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It is concentrated by the of thyroid hormone include the plasma membrane 100 pills aspirin pain disorder treatment plan, cy- thyroid buy aspirin 100 pills free shipping tuomey pain treatment center, where it inhibits thyroidal I uptake, incorpora- 65 Thyroid and Antithyroid Drugs 747 tion of I into Tg, coupling of iodotyrosine, and, eventu- succeeding months, especially in severe cases, protuber- ally, thyroid hormone secretion. Patients include somnolence, slow mentation, dryness and loss of with secondary hypothyroidism exhibit undetectable or hair, increased fluid in body cavities (e. In sec- sac), low metabolic rate, tendency to gain weight, hy- ondary hypothyroidism, a normal thyroid gland lacks perlipidemia, subnormal temperature, cold intolerance, the normal level of TSH stimulation necessary to syn- bradycardia, reduced systolic and increased diastolic thesize and secrete thyroid hormones. Such patients pulse pressure, hoarseness, muscle weakness, slow re- usually also have impaired secretion of TSH in response turn of muscle to the neutral position after a tendon to exogenous thyrotropin-releasing hormone (TRH) jerk, constipation, menstrual abnormalities, infertility, administration. Tumors, trauma, radiation ther- serum TSH concentrations) are usually treated with apy, or infiltrative disease of the hypothalamus can thyroxine with the aim of relieving symptoms and re- cause such damage. This relatively rare form of hy- ducing the serum TSH concentration into the normal pothyroidism is also characterized by inappropriately reference range. Iodine Clinical Manifestations supplementation alone may lead to the development of of Hypothyroidism acute hyperthyroidism. During the perinatal period, there is an absolute re- Patients with secondary or tertiary hypothyroidism quirement for thyroid hormone for the development are also usually treated with thyroxine, but the serum and maturation of the nervous and musculoskeletal sys- TSH concentration is not a reliable guide to therapy. In the perinatal nervous system, thyroid hormone The efficacy of thyroid hormone replacement in these plays a critical role in normal growth of the cerebral and patients must be assessed clinically and by measure- cerebellar cortices, the proliferation of axons, the ment of the serum T4 concentration. Hypothyroidism-induced impairment of ing hypothyroidism with the classic symptoms of hy- linear growth can lead to dwarfism in which the limbs pothyroidism. Decompensation into myxedema coma are disproportionately short in relation to the trunk may occur when the homeostatic mechanisms of the se- with the apparent bone age retarded in relation to verely hypothyroid patient are subject to a stressful pre- chronological age. The principal manifestation of tardation of mental development and growth) become myxedema coma is a deterioration of mental status (ap- manifest only in later infancy and are largely irre- athy, confusion, psychosis, but rarely coma). Consequently, early recognition and initiation mon clinical features include hypothermia, diastolic hy- of replacement therapy are crucial. In the absence of pertension (early), hypotension (late), hypoventilation, thyroid hormone therapy, the symptoms of infantile hy- hypoglycemia, and hyponatremia. If myxedema coma is pothyroidism include feeding problems, failure to suspected, the patient is usually admitted to an inten- thrive, constipation, a hoarse cry, and somnolence. In sive care unit for pulmonary and cardiovascular support 748 VII DRUGS AFFECTING THE ENDOCRINE SYSTEM and treated with intravenous T4 (or sometimes T3). The total thyroid hormone content of thyroid DRUGS USED IN THE TREATMENT glands and the ratio of T3 to T4 vary somewhat from OF HYPOTHYROIDISM one species to another. Thyroid USP preparations are therefore standardized on the basis of their iodine con- Levothyroxine Sodium tent. Thus, a Levothyroxine sodium (Levothroid, Synthroid, Levoxine) given preparation may satisfy the USP iodine assay re- is the sodium salt of the naturally occurring levorota- quirements and yet contain low amounts of T and T. It is the preparation of choice for Thyrar (a beef extract) and Armour Thyroid tablets (a maintenance of plasma T4 and T3 concentrations for pork extract) are evaluated by additional biological as- thyroid hormone replacement therapy in hypothyroid says to ensure consistent potency from one batch to an- patients. Since much of the T4 is deiodi- rified frozen porcine Tg preparation, is an attempt to nated to T3, it is usually unnecessary to use more ex- avoid the variability in desiccated thyroid prepara- pensive preparations containing both T4 and T3. It is also assayed and standardized for biological is to establish euthyroidism with measured serum con- potency. These two preparations have a higher ra- prove useful in removing the stimulatory effects of TSH tio of T to T than that found in human thyroid secre- 3 4 on the thyroid gland in the management of simple tion, so supraphysiological levels of T may occur in 3 nonendemic goiter, chronic thyroiditis, and TSH- the immediate postabsorptive period because of the dependent thyroid carcinoma. Liothyronine sodium (Cytomel) is the sodium salt of the naturally occurring levorotatory isomer of