Clinical practice guideline: benign paroxysmal positional vertigo.

Objectives: This guideline provides evidence-based recommendations on managing benign paroxysmal positional vertigo (BPPV), which is the most common vestibular disorder in adults, with a lifetime prevalence of 2.4 percent. The guideline targets patients aged 18 years or older with a potential diagnosis of BPPV, evaluated in any setting in which an adult with BPPV would be identified, monitored, or managed.

Clinical practice guideline: cerumen impaction.

Objective: This guideline provides evidence-based recommendations on managing cerumen impaction, defined as an accumulation of cerumen that causes symptoms, prevents assessment of the ear, or both. We recognize that the term "impaction" suggests that the ear canal is completely obstructed with cerumen and that our definition of cerumen impaction does not require a complete obstruction. However, cerumen impaction is the preferred term since it is consistently used in clinical practice and in the published literature to describe symptomatic cerumen or cerumen that prevents assessment of the ear.

Teaching physical diagnosis in the nursing home.

Physical diagnosis has traditionally been taught in the inpatient hospital setting. Changes in hospital reimbursement, as well as a shift to outpatient directed care, has resulted in a sicker inpatient profile. These patients are less amenable to the needs of the student first learning how to take a history and perform a physical examination.

Gastric carcinoid associated with achlorhydria, hypergastrinemia, and Addison's disease.

We have described a 40-year-old woman whose classic adrenal insufficiency, achlorhydria, and hypergastrinemia was complicated by the development of a gastric carcinoid. There is now evidence that patients with elevated serum gastrin levels are at increased risk for this rare tumor.

Double-blind controlled trial of the Garren-Edwards gastric bubble: an adjunctive treatment for exogenous obesity.

Since its approval by the Food and Drug Administration in September 1985, the Garren-Edwards gastric bubble has been extensively used as an adjunct to diet and behavioral modification in the treatment of exogenous obesity. In an attempt to evaluate the efficacy of the Garren-Edwards gastric bubble, a double-blind crossover study was undertaken. Ninety patients were randomized into three groups: bubble-sham, sham-bubble, and bubble-bubble in two successive 12-wk periods.

Development of presenile cataracts in association with high serum levels of phenytoin.

We report the occurrence of bilateral cataracts in a young adult which developed shortly after documented high serum levels of phenytoin. There are two previous reports (five patients) in the literature implicating this drug as a cause of cataract formation in humans. This is the first case in which toxic levels were measured.

Visualization of adrenocortical carcinoma lung metastases with iodine-131 labeled 6B-iodomethylnorcholesterol (NP-59).

This case report describes visualization of lung metastases secondary to adrenocortical carcinoma using I-131 labeled 6B-iodomethyl-19-norcholesterol (NP-59) in a 26-year-old woman with a recurrence of Cushing's syndrome one year following surgical removal of the primary tumor.

Lymphocytic adenohypophysitis causing pituitary mass.

Lymphocytic infiltration of the anterior pituitary is a rare complication of pregnancy, which has been reported in 18 cases. Symptoms begin in the last trimester or soon after delivery. Radiologically, an expanding mass in the sella may result in suprasellar extension.

Blue toe syndrome.

Blue toe syndrome is easily misdiagnosed because the cyanotic mottling resembles localized bruising from minor foot trauma. Clinicians who think of circulatory problems are sometimes led astray because the patient looks healthy and presents with excellent peripheral pulses. Appropriate laboratory studies can lead to a correct diagnosis.

High-resolution real-time sonography. The study of superficial body parts.

High-resolution real-time scanning such as described in this article remains limited to the very superficial areas of the body. This article has been designed to give the reader an up-to-date glimpse of the minute world of small parts scanning and aid the clinician in the optimal use of this noninvasive modality.

Far-advanced primary hyperparathyroidism in an 18-year-old young man.

