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You are in: emedicine specialties pediatrics otolaryngology rate this article email to a colleague synonyms and related keywords: rhinitis medicamentosa, rm, overuse of intranasal vasoconstrictive medications, topical nasal decongestants, rebound swelling, overuse of nasal spray author information author information introduction clinical differentials workup treatment medication follow-up miscellaneous bibliography craig f garfield, md, mapp, is a member of the following medical societies: ambulatory pediatric association , and american academy of pediatrics editor s ; : orval brown, md , director of otolaryngology clinic, professor, department of otolaryngology-head and neck surgery, university of texas southwestern medical center at dallas; mary l windle, pharmd , adjunct assistant professor, university of nebraska medical center college of pharmacy, pharmacy editor, emedicine , inc; john e mcclay, md , assistant professor, department of otolaryngology, division of pediatric otolaryngology, children's medical center, university of texas at southwestern; daniel rauch, md, faap , director, pediatric hospitalist program, associate professor, department of pediatrics, new york university school of medicine; and maureen strafford, md , arnold p gold foundation associate professor, departments of anesthesiology and pediatrics, tufts university and tufts-new england medical center disclosure introduction author information introduction clinical differentials workup treatment medication follow-up miscellaneous bibliography background: rhinitis medicamentosa rm ; is a condition of rebound nasal congestion brought on by overuse of intranasal vasoconstrictive medications.
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A high level of clinical suspicion may lead to early diagnosis by doing smear and culture examination of pus for both bacterial pathogens and AFB ; , histopathological examination of granulation tissue and or PCR of the discharge. ACKNOLWLEDGEMENTS The authors are grateful to the Dean, Perundurai Medical College for permitting them to report the case and to Dr.Sivakumar, Asstt.Prof. of ENT, Perundurai Medical College for his guidance and celexa.
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Received July 17, 1995. Revision received November 1, 1995. Accepted November 17, 1995. Address all correspondence and requests for reprints to: Kunihiko Hanew MD, Hanew Endocrine Clinic, 2-5 Hasekura-cho, Sendai 980, Japan. * This work was partly supported by a grant from the Intractable Disease Division, Public Health Bureau, Ministry of Health and Welfare, Japan and cephalexin.
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April 11, 2003, "Late-Life Depression and Other Psychiatric Disorders, " Rehabilitation Institute, Geriatric Rehabilitation Course: Perspectives on Successful Aging in the New Millennium, Chicago, IL March 3, 2003, "Partners in Care: A Replication and Research Evaluation of Integrative Care for the Elderly Patient in Primary Care, " American Association Geriatric Psychiatrists Annual Meeting, Honolulu, HI December 6, 2002, "Societal Implications of Long-Term Illness, " Dementia Mini-fellowship: Update on Managing Behavioral Syndromes, Atlanta, GA. December 6, 2002, "Non-pharmacologic Approaches to Treating BPSD, " Dementia Minifellowship: Update on Managing Behavioral Syndromes, Atlanta, GA. November 9, 2002, "A Long-Term View, " Dementia Min-ifellowship: Update on Managing Behavioral Syndromes, Chicago, IL. November 8, 2002, "Societal Implications of Long-Term Illness, " Dementia Mini-fellowship: Update on Managing Behavioral Syndromes, Chicago, IL. November 8, 2002, "Non-pharmacologic Approaches to Treating BPSD, " Dementia Minifellowship: Update on Managing Behavioral Syndromes, Chicago, IL. * October 26, 2002, "Challenges of Expert Witnesses in Psychogeriatric Legal Settings, " IPA Asia Pacific Regional Meeting, Hong Kong, China. October 26, 2002, "SSRIs in Major Depression in the Elderly: Efficacy, Safety, Cognition, and Quality of Life, " IPA Asia Pacific Regional Meeting, Hong Kong, China. October 1, 2002, "The Interface of Psychiatry and Law in the Elderly: Implications for Estate Planning and Execution of Trusts and Wills, " Louis Susman Memorial Tax Seminar, Chicago, IL. * April 17, 2002, "Depression and Cognitive Impairment in Depressed Elderly Patients, " Rome, Italy. * April 13, 2002, "Behavioral and Psychological Symptoms of Dementia BPSD ; , " Istanbul, Turkey. * March 6, 2002, "SSRIs in Major Depression in the Elderly: Double-Blind Trials, " Presentation in Oslo, Norway. April 10, 2001, "Opening Keynote Address: Let's Talk Mental Health and Aging: Past, Present and claritin.