T3. Liothy- ronine is generally not used for maintenance thyroid hormone replacement therapy because of its short plasma half-life and duration of action. The use of T3 ADVERSE EFFECTS OF TREATMENT alone is recommended only in special situations, such as WITH THYROID HORMONE in the initial therapy of myxedema and myxedema coma The most common adverse effects (i. The use of T3 alone include cardiac palpitation and arrhythmias, tachycar- may also be useful in patients with the rare condition of dia, weight loss, tremor, headache, insomnia, and heat 5 -deiodinase deficiency who cannot convert T4 to T3. Liotrix In patients with longstanding hypothyroidism and Liotrix (Euthroid, Thyrolar) is a 4:1 mixture of levothy- those with ischemic heart disease, rapid correction of roxine sodium and liothyronine sodium. Like levothy- hypothyroidism may precipitate angina, cardiac ar- roxine, liotrix is used for thyroid hormone replacement rhythmias, or other adverse effects. Although the idea of replacement therapy should be started at low initial combining T and T in replacement therapy so as to doses, followed by slow titration to full replacement as 4 3 mimic the normal ratio secreted by the thyroid gland is tolerated over several months.

These studies are in their preliminary stages cheap 100pills aspirin with amex treatment for nerve pain in dogs, how- with different properties and uses generic aspirin 100 pills visa lower back pain treatment videos. Other species of magnolia are used by Western Magnolia flower, xin yi hua, is associated with the herbalists. Its main function magnolia include white bay, beaver tree, swamp sas- is to open the airway. Little scientific research has been safras (not to be confused with other forms of sassafras done on the magnolia flower. The New World species of magnolia are smaller than their Asian counter- Magnolia bark and root are also used occasionally in parts, ranging in height from 6-30 ft (2-10 m). Both the Western herbalism, although they are not major healing bark and the root are used in Western herbalism. At one time, magnolia root was used to treat rheumatism, and was thought to be superior to quinine in General use treating chills and fever. Russ- ian herbalists use an oil extracted from the flowers and In Chinese herbalism, magnolia bark, hou po, is as- young leaves to treat hair loss and as an antiseptic on skin sociated with the stomach, lungs, spleen, and large intes- wounds. It is used to treat menstrual cramps, abdominal flower is a minor remedy for asthma and fainting. Injections of magnolia bark extract are Little recent scientific research has been done on said to cause muscle relaxation. It is also used in formu- magnolia in the West; however, Asian researchers have las to treat coughing and asthma. As of 2002, honokiol has attracted interest for its ders thought to move upward in the body. In addition, it is being studied for its Research suggests that compounds found in magno- ability to induce apoptosis, or cell self-destruction, in lia bark may have mild antibacterial and antifungal prop- lung cancer cells. In Japan, honokiol is considered a 1274 GALE ENCYCLOPEDIA OF ALTERNATIVE MEDICINE 2 useful anxiolytic; herbal preparations containing honoki- ol are prescribed as mild tranquilizers. Preparations Anxiolytic—A medication or preparation given as Magnolia bark is most commonly used in the fol- a tranquilizer. Magnolia is thought to contain certain chemicals that cause • Agastache: for treatment of stomach flu and gastroin- the apoptosis of cancer cells. Honokiol—A compound derived from magnolia • Apricot seed and linum: for treatment of chronic con- that is used in some Japanese herbal preparations stipation and hemorrhoids. Honokiol may also be use- • Bupleurum, inula and cyperus: for treatment of stress- ful in treating lung cancer. All these formulas can be made into teas or are com- mercially available as pills or capsules. In addition, allergic re- actions to the pollen from magnolia trees are not unusual. Frey, PhD Interactions In Chinese herbalism, both magnolia bark and flow- Maharishi Ayurveda see Ayurvedic ers are often used in conjunction with other herbs with medicine no reported interactions. There are no formal studies of its interactions with Western pharmaceuticals; however, Mai men dong see Ophiopogon there are anecdotal reports of harmful interactions be- tween magnolia bark and prescription weight-loss med- ications. In addition, magnolia should not be taken to- gether with any medications given to lower blood pres- sure, as it increases their effects. Maitake Description Resources BOOKS Maitake, Grifola frondosa, is a mushroom found Chevallier, Andrew. It is also called “hen-in-the- searchers attribute this latter result to the X and ES frac- woods” and can reach the size of a head of lettuce. More recent studies of the use of cause maitake comes from the polypores group, it pro- MD-fraction in treating cancer patients have also found duces a bunch of leaf-like clumps that are intertwined. This culture is used to make what is called a that started the tumor growth and nail them for destruc- spawn, which is then inoculated into production logs tion. During the next 30 days, cells and prevents them from occurring elsewhere in the the spawn settles in and binds to the log.