Advanced debilitating primary hyperparathyroidism has become a clinical rarity as the condition is diagnosed at an asymptomatic stage in more patients. An 18-year-old young man is described who was referred because of an expanding facial mass. Evaluation revealed the classic musculoskeletal findings of severe primary hyperparathyroidism, as originally reported in the early part of the century.

CT findings in Addison's disease.

The computed tomographic findings in five patients with depleted adrenal cortical reserve were evaluated. A single patient with idiopathic adrenal atrophy revealed small adrenal remnants bilaterally. Three patients with tuberculosis demonstrated dense calcification in one or both adrenal beds without evidence of normal glandular remnants.

Parameters of thyroid function in patients with active acromegaly.

In order to determine if acromegaly per se may be associated with abnormalities in thyroidal economy, serum thyroxine-binding globulin (TBG), resin T3 uptake, total and free T4, T3, and reverse T3 concentrations were measured in 21 patients with active acromegaly. Mean (+/- SE) total T4, T3, and reverse T3 levels were 7.1 +/- 0.

Comparison of clofibrate and chlorpropamide in vasopressin-responsive diabetes insipidus.

Six patients with vasopressin-responsive diabetes insipidus (DI) received clofibrate and chlorpropamide, singly and in combination. Decrease in urinary output averaged (mean +/- SEM): (1) clofibrate 2 g/day, 47% +/- 6%; (2) chlorpropamide 250 mg/day 59% +/- 5%; (3) clofibrate 2 g/day plus chlorpropamide 125 mg/day, 54% +/- 7%; (4) clofibrate 2 g/day plus chlorpropamide 250 mg/day 61% +/- 4%. Water deprivation tests before and during treatment showed significantly higher basal, final, and peak urinary osmolalities (Uosm) and lower free water clearance (CH20) on chlorpropamide, singly and in combination: clofibrate raised Uosm less but significantly decreased CH2O.

Nonautonomy of parathyroid hormone and urinary cyclic AMP in primary hyperparathyroidism.

This study demonstrates that appreciable changes in serum parathyroid hormone and urinary cyclic AMP occur during experimentally induced hyper- and hypocalcemia in almost all patients with primary hyperparathyroidism regardless of histology. A single patient with tertiary hyperparathyroidism also demonstrated a significant elevation of serum parathyroid hormone and urinary cyclic AMP in response to EDTA induced reduction in ionized calcium. Thus, total autonomy of hormone secretion was not present in the great majority of the patients with a parathyroid adenoma, parathyroid hyperplasia, or the single patient with tertiary hyperparathyroidism.

A radioimmunoassay for 3,3',5'-L-triiodothyronine (reverse T3): assessment of thyroid gland content and serum measurements in conditions of normal and altered thyroidal economy and following administration of thyrotropin releasing hormone (TRH) and thyrotropin (TSH).

The present report describes the development of a radioimmunoassay for 3,3',5'-L-triiodothyronine (reverse T3) which is performed on unextracted serum. Utilizing this radioimmunoassay, 21 normal subjects had a mean (+/-SD) serum reverse T3 level of 60 +/- 12 ng/100 ml, 17 of 19 hyperthyroid patients had elevated serum reverse T3 levels, and 10 of 11 hypothyroid subjects had decreased serum reverse T3 concentrations. Thyroidal secretion of reverse T3 was assessed by measurements in samples obtained from the internal carotid artery and jugular vein of sheep following the administration of thyrotropin releasing hormone (TRH) or bovine thyrotropin (TSH).

Studies on the nature of thyroidal suppression during acute falciparum malaria: integrity of pituitary response to TRH and alterations in serum T3 and reverse T3.

The nature of the suppression of the pituitary-thyroid axis during infection was studied by testing the integrity of thyrotropin (TSH) and prolactin (PRL) responses to thyrotropin-releasing hormone (TRH) during acute falciparum malaria in human volunteers. During infection, TSH responses to TRH were found to be intact while PRL secretion was slightly increased. That serum T3 levels abruptly declined during infection while serum T4 was stable or increasing suggested an alteration in peripheral degradative pathways and prompted the measuremnt of reverse T3.