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Ment of adults recovering from alcohol or other drug problems. JAMA. 1998; 279: 1227-1231. McLellan AT, Arndt IO, Metzger DS, Woody GE, O'Brien CP. The effects of psychosocial services in substance abuse treatment. JAMA. 1993; 269: 1953-1959. McLellan AT, Hagan TA, Levine M, et al. Supplemental social services improve outcomes in public addiction treatment. Addiction. 1998; 93: 1489-1499. D'Aunno TA. Linking substance abuse treatment and primary health care. In: Egertson JA, Fox DM, Leshner AI, eds. Treating Drug Abusers Effectively. Malden, Mass: Blackwell Publishers; 1997: 311-351. Chappel JN. Attitudes toward the treatment of substance abusers. In: Lowenson J, Ruiz P, Millman R, eds. Comprehensive Textbook of Substance Abuse. Baltimore, Md: Williams & Wilkins; 1992: 983-996. Lewis DC, Niven RG, Czechowicz D, Trumble J. A review of medical education in alcohol and other drug abuse. JAMA. 1987; 257: 2945-2948. Geller G, Levine DM, Mamon RD, Moore RD, Bone LR, Stokes EJ. Knowledge, attitudes, and reported practices of medical students and housestaff regarding the diagnoses and treatment of alcoholism. JAMA. 1989; 261: 3115-3120. Adger H Jr, Macdonald DI, Wenger S. Core competencies for involvement of health care providers in the care of children and adolescents in families affected by substance abuse. Pediatrics. 1999; 103: 1083-1084. Sirica C, ed. Training About Alcohol and Substance Abuse for All Primary Care Physicians. New York, NY: Josiah Macy Jr Foundation; 1995. Friedmann PD, McCullough DM, Chin MH, Saitz R. Screening and intervention for alcohol problems: a national survey of primary care physicians and psychiatrists. J Gen Intern Med. 2000; 15: 84-91. Cohen P, Cohen J. The clinician's illusion. Arch Gen Psychiatry. 1984; 41: 11781182. Saitz R, Sullivan LM, Samet JH. Training community-based clinicians in screening and brief intervention for substance abuse problems: translating evidence into practice. Subst Abuse. 2000; 21: 21-32. Adams A, Ockene JK, Wheller EV, Hurley TG. Alcohol counseling: physicians will do it. J Gen Intern Med.1998; 13: 692-698. Schoenbaum M, Zhang W, Sturm R. Costs and utilization of substance abuse care in a privately insured population under managed care. Psychiatr Serv. 1998; 49: 1573-1578. Goldman W, McCulloch J, Sturm R. Costs and use of mental health services before and after managed care. Health Aff Millwood ; . 1998; 17: 40-52. Larson MF, Samet JH, McCarty D. Managed care of substance abuse disorders: implications for generalist physicians. Med Clin North Am. 1997; 81: 1053-1069. Sturm R. Tracking changes in behavioral health services: how have carve-outs changed care? J Behav Health Serv Res. 1999; 26: 360-371. Stein B, Reardon E, Sturm R. Substance abuse service utilization under managed care: HMOs versus carve-out plans. J Behav Health Serv Res. 1999; 26: 451-456. Sturm R, McCulloch J. Mental health and substance abuse benefits in carve-out plans and the Mental Health Parity Act of 1996. J Health Care Finance. Spring 1998; 24: 82-92. Sturm R, Zhang W, Schoenbaum M. How expensive are unlimited substance abuse benefits under managed care? J Behav Health Serv Res. 1999; 26: 203-210. McLellan AT, Woody GE, Metzger D, et al. Evaluating the effectiveness of addiction treatments: reasonable expectations, appropriate comparisons. Milbank Q. 1996; 74: 51-85. O'Brien CP, McLellan AT. Myths about the treatment of addiction. Lancet. 1996; 347: 237-240. Teitelbaum M, Walker A, Gabay M, Gross M, Mason T, Weitzman E. Analysis of Barriers to the Delivery of Integrated Primary Care Services and Substance Abuse Treatment: Case Studies of Nine Linkage Program Projects. Bethesda, Md: Abt Associates Inc; 1992. Umbricht-Schneiter A, Ginn DH, Pabst KM, Begelow GE. Providing medical care to methadone clinic patients: referral vs. on-site care. J Public Health. 1994; 84: 207-210. Willenbring ML, Olson DH. A randomized trial of integrated outpatient treatment for medically ill alcoholic men. Arch Intern Med. 1999; 159: 1946-1952. Willenbring ML, Olson DH, Bielinski J. Integrated outpatient treatment for medically ill alcoholic men: results from a quasi-experimental study. J Stud Alcohol. 1995; 56: 337-343. Willenbring ML, Olson D, Bielinski J, Lynch J. Treatment of medically ill alcoholics in the primary care setting. In: Beresford T, Gomberg E, eds. Aging and Alcohol. Cambridge, Mass: Oxford University Press; 1995: 249-262. Management of persons with substance abuse disorders: assessment and management in primary care. Available at: : 63.89.88.99 sud maps map A . Accessibility verified September 27, 2000. Bodenheimer T. Disease management in the American market. BMJ. 2000; 320: 563-566 and climara and cardura, for example, carrdura 1 mg.
