncertain here is the rationale for the lack of response (decreased mPAP and PVR) to the BNP infusion alone but the positive response when sildenafil was added. The authors believe that the dose or duration of the BNP infusion may not have been adequate. Further studies are needed to determine whether there is a place for chronic BNP therapy in the treatment of PAH.ReferencesHill NS, Klinger JR, Warburton RR, et al. Brain natriuretic peptide: possible role in the modulation of hypoxic pulmonary hypertension. Am J Physiol. 1994;266:L308-L315.Hutchison HG, Trindade PT, Cunanan DB, et al. Mechanisms of natriuretic-peptide-induced growth inhibition of vascular smooth muscle cells. Cardiovasc Res. 1997;35:158-167.Klinger JR, Warburton RR, Pietras L, et al. Brain natriuretic peptide attenuates the development of pulmonary hypertension in hypoxia-adapted rats. J Appl Physiol. 1998;84:1646-1652.Klinger JR, Warburton RR, Pietras L, et al. Genetic disruption of atrial natriuretic peptide causes pulmonary hypertension in normoxic and hypoxic mice. Am J Physiol. 1999;276:L868-L874.

Abstract

This is a part of article Pulmonary Hypertension, February 2006 Taken from "Erectile Disfunction Medication" Information Blog

Bilayered Extracellular Matrix Technology & Wound Healing

Discussion

The morbidity and economic burden associated with venous ulcers have led to a growing interest in the development of new approaches to accelerate healing. In this retrospective study, the authors have shown that ECM does not significantly improve venous ulcer healing compared to standard compression dressing. Although ECM leaves an adequate layer of granulation tissue, is easy to apply, and is well tolerated by patients, the physicians at the CMC Wound Care Center believe that the foundation of venous ulcer treatment includes the control of lower-extremity edema and the maintenance of a more stable compression pressure. Given the data collected by this project and the present body of evidence collected to date, it is recommended that further considerations be made to augment clinicians' armament to treat venous leg ulcers.

The standard of care for patients with venous disease implies following a "minimum" set of parameters and treatment regimens. These standards focus on accurate diagnosis, local wound care, infection control, and the application of compression therapy. The mainstay of therapy has been the relief of venous hypertension by external compression.[10,12,13] The traditional Unna boot is a popular and effective form of compression therapy. It is a moist zinc-impregnated bandage and provides both compression and topical treatment.[8] Additionally, compression may be applied by re-enforcement of web-role elastic bandage in multiple layers. However, this decision remains with the clinician. Available data has not proved nor disproved the effectiveness of this theory. Fletcher and Sheldon[14] reviewed 24 randomized trials and found that compression alone is superior to other treatment modalities without compression. This significant difference was partly explained by the maintenance of a more stable compression pressure. Conversely, the Unna boot does not accommodate changes in the volume of the leg. Another disadvantage is the operator-dependent nature of the compression achieved. In many studies, no clear difference in the effectiveness of different types of compression systems has been shown.[9] However, compression therapy has remained the standard therapy.[10,12]

Extracellular matrix is a new biomaterial taken from porcine small intestine. The sub-mucosa provides strength to the intestine through a complex organization of collagen that forms a fibrous matrix. Extracellular matrix is extracted from the intestine in a manner that removes all cells but leaves the complex matrix intact. It retains the natural composition of matrix molecules, such as collagen (types I, III, IV), glycosaminoglycans (hyaluronic acid, chondroitin sulfate A and B), proteoglycans, and glycoproteins (fibronectin), which are known to have important roles in host tissue repair and remodeling. Benbow[11] reported that ECM stimulates healing in noninfected wounds.

