By V. Ramon. Thomas Edison State College. 2019.
In primitive societies it is obvious that in the exercise of medical skill levitra soft 20 mg amex, the recognition of moral power is implied order levitra soft cheap. Nobody would summon the medicine man unless he conceded to him the skill of discerning evil spirits from good ones order levitra soft 20 mg amex. Here medicine is exercised by full-time specialists who control large populations by means of bureaucratic institutions cheap levitra soft 20 mg. Unlike guilds, which determine only who shall work and how, they determine also what work shall be done. In the United States the medical profession owes this supreme authority to a reform of the medical schools just before World War I. The medical profession is a manifestation in one particular sector of the control over the structure of class power which the university-trained elites have acquired. Only doctors now "know" what constitutes sickness, who is sick, and what shall be done to the sick and to those whom they consider at a special risk. Paradoxically, Western medicine, which has insisted on keeping its power apart from law and religion, has now expanded it beyond precedent. In some industrial societies social labeling has been medicalized to the point where all deviance has to have a medical label. The eclipse of the explicit moral component in medical diagnosis has thus invested Aesculapian authority32 with totalitarian power. The divorce between medicine and morality has been defended on the ground that medical categories, unlike those of law and religion, rest on scientific foundations exempt from moral evaluation. It is obvious that in this kind of context it is easy to shun the issue of social iatrogenesis with which I am concerned. The assertion of value-free cure and care is obviously malignant nonsense, and the taboos that have shielded irresponsible medicine are beginning to weaken. Between 1950 and 1971 public expenditure for health insurance increased tenfold, private insurance benefits increased eightfold,37 and direct out-of- pocket payments about three-fold. The proverb "Few lawyers die well, few physicians live well" had its equivalent in most European languages. Now physicians have come to the top, and in capitalist societies this top is high indeed. Yet it would be inaccurate to blame the inflation in medicine on the greed of the medical profession. The cost of administering the patient, his files, and the checks he writes and receives can take a quarter out of each dollar on his bill. Since 1950 the cost of keeping a patient for one day in a community hospital in the United States has risen by 500 percent. Administrative costs have exploded, multiplying since 1964 by a factor of 7; laboratory costs have risen by a factor of 5, medical salaries only by a factor of 2. Costs overruns in programs of the Health, Education, and Welfare Department exceed those in the Pentagon. Between 1968 and 1970 Medicaid costs increased three times faster than the number of people served. It is therefore ironic that during this unique boom in health care the United States established another "first. The death rate for American males aged forty-five to fifty-four is comparatively high. Of every 100 males in the United States who turn forty-five only 90 will see their fifty-fifth birthday, while in Sweden 95 will survive the decade. Hospitals register well-insured patients, and rather than providing old products more efficiently and cheaply, are economically motivated to move towards new and increasingly expensive ways of doing things. Changing products rather than higher labor costs, bad administration, or lack of technological progress are blamed for the rise. His out-of-pocket costs appear increasingly modest, even though the services offered by the hospital are more costly. Insurance for high-cost sick- care is thus a self-reinforcing process which invests the providers of care with the control of increasing resources. But like all other such remedies, capitation enlarges the iatrogenic fascination with the health supply. In England the National Health Service has tried, albeit unsuccessfully, to ensure that cost inflation will be less plagued by conspicuous flimflam. The need was assumed to be finite and quantifiable, the ballot box the best place to decide the total budget for health, and doctors the only ones able to determine the resources that would satisfy the need of each patient. But need as assessed by medical practitioners has proved to be just as extensive in England as anywhere else. The fundamental hope for the success of the English health-care system lay in the belief in the ability of the English to ration supply. Until about 1972 they did so, in the opinion of an author who surveyed British health economics, "by means in their way almost as ruthless but generally held to be more acceptable than the ability to pay. But this stern commitment to equality prevented only those astounding misallocations for prestigious gadgetry which provided an easy starting point for public criticism in the United States. Since 1972 the Health Service in Britain has undergone a traumatic change, for complex economic and political reasons. The initial success of the Health Service and the present unique disarray in the system make predictions for the future impossible. Yet curiously, England is also one of the few industrialized countries where the life expectancy of adult