ROFESSIONAL MEDICAL ASSOCIAtions (PMAs), bringing together physicians in the same specialty or subspecialty, make many distinctive contributions to advancing the quality of medical care. In the first instance, PMAs play a vital role in medical education. Their meetings, publications, journals, and continuing medical education (CME) courses inform members of new and established diagnostic and treatment procedures. The PMAs also issue detailed practice guidelines that set the standards for efficient and effective patient care. Moreover, PMAs define ethical norms for their members, promulgating codes of conduct for professional behavior. At the same time, PMAs pursue a public agenda. They advocate for the particular interests of their members, for patients, and for what they believe to be the best interests of society. [1][2][3]
Treatment with aminoglycosides is known to cause irreversible hearing loss, typically affecting higher-frequency hearing first and progressing to lower frequencies. Standardized methodology has not been developed for early detection of ototoxicity. Serial conventional (0.25-8 kHz) and high-frequency (9-20 kHz) hearing threshold monitoring was done prospectively in 53 hospitalized patients administered aminoglycosides. Hearing loss occurred in 47% of the ears studied, with hearing loss first appearing in the high-frequency range in 71% of ears showing change. Analysis of data on an individual basis revealed a five-frequency range most susceptible to initial ototoxicity. Testing only this range would have resulted in early identification of 82% of ears showing change. Results confirm the critical need for serial auditory threshold monitoring encompassing high frequencies in patients receiving aminoglycosides. A shortened five-frequency monitoring protocol is presented and suggested for use with patients unable to tolerate lengthy audiometric testing procedures.
The ACTH-cortisol axis was studied in 15 hemodialysis patients. Basal plasma cortisol concentrations were found to be elevated and ACTH to be in the high normal range. Cortisol responded normally to exogenous ACTH, but neither cortisol nor ACTH were suppressed in response to oral dexamethasone. 11-Deoxycortisol and ACTH concentrations did not rise normally in response to either oral or iv metyrapone. We conclude that standard testing of the ACTH-cortisol axis in dialysis patients yields results suggesting Cushing's syndrome.
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