Prospects to augment compressive therapy could include spray application of living keratinocytes and fibroblasts as biological dressings. For surgical management of venous hypertension to resolve venous reflux, the patient's vein reflux is treated with endoluminal radiofrequency thermal occlusion, which obliterates the vein. Hydroxyrutosides restore endothelial barrier function. Electrical stimulation has been recently shown in a meta-analysis to provide significant benefit for healing chronic wounds of many etiologies, including venous ulcers, and at this point has the most literature-based support.[15-18]  Printer- Friendly Email ThisReprint Address

Ira Lown, MD, Cabrini Medical Center, Department of Surgery 227 E. 19th St., New York, NY 10003 Phone: 212-995-6000; Email: iralown@yahoo.com .

Wounds.  2005;17(2):27-31.  ©2005 Health Management Publications, Inc.
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New York Times Examines Debate Over Medicare Coverage of Erectile-Dysfunction Medications

The… New York Times on Tuesday examined the ongoing debate over whether Medicare should cover erectile-dysfunction medications, such as Pfizer's Viagra. CMS officials last month said that they interpreted the policies governing the new Medicare prescription drug benefit to mean that drugs such as Viagra, Eli Lilly's Cialis and GlaxoSmithKline's Levitra must be covered if they are prescribed by a doctor. CMS' announcement prompted Rep. Steve King (R-Iowa) this month to introduce a bill prohibiting Medicare from covering drugs "prescribed for the treatment of impotence."

Support
Kindra Strupp, a spokesperson for Lilly, said, "Erectile dysfunction is not a trivial thing for men who suffer from it. We've heard from thousands of men that it can interfere with their intimacy, erode their relationships with their partners, damage their self-esteem and lead to depression." Lilly, Pfizer and GSK are focusing efforts to retain Medicare coverage for ED drugs on three arguments: that ED is a medical condition recognized by providers and health insurers; that men seeking treatment for ED frequently are found to have underlying conditions such as diabetes and high blood pressure that otherwise would not have been detected; and that using a formulary that requires prior authorization, charges higher copayments or limits the number of pills that can be dispensed could prevent abuse of ED medications.

Medical Necessity
Daniel Callahan, co-founder of the Hastings Center bioethics research institute, said that a "possible compromise solution" might be to "set specific medical criteria allowing Medicare coverage for [the] drugs when erectile dysfunction can be traced to some identifiable medical condition other than age." Robert George, a professor at Princeton University and a member of the President's Council on Bioethics, said, "If impotence occurs in the normal course of a human life, as a consequence of aging, these drugs should not be covered. But if there is a real health problem, I am inclined to say the drugs should be covered." William Gee, chair of the health policy council of the American Urological Association, said, "For a 70-year-old man with hardening of the arteries caused by smoking, for a man with diabetes or multiple sclerosis or a man who has had pelvic surgery for cancer, there are clear medical indications for these drugs." Arthur Caplan, director of the Center for Bioethics at the University of Pennsylvania, said the issue has forced policy makers to ask, "What emphasis will we give to quality of life as a goal for pharmacological intervention?" (Pear, New York Times, 2/22).

Medicare Advantage Program
In related news, CMS Administrator Mark McClellan on Friday announced that the agency has received more than 141 applications from health plans to participate in the Medicare Advantage Program, indicating that beneficiaries will "see a robust [program] when it really gets started in January." The new Medicare law includes a provision calling for financial incentives to health plans to attract them to the MA program. According to CQ HealthBeat, the 141 applications are in addition to the 152 HMOs, 26 PPOs and seven private fee-for-service plans currently in the program. The figures also do not reflect applications for regional plans, which are due March 23 (CQ HealthBeat, 2/18).

Rising Costs
The Minneapolis Star Tribune on Sunday examined the "surprising escalation" in the cost of Medicare and experts' concerns that the program's financial outlook could necessitate reforms earlier than Social Security (Westphal, Minneapolis Star Tribune, 2/21).

