Clinical entity

The main role of the human thyroid gland is production of thyroid hormones (iodinated amino acids), essential for adequate growth, development, and energy metaboHsm (1 6). Thyroid underfunction is an occurrence that can be treated successfully with thyroid preparations. In addition, the thyroid secretes calcitonin (also known as thyrocalcitonin), a polypeptide that lowers excessively high calcium blood levels. Thyroid hyperfunction, another important clinical entity, can be corrected by treatment with a variety of substances known as antithyroid dmgs. 

This is not a distinct clinical entity. The most frequent form of the condition is primarily associated with severe cardiac dysfunction often in combination with dysmorphy. It is confusing, however, because a paralytic attack is accompanied by extrasystoles and tachycardia. Serum may be high, low or normal. A familial form of the disorder is exacerbated by cold and high but is relieved by Na loading. It is, however, not associated with any specific changes in serum K. ... 

Bacterial and viral myositis is well recognized as a clinical entity by muscle pathologists. The viruses most commonly involved appear to be the Coxsackie viruses, the arboviruses, influenza virus, and HIV, but the mechanism whereby the viral infection gives rise to the myositic syndrome is not known. A detailed discussion of such problems is presented later on pages 333-334. 

Three years after introduction of aspirin into therapy, Hirschberg in Poznan, now in Poland, described the first case of a transient, acute angioedema/urticaria, occurring shortly after ingestion of aspirin. Reports of anaphylactic reactions to aspirin soon followed. The other major type of adverse reaction, acute bronchospasm, was described in the second decade of the 20th century. In 1920, Van der Veer reported the first death due to aspirin. The association of aspirin sensitivity, asthma and nasal polyps was first recorded by Widal in 1922. This clinical entity, later named the aspirin triad was popularized in 1968 by Samter and Beers [3], who presented a... 

Locally advanced cancer breast cancer generally refers to breast carcinomas with significant primary tumor and nodal disease but in which distant metastases cannot be documented. A wide variety of clinical scenarios can be seen within this group of patients, including neglected tumors that have spread locally and inflammatory breast cancers that are a unique clinical entity. Many locally advanced breast cancers are diagnosed in patients who have had symptoms for months to years and have neglected to seek medical attention. Patients with inflammatory breast cancer often are treated inappropriately for cellulitis with antibiotics for several weeks to months. 

Psoriatic arthritis is a distinct clinical entity in which both psoriatic lesions and inflammatory arthritis-like symptoms occur. Distal interphalangeal joints and adjacent nails are most commonly involved, but knees, elbows, wrists, and ankles may also be affected. 

Respiratory Effects. Pulmonary edema was observed in a patient after an attempted suicide with endrin and was thought to be due to chemical pneumonitis following aspiration of aromatic hydrocarbons contained in the ingested formulation. The authors state that the hydrocarbons may have been the cause of the pulmonary effects (Runhaar et al. 1985), since hydrocarbon-induced chemical pneumonitis is a well established clinical entity. 

Los s-of-function mutations in the cardiac calcium channel underlie a new clinical entity characterized by ST-segment elevation, short QT intervals, and sudden cardiac death. Circulation, 115, 442-449. 

A few years after the pioneering studies of Alois Alzheimer (1864-1915) with August D., Johann F., and other patients, reported between 1907 and 1911 (43-46), it soon became clear that AD was a clinical entity that accumulated in some families. 

Anorexia nervosa was first described as a distinct clinical entity by Sir William Gull in 1873. He described... 

The sponsor proposing to develop a drug for an orphan indication is required to submit an application for the designation of a drug as orphan for a defined clinical entity. To meet the criteria for a successful orphan designation, the applicant should establish ... 

Obstetric infections include infections which occur during pregnancy, delivery and in the postpartum period, and which affect the uterus or its content. Clinical entities are amnionitis, and post partum or post-caesarean endometritis and infected abortion. Symptoms are lower abdominal pain, fever and eventually foetid amniotic fluid or lochia. 