males has not yet declined, though the chronic diseases of this group have already shown an increase similar to that observed a decade earlier across the Atlantic. The number of physicians and hospital days per capita seems to have doubled between 1960 and 1972, and costs to have increased by about 260 percent. The Russians, for instance, limit by decree mental disease requiring hospitalization: they allow only 10 percent of all hospital beds for such cases. The proportion of national wealth which is channeled to doctors and expended under their control varies from one nation to another and falls somewhere between one-tenth and one-twentieth of all available funds. Excepting only the money allocated for treatment of water supplies, 90 percent of all funds earmarked for health in developing countries is spent not for sanitation but for treatment of the sick. From 70 percent to 80 percent of the entire public health budget goes to the cure and care of individuals as opposed to public health services. All countries want hospitals, and many want them to have the most exotic modern equipment. The poorer the country, the higher the real cost of each item on their inventories. As to cost, the same is true of the physicians who are made to measure for these gadgets. The education of an open-heart surgeon represents a comparable capital investment, whether he comes from the Mexican school system or is the cousin of a Brazilian captain sent on a government scholarship to study in Hamburg. It is clearly a form of exploitation when four-fifths of the real cost of private clinics in poor Latin American countries is paid for by the taxes collected for medical education, public ambulances, and medical equipment. But the exploitation is no less in places where the public, through a national health service, assigns to physicians the sole power to decide who "needs" their kind of treatment, and then lavishes public support on those on whom they experiment or practice. Once President Frei of Chile had started on one palace for medical spectator-sports, his successor, Salvador Allende, was forced to promise three more. The prestige of a puny national team in the medical Olympics is used to intensify a nationwide addiction to therapeutic relationships that are pathogenic on a level much deeper than mere medical vandalism. Only in China at least, at first sight does the trend seem to run in the opposite direction: primary care is given by nonprofessional health technicians assisted by health apprentices who leave their regular jobs in the factory when they are called on to assist a member of their brigade. The achievements in the Chinese health sector during the late sixties have proved, perhaps definitively, a long- debated point: that almost all demonstrably effective technical health devices can be taken over within months and used competently by millions of ordinary people. Despite such successes, an orthodox commitment to Western dreams of reason in Marxist shape may now destroy what political virtue, combined with traditional pragmatism, has achieved. The bias towards technological progress and centralization is reflected already in the professional reaches of medical care. China possesses not only a paramedical system but also medical personnel whose educational standards are known to be of the highest order by their counterparts around the world, and which differ only marginally from those of other countries. Most investment during the last four years seems to have gone towards the further development of this extremely well qualified and highly orthodox medical profession, which is getting increasing authority to shape the over-all health goals of the nation. University-trained personnel instruct, supervise, and complement the locally elected healer. This ideologically fueled development of professional medicine in China will have to be consciously limited in the very near future if it is to remain a balancing complement rather than an obstacle to high-level self-care. But there is no reason to believe that cost increases in pharmaceutical, hospital, and professional medicine in China are less than in other countries. For the time being, however, it can be argued that in China modern medicine in rural districts was so scarce that recent increments contributed significantly to health levels and to increased equity in access to care.
The mortality rate for gall bladder surgeries did not decline as a result of the lower risk because so many more were performed order levitra soft without a prescription. When studies were finally done on completed cases buy levitra soft, the results showed that laparoscopic cholecystectomy was associated with reduced inpatient duration buy cheap levitra soft online, decreased pain buy levitra soft 20mg amex, and a shorter period of restricted activity. But rates of bile duct and major vessel injury increased and it was suggested that these rates were worse for people with acute cholecystitis. Patient demand, fueled by substantial media attention, was a major force in promoting rapid adoption of these procedures. The major manufacturer of laparoscopic equipment produced the video that introduced the procedure in 1989. Doctors were given two-day training seminars before performing the surgery on patients. In 1992, the Canadian National Breast Cancer Study of 50,000 women showed that mammography had no effect on mortality for women aged 40-50. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. Patient, provider and hospital characteristics associated with inappropriate hospitalization. The cost of inappropriate admissions: a study of health benefits and resource utilization in a department of internal medicine. Fourth Decennial International Conference on Nosocomial and Healthcare-Associated Infections. Malnutrition and dehydration in nursing homes: key issues in prevention and treatment. Nationwide poll on patient safety: 100 million Americans see medical mistakes directly touching them [press release]. Characteristics of medical school faculty members serving on institutional review boards: results of a national survey. Peer reporting of coworker wrongdoing: A qualitative analysis of observer attitudes in the decision to report versus not report unethical behavior. The incident reporting system does not detect adverse drug events: a problem for quality improvement. Clinical pharmacy services, hospital pharmacy staffing, and medication errors in United States hospitals. The incidence and severity of adverse events affecting patients after discharge from the hospital. Antibiotic prescribing by primary care physicians for children with upper respiratory tract infections. Prescriptions of systemic antibiotics for children in Germany aged between 0 and 6 years. Antibiotic treatment of adults with sore throat by community primary care physicians: a national survey, 1989- 1999. Impact of antibiotics on conjugational resistance gene transfer in Staphylococcus aureus in sewage. Combined in situ and in vitro assessment of the estrogenic activity of sewage and surface water samples. Ozonation: a tool for removal of pharmaceuticals, contrast media and musk fragrances from wastewater? Determination of neutral pharmaceuticals in wastewater and rivers by liquid chromatography-electrospray tandem mass spectrometry. Trace determination of fluoroquinolone antibacterial agents in urban wastewater by solid-phase extraction and liquid chromatography with fluorescence detection. Determination of antibiotics in different water compartments via liquid chromatography-electrospray tandem mass spectrometry. Prescription of non-steroidal anti-inflammatory agents and risk of iatrogenic adverse effects: a survey of 1072 French general practitioners. Economic analysis of conventional-dose chemotherapy compared with high-dose chemotherapy plus autologous hematopoietic stem-cell transplantation for metastatic breast cancer. Does inappropriate use explain geographic variations in the use of health care services? Excess length of stay, charges, and mortality attributable to medical injuries during hospitalization. Injuries in hospitals pose a significant threat to patients and a substantial increase in health care charges [press release]. Radiation from Medical Procedures in the Pathogenesis of Cancer and Ischemic Heart Disease: Dose-Response Studies with Physicians per 100,000 Population. Preventing Breast Cancer: The Story of a Major, Proven, Preventable Cause of This Disease. Continuous electronic heart rate monitoring for fetal assessment during labor (Cochrane Review). Assessing benefits and harms of hormone replacement therapy: clinical applications. A retrospective study of intra-operative and postoperative maternal complications of cesarean section during a 10-year period. Smoking and cancer: the cigarette papers: how the industry is trying to smoke us all. Consumer group criticizes Thompson letter dismissing report on dangerous staffing levels in nursing homes [news release]. Multi-site study of incidence of pressure ulcers and the relationship between risk level, demographic characteristics, diagnoses and prescription of preventive interventions. Accuracy of death certificates for coding coronary heart disease as the cause of death. The relationship between physical restraint removal and falls and injuries among nursing home residents. California reaches $100 million multi-state settlement with drug giant Mylan over alleged price-fixing scheme [press release]. It also funds studies on fundamental processes such as how cells commu nicate, how our bodies use energy, and how we respond to medicines. The results of this research increase our understanding of life and lay the foundation for advances in the diagnosis, treatment, and prevention of disease. Disclaimer Trade names have been used throughout this booklet to illustrate concepts about medicines that are familiar to readers. The mention of specic products is not an endorsement of their use or effectiveness. Produced by the Ofce of Communications and Public Liaison National Institute of General Medical Sciences National Institutes of Health U. Researchers predict that the medicines of the future may not only look and and you know it s time to see a doctor. In contrast, future medicines may match the chemical needs of your body, as inuenced by your genes. Knowing your unique genetic make-up could help your doctor prescribe the right medicine in the right amount, to boost its effectiveness and minimize possible side effects. Along with these so-called pharmacogenetic approaches, many other research directions will help guide the prescribing of medicines. The science of pharmacology understanding the basics of how our bodies react to medicines and how medicines affect our bodies is already a vital part of 21st-century research. As scientists unravel the many different ways medicines scientists understand