Another name for BOR syn- there is an abnormal opening in the roof of the drome is Melnick-Fraser syndrome cheap 100 pills aspirin with mastercard pain and spine treatment center nj. Individuals with mouth that allows the nasal passages and the BOR syndrome typically have physical differences that mouth to be improperly connected buy 100 pills aspirin free shipping back pain treatment nerve block. These birth defects are Congenital—Refers to a disorder which is present caused by a change (mutation) in a gene. Cyst—An abnormal sac or closed cavity filled with Genetic profile liquid or semisolid matter. Scientists recently discovered that mutations in the Deoxyribonucleic acid (DNA)—The genetic EYA1 gene cause BOR syndrome. The EYA1 gene is material in cells that holds the inherited instruc- located on chromosome 8. The exact function of the tions for growth, development, and cellular func- EYA1 gene is unknown, but mutations in this gene dis- tioning. The branchial arches are Fistula—An abnormal passage or communication tissues that develop very early in pregnancy and are between two different organs or surfaces. Gene—A building block of inheritance, which BOR syndrome is inherited in a dominant manner. Each gene is son has a mutation in one of their EYA1 genes, the dis- found on a precise location on a chromosome. The characteristics of the Gustatory lacrimation—Abnormal development syndrome can be extremely variable in severity. A mutation can also occur by chance, in an individual without a family history of Microtia—Small or underdeveloped ears. If a child inherits an abnormal gene Mutation—A permanent change in the genetic from a parent, the signs of the disorder can be very dif- material that may alter a trait or characteristic of ferent between the parent and the child. This is called an individual, or manifest as disease, and can be variable expressivity. Once an individual has a mutation in the EYA1 gene, there is a 50/50 chance with each pregnancy that the gene Renal agenesis—Absence or failure of one or both will be passed on. It does not matter if the gene Unilateral—Refers to one side of the body or only is inherited from the mother or the father. Variable expressivity—Differences in the symp- Demographics toms of a disorder between family members with BOR syndrome occurs in one of every 40,000 live the same genetic disease. BOR syndrome is seen in all ethnic groups and GALE ENCYCLOPEDIA OF GENETIC DISORDERS 171 Branchiootorenal Syndrome Hearing loss Cleft palate Bifid uvula Hearing loss Hearing loss Polycystic kidneys Hearing loss Hearing loss Hearing loss Branchial cleft cyst Cleft palate Kidney problem One kidney missing (Gale Group) cultures. One abnormally shaped, malfunctioning, or totally absent study suggested that 2% of individuals with severe hear- (renal agenesis). Other less common characteristics associated with BOR syndrome include cleft palate, facial nerve paraly- sis, and abnormalities of the tear ducts. Some The characteristics associated with BOR syndrome patients with BOR syndrome uncontrollably develop are highly variable. Other individu- als with BOR syndrome have a few minor physical Diagnosis differences. The birth defects can occur on only one side of the face (unilateral) or be present on both sides The diagnosis of BOR syndrome is made when an (bilateral). An individual does not need to have Abnormal development of the ears is the most com- all three components of the disorder in order to be diag- mon characteristic of BOR syndrome. Ear tags (excess pieces of skin) may be seen on the There is no readily available genetic test that can cheek next to the ear. Some laboratories are per- skin on the outside of the ear) are found in 75% of forming DNA testing for mutations in the EYA1 gene, patients with BOR syndrome. Hearing loss is present in however, this testing is currently being offered on a 85% of individuals with BOR syndrome and this loss research basis only. The most distinctive finding in individuals with BOR syndrome is the presence of cysts or fistulas in the Treatment and management neck region due to abnormal development of the Once a child is diagnosed with BOR syndrome, branchial arches. If Approximately two-thirds of individuals with BOR hearing loss is evident, the child should be referred to a syndrome also have kidney abnormalities.