Epilepsy (or epilepsies, since markedly different clinical entities exist) is a common neurological abnormality affecting about 1% of the human population. Epilepsy is a chronic, usually life-long disorder characterized by recurrent seizures or convulsions and usually, episodes of unconsciousness and/or amnesia. Table 32.1 illustrates the major types of epileptic seizures. Patients often exhibit more than one type. In most instances, the cause of the seizure disorder is not known (idiopathic epilepsy), although trauma during birth is suspected of being one cause. 

Ethanol produces a number of depressant effects on the myocardium. Atrial arrhythmias and ventricular tachycardia may arise from chronic ethanol use. A serious clinical entity, alcoholic cardiomyopathy, has also been described. 

Despite these data showing surprisingly extensive use of psychotropic medications, there are no adequate studies of either the efficacy or safety of these medications in the preschool population. Two important questions raised by Zito et ah, were (1) what clinical entities are being treated with psychotropics in the 2-4-year-old population, and (2) is the absolute use and increase in use justified The publication of this paper in February 2000, raised sufficient concern to provoke the planning and conduct of several meetings focused at least in part on this topic in the fall of 2000. 

One of these was a session of the FDA s Pediatric Advisory Subcommittee on September 11, 2000, that focused on the question of what clinical entities are in fact being treated in this age group (www.fda.gov/ ohrms/dockets/ac/cderOO. htm). 

Glassman AH, Roose SP Delusional depression a distinct clinical entity Arch Gen Psychiatry 38 424-427, 1981... 

Antimicrobial agents are frequently used before the pathogen responsible for a particular illness or the susceptibility to a particular antimicrobial agent is known. This use of antimicrobial agents is called empiric (or presumptive) therapy and is based on experience with a particular clinical entity. The usual justification for empiric therapy is the hope that early intervention will improve the outcome in the best cases, this has been established by placebo-controlled, double-blind prospective clinical trials. For example, treatment of febrile episodes in neutropenic cancer patients with empiric antimicrobial therapy has been demonstrated to have impressive morbidity and mortality benefits even though the specific bacterial agent responsible for fever is determined for only a minority of such episodes. 

Finally, there are many clinical entities, such as certain episodes of community-acquired pneumonia, in which it is difficult to identify a specific pathogen. In such cases, a clinical response to empiric therapy may be an important clue to the likely pathogen. 

Chan NN, Brain HP, Feher MD. Metformin-associated lactic acidosis a rare or very rare clinical entity Diabet Med 1999 16(4) 273-81. 

Camby I, Lefranc F, Titeca G, Neuci S, Fastrez M, Dedecken L, Schafer BW, Brotchi J, Heizmann CW, Pochet R, Salmon I, Kiss R, Decaestecker C. 2000. Differential expression of SI00 calcium-binding proteins characterizes distinct clinical entities in both WHO grade II and III astrocytic tumours. Neuropathol Appl Neurobiol 26(l) 76-90. 

Panja, R. K., 1977, Acrokeratosis verruciformis (Hopf)-A clinical entity Br J Dermatol, 96 643-52. 

Lll. Lowe, C. U., Terrey, M., and MacLachlan, E. A., Organic aciduria decreased renal ammonia production, hydrophthalmos and mental retardation. A clinical entity. Am. ]. Diseases Children 83, 164-184 (1952). 

Acne-prone skin is often classified under the sensitive skin category by cosmetic consumers. However, as many dermatologists consider it to be a separate clinical entity, acne-prone skin and acneiform eruptions will not be discussed here. 

Stroke is a clinical diagnosis and the acute onset of focal neurological symptoms is the major indicator of stroke. Whereas typical stroke symptoms such as hemiparesis, amaurosis or dysarthria are easy to recognize, other stroke syndromes such as vertebrobasilar strokes or predominant neuropsychological manifestations are subject to misdiagnosis especially for non-neurologists. Misdiagnosis may be due to a non-vascular medical condition that simulates a stroke syndrome - a condition coined stroke mimicry . Or, a stroke may resemble another non-vascular clinical entity - a circumstance termed as stroke chameleon (Huff 2002). 

---