precisely how cells interact in work in the body and how this information guides the body, they can tailor medicines to patch gaps the hunt for drugs of the future. Pharmacology in cell communication pathways or halt signaling is a broad discipline encompassing every aspect circuits that are stuck on, as in cancer. Experimental chickens pharmacological research going on at universities are laying medicine-containing eggs. Department of Health and Human to speed on how scientists are looking to nature Services. Along with biology and chemistry, the engineering and computer sciences are leading us to novel ways of getting drugs where they need to go in the body. Or why a confused with pharmacy, a separate discipline in swig of grapefruit juice with breakfast can raise the health sciences that deals with preparing and blood levels of some medicines in certain people?
A syndrome including poor growth levitra soft 20mg fast delivery, gastrointestinal symptoms order levitra soft on line amex, evidence of allergy generic 20 mg levitra soft amex, iron deficiency anemia and pulmonary hemosiderosis buy levitra soft 20mg low cost. Identification of allergenic fractions in flour and comparison of diagnostic methods. Anaphylaxis after ingestion of beignets contaminated with Dermatophagoides farinae. Exercise-induced anaphylaxis: a serious form of physical allergy associated with mast cell degranulation. Multicenter, double-blind, placebo-controlled, multiple-challenge evaluation of reported reactions to monosodium glutamate. Proper use of skin tests with food extracts in diagnosis of hypersensitivity to food in children. Objective clinical and laboratory studies of immediate hypersensitivity reactions to foods in asthmatic children. Relationship between food-specific IgE concentrations and the risk of positive food challenges in children and adolescents. Effect of combined maternal and infant food-allergen avoidance on development of atopy in early infancy: a randomized study. Genetic and environmental factors affecting the development of atopy from birth through age 4 in a prospective randomized controlled study of dietary avoidance [Abstract]. The development and prediction of atopy in high-risk children: follow-up at age seven years in a prospective randomized study of combined maternal and infant food allergen avoidance. Mapping and mutational analysis of the IgE-binding epitopes on Ara h 1, a legume vicilin protein and a major allergen in peanut hypersensitivity. Identification and mutational analysis of the immuno dominant IgE epitopes of the major peanut allergen Ara h 2. It is frequently associated with a personal or family history of allergic rhinitis or asthma. In addition to their cytotoxic properties, these proteins are also capable of inducing basophil and mast cell degranulation to release inflammatory mediators ( 18). The most frequently used clinical criteria are those proposed by Hanifin and Rajka (28). Of note, a significant number of adult patients who present with occupational hand eczema have a personal history of atopy ( 31). Skin-prick tests are useful when they are negative because they have high negative predictive value of more than 95% (37,38). On the other hand, positive skin prick test have a positive predictive value of less than 50% ( 37,38). Oral food challenges should be performed in a setting that is well prepared for managing severe allergic reactions. Double-blind, placebo-controlled oral food challenges are considered to be the gold standard for diagnosing food allergy ( 35). Getting a bacterial culture with antibiotic sensitivity from skin wounds can direct antibiotic choice in patients with clinical evidence of staphylococcal skin infection (e. For patients who are diagnosed with food allergy, the offending foods should be eliminated from the diet. A dietary consultation is often helpful in the elimination of food allergens, as well as in planning a nutritionally balanced diet. For patients with indoor pet sensitivity, the animals should be removed from the home environment or kept outdoors (46). The use of milder superfatted soaps for cleansing can help to prevent skin dryness. The bath should be followed immediately by the application of an emollient to uninvolved skin areas and topical corticosteroids to affected areas. In patients who do not respond to low-potency topical corticosteroids, a medium-potency topical corticosteroids such as 0. Ointment preparations of corticosteroids used after baths generally have less drying effect due to their occlusive nature. Therefore, they are preferred over creams in dry weather conditions and in patients who do not sweat excessively. Potential side effects of topical corticosteroids include skin atrophy, striae, and adrenal suppression (47). These side effects are related to the potency of the corticosteroids, the body surface area covered, and the duration of use. Topical corticosteroid potency ranking Localized superficial staphylococcal skin infection may be treated with topical antibiotic such as mupirocin (Bactroban). Tar shampoos or low-potency topical corticosteroid lotions may be helpful in controlling scalp itching. This therapy increases hydration, penetration of topical corticosteroids, and pruritus control, and therefore allows rapid healing of excoriated lesions. However, overuse of wet dressings may lead to chilling, maceration of the skin, and secondary infection ( 34). Therefore, wet dressing