The consequents of information carrier exposure and seeking are many discount aspirin 100pills with visa pain treatment back, including information gain buy aspirin 100 pills otc hip pain treatment relief, affective support, emotional adjustment, social adjustment, attitude change, knowledge change, behavior maintenance, a feeling of greater control over events, reduction of uncertainty, and compliance with medical advice (Johnson, 1997). Information seeking can be defined simply as the purposive acquisition of information from selected information carriers. Cancer-related information seeking has become increasingly important over the last decade. Not too long ago, information related to cancer was the exclusive preserve of doctors and other health professionals. With this access has come an increasing shift of responsibility (some might say burden) to the individual to convert information into knowledge, in the process making decisions concerning his/her treatment and adjust- ment to cancer (Johnson, Andrews, Case, & Allard, in press). Individual Responsibility/Client/Consumer Movement Increasingly the responsibility for health-related matters is passing to the individual, partly because of legal decisions that have entitled patients to full information (Johnson, 1997). Facilitating and enhancing this consumer movement have been explo- sive developments in information technologies, which make more specialized media sources available, permitting increased choice in information carriers, and increased connectivity with other interested parties (Case, Johnson, Andrews, Allard, & Kelly, 2004; Duncan, 1994). Large numbers of patients do not receive state of the art treatments (Freimuth et al. The overload of information on health professionals today forces decentrali- zation of responsibilities, with increasing responsibility passing to individuals if they are going to receive up-to-date treatment. The physician is no longer the exclusive source of medical knowledge; they must be cognizant of the welter of information available and their role in this complex system (Parrott, 2003). Recognition of the limits of health professionals also requires individuals to be able to confirm and corroborate information by using multiple sources. In fact, patients often call the CIS to verify information they receive elsewhere (Freimuth et al. Cancer patients tend to want much more information than healthcare providers can give to them, even if willing (Johnson, 1997). Information that to a client is necessary for coping with cancer, may be seen by doctors as an intrusion into their prerogatives. Exacerbating this problem is the fact that doctors and patients may not share similar outcome goals. Traditionally, doctors have viewed the ideal patient as one who came to Copyright © 2005, Idea Group Inc. Copying or distributing in print or electronic forms without written permission of Idea Group Inc. Organizing for Knowledge Management 239 them recognizing their authority and who were willing to comply totally (with enthusi- asm) with recommended therapies (Hibbard & Weeks, 1987). Perhaps the most threatening aspect of enhanced information seeking for health professionals is their loss of control. Many doctors have legitimate concerns about self- diagnosis and patients possessing just enough information to be dangerous (Broadway & Christensen, 1993) and the general preferences of consumers may cause them to avoid unpopular, albeit effective, invasive procedures (Greer, 1994). Still, the more control that health professionals have, the less effective they may ultimately be, especially in terms of insuring that clients act according to consensus views of treatment (Johnson, 1997). There are a number of indications that programmatically the best channels for providing cancer-related knowledge are those channels that constitute a hybrid of the positive properties of both mediated and interpersonal channels. Information and referral centers can take many forms, such as hotlines, switchboards, and units within organizations (e. They serve three primary functions: educating and assisting people in making wise choices in sources and topics for searches; making information acquisition less costly; and being adaptable to a range of users (Doctor, 1992). These services have been found to offer considerable help and assistance to callers (Marcus, Woodworth, & Strickland, 1993). Telephone information and referral services like the CIS represent a unique hybrid of mediated and interpersonal channels, since they disseminate authoritative written information, as well as verbal responses to personal queries (Freimuth et al. The hybrid nature of telephone services is important, since it can overcome some of the weaknesses of other channels. They have the additional advantage of homophily of source, a crucial factor in effective communication (see Rogers, 2003), since the calls are handled by individuals of closer status and background to potential callers than are physicians. It has been suggested that the CIS provides an important link between symptomatic people and health services, since a substantial proportion of callers follow up with more information seeking, passing on information to others, or consultations with health professionals (Altman, 1985). The advantages of telephone services as a channel include they: are free, are available without appointment and forms, offer a high level of empathic understanding, offer greater client control, permit anonymity for both parties, bridge geographic barriers, provide immediate responses, the client can take greater risks in expressing feelings, convenience, cost effectiveness, and personalized attention (Johnson, 1997). All these factors are reflected in respondents rating CIS as the highest quality source of cancer information (Mettlin et al.