Broadcast Coverage
NBR on Monday in a series of segments reported on the future of Medicare. The segments included comments from NBR on Monday in a series of segments reported on the future of Medicare. The segments included comments from Michael Carter, vice president of Hay Group; Paul Ginsberg, president of the Center for Studying Health System Change; Gail Wilensky, a senior fellow at Project Hope; Dr. Marcia Gomez, a medical director of health services at Humana; Marsha Gold, a senior fellow at the Mathematica Policy Research; McClellan; Amy Compton Phillips, care management director at Kaiser Permanente; President Bush; and parents, employers and retirees (Yastine, NBR, 2/21).

A complete transcript of the segments is available online.

"Reprinted with permission from kaisernetwork.org kaisernetwork.org. You can view the entire Kaiser Daily Health Policy Report, search the archives, or sign up for email delivery at http://www.kaisernetwork.org/dailyreports/healthpolicy. The Kaiser Daily Health Policy Report is published for kaisernetwork.org, a free service of The Henry J. Kaiser Family Foundation . © 2005 Advisory Board Company and Kaiser Family Foundation. All rights reserved.
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Thyrotropin-secreting Pituitary Tumor and Hashimoto’s Disease

A 69-year-old man was referred for elevated serum T3 and T4.
He had been generally asymptomatic except for mild hyperhidrosis, mild heat attitude, and an occasional cephalalgia.
Ternion period ago he was noted to have a multinodular goiter with cold areas on echography scans.
Thyroid fine-needle biopsy was reported as follicular neoplasm, and the affected role had a stake hemithyroidectomy, which revealed a multinodular goiter.
Antithyroglobulin, antithyroperoxidase antibodies, and serum TSH levels were elevated, and the semantic role was diagnosed with Hashimoto’s disease and started on thyroid exchange therapy.
His medical arts included non-insulin-dependent diabetes, resection of prostatic adenocarcinoma, and Anemia of chronic disease.
His medications were acetaminophen, aspirin, buspirone, fexofenadine, flunisolide, furosemide, glipizide, hydralazine, Synthroid, metformin, morphine, potassium compound, prazosin, quetiapine, timolol, and venlafaxine.
He is a person and nonalcoholic, and denies drug utilization.
No thyroid disorderliness was noted in his house.
His capitulation of systems was photographic film for palpitations, temperament, disturbed bowel routine, temblor, and visual strangeness.
The semantic role had a 25-pound physical property gain during the previous year and has remained soul with housework.
On physical self-contemplation, he had normal vital signs except for a legume of 50 beats/min.
He had normal visual fields and normal extraocular and palpebral change.
The head communicating was unremarkable.
His left thyroid lobe was enlarged, firm, and nontender.
The thorax, pith, lung, and abdominal examinations were unremarkable.
The neurologic investigating was normal.

After undergoing thyroidectomy, he was placed on thyroid renewal, but his T3 and T4 levels started to step-up with persistent top in TSH levels. l-Thyroxine was gradually decreased and then stopped.
He was referred to the ductless gland healthcare facility for further social control.
Research lab findings included elevated values of free T4, free T3, amount T3, TSH, antithyroglobulin, and antimicrosomal antibodies.
Normal values were found for cortisol, prolactin, testosterone, follicle-stimulating hormone, luteinizing hormone, α-subunit, and thyroid-stimulating immunoglobulin.
Serum sex protective cover globulin was elevated (Table 1).
His hemoglobin was 10.2 g/dl (hematocrit, 31.1%) with a normal achromatic color origin cell numeration.
His habitant software test and electrolytes were normal.
His basal TSH of 7.4 µIU/ml increased to 9.5 µIU/ml after 500 µg of IV TRH.
A thyroid 123I scan showed an increased 5-hour human process of 23% and a 24-hour bodily function of 53% with a diffuse uniform blowup of the left side (Table 2 and Fig. 1).
A head magnetic ringing pictorial representation (MRI) scan showed pituitary exposure suggestive of adenoma with suprasellar annex arrival but not compressing the optic chiasm (Fig. 2).
The visual theatre of operations communication via the perimetry was normal.
The case was referred for surgical intercession.
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