therapy should be closely monitored by an experienced physician, and is optimally administered in a day hospital program. In addition to wet dressing therapy, it may be necessary to implement temporary dietary and environmental limitations in order to prepare the patient for subsequent evaluations. Therefore, patients who have failed outpatient management will need to be hospitalized in a controlled environment. However, the adverse effects of sedatives, including respiratory depression, should be monitored closely. Therefore, a short course of systemic corticosteroids should be followed by implementation of intensified skin hydration and topical corticosteroid therapy during the tapering period to suppress the rebound flaring. However, liver function tests should be monitored in patients given these antifungal medications. Currently, the mechanism of action for topical phosphodiesterase inhibitors is not fully understood but may be associated with their inhibitory effects on inflammatory cytokines ( 58). Cyclosporine Oral cyclosporine works primarily through the suppression of inflammatory cytokine production by T cells ( 60). The major disadvantages of cyclosporine treatment consist of the need for frequent blood chemistry and cell count monitoring, renal toxicity, hypertension, and potential long-term risk for malignancy ( 61). When administered systemically, tacrolimus is an effective immunosuppressant in organ transplantation but possesses systemic side effects similar to those of cyclosporine ( 65). Due to its smaller molecular size compared with cyclosporine and better skin penetration ( 65), a topical form of tacrolimus has been developed for the treatment of inflammatory skin diseases. There was no significant difference in efficacy between the three different concentrations of tacrolimus ointment in general. The only significant adverse effect was a local burning sensation at the site of tacrolimus application ( 67). Therefore, initial evaluation should include ruling out sensitivities to food (particularly in children) and inhalant allergens. Other first-line preventive and symptomatic treatments include adequate skin hydration, topical corticosteroids, and the use of first-generation antihistamine at bedtime. Secondary bacterial, viral, or fungal infection should be treated with appropriate antimicrobial agents. These topical medications have been shown to have excellent clinical efficacy without significant side effects. A 3-year follow-up in 250 children: food allergy and high risk of respiratory symptoms. Worldwide variations in the prevalence of symptoms of atopic eczema in the International Study of Asthma and Allergies in Childhood. Atopic dermatitis: a genetic-epidemiologic study in a population-based twin sample. Decreased interferon gamma and increased interleukin-4 production in atopic dermatitis promotes IgE synthesis. Characterization of the mononuclear cell infiltrate in atopic dermatitis using monoclonal antibodies. Differential in situ cytokine gene expression in acute versus chronic atopic dermatitis. The role of superantigens in human diseases: therapeutic implications for the treatment of skin diseases, Br J Dermatol 1998;139(suppl 53):17 29.
However order cheap levitra soft on line, it is possible to have contact allergy to the formaldehyde resins used in these fabrics levitra soft 20 mg free shipping. Because allergy to clothing is not usually identified using a standard patch test buy levitra soft online from canada, testing requires specialized nonstandard allergens 20 mg levitra soft sale. Spandex (except some from Europe which contains mercaptobenzothiazole) and Lycra are good substitutes. Plastic-related Dermatitis Plastics that can sensitize include epoxies (before full hardening occurs), paratertiary butyphenol formaldehyde resin (commonly used in leather adhesives), and acrylate and methacrylate monomers (40,41). Acrylic monomers, used in about 95% of dentures in the United States, are a common cause of contact allergy in dentists. Acrylic sculptured nails, nail products, and acrylic prostheses also can cause sensitization. Plants Allergic contact dermatitis to plants is most commonly due to the oleoresin fraction, especially the essential oil fraction. In contrast, type I reactions to plants are most commonly due to pollen and other plant proteins. Rhus Rhus dermatitis (poison ivy, oak, and sumac) is the most common form of allergic contact dermatitis seen in both children and adults in the United States ( 42,43). Ragweed Ragweed dermatitis generally affects older individuals and rarely occurs in children ( 44). Men are affected 20 times more often than women, primarily those who are dairy farmers. Although a sesquiterpene lactone mix is available for patch testing and will be positive in many cases of compositae allergy, it will miss some cases because sesquiterpene lactones may not be cross-reactive. Alstromeria Alstromeria (Peruvian lilly) is a common cause of allergy in florists and is due to tuliposide-A (a butyrolactone) ( 45). Photoreactions Phototoxic reactions are due to nonimmunologic mechanisms, usually occur on first exposure, and tend to resemble sunburn ( 46). Berloque dermatitis on the neck is caused by perfumes containing oil of bergamot (bergapten or 5-methoxy-psoralens). The most common cause in the past was halogenated salcylanides in soaps and cleansers; however, these are no longer used in the United States or