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IS-O-03 Role of Indoxyl Sulfate in the Osteoblast Transformation of Cultured Human Aortic Smooth Muscle Cells Department of Clinical Preventive Medicine, Nagoya University School of Medicine, Nagoya, Japan 1 Department of Pathology, Nagoya University School of Medicine, Nagoya, Japan2 ; Gulinuer Muteliefu 1 ; Atsushi Enomoto 2 ; Ping Jiang 2 ; Ayinuer Adijiang1 ; Zaoreguli Tumier1 ; Kentaro Taki1 ; Masahide Takahashi2 ; Toshimitsu Niwa1 ; Purpose Vascular calcification is a strong prognostic marker of cardiovascular disease mortality in CKD patients, but the mechanisms underlying vascular calcification are still obscure. Uremic serum induced osteopontin expression in cultured bovine vascular smooth muscle cells VSMC ; . Thus, we hypothesized that the accumulation of indoxyl sulfate IS ; , a uremic toxin, might be responsible for the mechanisms of vascular calcification. This study is focused on the role of IS in the osteoblast transformation of VSMC cultured in vitro. Method Human aortic smooth muscle cells HASMC ; were incubated with IS at various concentrations for 48 hours. The expression of osteopontin, alkaline phosphatase ALP ; , OAT1 and OAT3 in HASMC were determined by Western blotting. Results IS increased the expression of osteopontin, a marker protein of osteoblast transformation, in a concentration-dependent manner in cultured HASMC. Expression of OAT3, a transporter of IS, was detected in HASMC, whereas expression of OAT1 was hardly detected in HASMC. IS also increased ALP expression in HASMC. Conclusion IS up-regulates the expression of osteopontin and ALP in HASMC. These results support the notion that the accumulation of IS may be one of the risk factors for the development of vascular calcification.
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Very few studies are available regarding the use of traditional CHT products. Sheehan, et al, carried out an 8-week study of 40 adults with long-standing difficult-to-treat AD. This was a double-blind crossover study with patients randomized to receive an oral Chinese herbal mixture known as Zemaphyte Phytopharm PLC ; or an inactivated herb placebo. There were significant improvements noted in itching, erythema, the ability to sleep, and surface damage in the treatment group. In terms of potency and quantity required, topical corticosteroid use was reduced while on active treatment, when compared to those taking placebo.18 A similar trial with 47 children showed the same results over 8 weeks of active treatment. The pharmacology and mechanisms of action were unknown. There was no evidence of hematological, renal or hepatic toxicity.19 A one-year open follow-up study using Zemaphyte with 37 children from the previous study had 10 27% ; patients withdraw because of inadequate response. Four of the responding patients withdrew early because the treatment was unpalatable. Also, preparation required boiling some of the herbal constituents in 600ml water for 90 minutes, which was considered too long by some patients. Of the remaining 23 patients, seven experienced a 90% reduction in severity and were able to stop the treatment within 6 months to 1 year. Sixteen patients required continuous treatment, though their treatments were reduced from one each day to one every 5 days. In total, 18 out of 23 patients 78% ; demonstrated a 90% reduction in severity at the end of the study. A reversible asymptomatic elevation of the transaminase level was seen at 7-14 times normal in two patients. Approximately 33% of the patients had a mild diarrhea in the first few weeks of treatment.20 A further long term open trial, included 17 adult patients21 who were volunteers from the original trial.18 At the end of one year, 12 of the 17 adults, or 71% had a greater than 90% reduction in severity and the other five patients had a 60% reduction in severity. No patients withdrew. There were no laboratory abnormalities seen in these adults, and mild diarrhea was the only major complaint.21 An open trial comparing the original decoction used by Sheehan, et al18 to a new granular preparation showed no difference in efficacy. However, patients receiving the granular preparation did comment on the increased palatability and ease of administration.22 Commonly, Zemaphyte Phytopharm PLC ; contains a mixture of 10 herbs with some known pharmacological agents and action. Analysis of these herbs revealed that none of them had nonsteroidal anti-inflammatory activities, but some displayed steroid like or antihistaminic like activities. One ingredient displayed immunosuppressive activity.23 Latchman, et al, discovered that Zemaphyte is associated with a reduction of serum IgE complexes and that it targets the immunologic features that seem to be involved in the pathogenesis of AD.24 A more detailed study of the immune mechanisms in the skin of patients with AD using Zemaphyte and other non-defined, for example, cardrua for bph.
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