Europe. Hexachlorophene, a halogenated phenol, also can cause photoallergy and can cross-react with these compounds. Phenothiazines are used in insecticides and can cause topical photoallergy and phototoxic reactions. This does not occur by the oral route, with the exception of chlorpromazine, which can cause phototoxic reactions. Most topical sulfonamides are not photosensitizers, but sulfanilamide can cause both photoallergic and phototoxic reactions. Potent materials that may sensitize on the first application include plant oleoresins, paraphenylenediamine, and methylsalicylate. Patch testing and especially repeated patch testing should not be performed unnecessarily. This is especially important when testing with a contactant not included in the standard patch test materials. To be significant, a substance must elicit a reaction at a concentration that will not cause reactivity in a suitable number of normal controls. Patch testing should never be performed in the presence of an acute or widespread contact dermatitis. False-positive reactions may be obtained because of increased reactivity of the skin. In addition, a positive patch test reaction with the offending agent may cause a flare-up of the dermatitis. The patient should be carefully instructed at the time of patch test application to remove any patch that is causing severe irritation. As mentioned earlier, an anaphylactoid reaction can occur when testing for contact urticaria. An interesting but poorly understood complication is the occasional occurrence of the nephrotic syndrome and glomerulonephritis in severe generalized contact dermatitis caused by poison ivy or poison oak (49). For limited, localized allergic contact dermatitis, cool tap water compresses and a topical corticosteroid are the preferred modalities. When the dermatitis is particularly acute or widespread, systemic corticosteroids should be used. In instances when further exposure can be avoided, such as poison ivy dermatitis, there should be no hesitation in administering systemic corticosteroids. This is a classic example of a self-limited disease that will respond to a course of oral corticosteroid therapy. The popular use of a 4- to 5-day decreasing steroid regimen often results in a flare-up of the dermatitis several days after discontinuing the steroids. The response to systemic corticosteroids is generally dramatic, with improvement apparent in only a few hours. Three rules that might be applied to systemic corticosteroid therapy in acute contact dermatitis are (a) use an inexpensive preparation such as prednisone; (b) use enough (1 mg/kg); and (c) avoid prolonged administration (rarely more than 2 weeks of therapy is required). For secondary infection resulting from scratching because of the pruritus of allergic contact dermatitis, antibiotics may be needed. Because of the risk involved in sensitization from topical antibiotics, the oral or injectable forms are preferred. For that reason, avoid topical applications of medications that have a high index of sensitization. When the offending agent causing allergic contact dermatitis is discovered, careful instruction must be given to the patient so as to avoid it in the future. The physician should discuss all of the possible sources of exposure, and when dealing with occupational dermatitis, should have knowledge about suitable jobs for patients. When dealing with a plant sensitizer, the patient should be instructed in the proper identification of the offending plant. If sensitization has occurred, the amount of information about the allergen is correlated with the condition of the skin. It has been reported that if the patient is aware of the allergen and informed about the variety of substances that contain it, the skin condition is much more satisfactory that if the patient knows little about the allergen (51). The use of protective clothing is beneficial, as are newly available barrier creams. Early diagnosis and evidence of further allergen exposure are critical if chronic, debilitating dermatitis is to be avoided (52). Langerhans cells: role in contact hypersensitivity and relationship to lymphoid dendritic cells and to macrophages. The diagnostic evaluation treatment, and prevention of allergic contact dermatitis in the new millennium. Statement of the problem, solution(s) of the industry, and the current use of formaldehyde and formaldehyde-releasing biocides. Methyldibromoglutaronitrile (Euxyl K 400): an important new allergen in cosmetics. Allergy to cocamidopropyl betaine may be due to amidoamine: a patch test and product use test study. Contact and photocontact sensitivity to sunscreens: review of a 15-year experience and of the literature. Studies in patients with corticosteroid contact allergy: understanding cross-reactivity among different steroids. Results of patch testing with a specialized collection of plastic and glue allergens. Photoallergic contact dermatitis: results of photopatch testing in New York, 1985 to 1990. Fatal anuria, the nephrotic syndrome and glomerular nephritis as sequels of the dermatitis of poison oak. The aspirin triad or occurrence of nasal polyps in association with asthma and aspirin sensitivity was first identified in 1911 ( 2). Nasal polyps represent a consequence of chronic mucosal inflammation; this condition also has been referred to as hypertrophic rhinitis. In most cases, nasal polyps arise from the middle meatus and clefts of the ethmoid region ( 3).