December 14, 2007 Archives - Clinical Advisor

Print Issue: December 14, 2007

FOR DIFFICULT CATHETERIZATION

When urethral catheterization proves difficult, bypass prostate swelling due to benign prostatic hyperplasia, prostate tumor, or external mass by using a 10-cc syringe to inject normal saline into the catheter lumen while pushing the Foley catheter at the same time.—Dilip P. Ghodasara, MD, Charleston, W.Va. I have never tried this trick. My favorite technique for…

ANTIHYPERTENSIVE DRUGS AND PREGNANCY

I was taught that methyldopa is labeled “Cat. B” for pregnancy and beta blockers and calcium channel blockers are “Cat. C,” but you consider these classes safe (Item 106-4). Please explain.—Norman Zellers, MSPAS, PA-C, Carson City, Nev. Category B means that there is no evidence of risk in humans: Either animal findings show risk (but…

ARE OCS SAFE IN PERIMENOPAUSAL WOMEN?

In light of the Women’s Health Initiative (WHI) findings, is the use of oral contraceptives (OCs) safe in low-risk perimenopausal women?—Debra Palfrey, PA-C, Plymouth, Mass. A low-estrogen OC (20 µg ethinyl estradiol) remains an appropriate treatment for perimenopausal women who seek relief of menopausal symptoms as well as those who desire contraception or need control…

Clostridium difficile diarrhea

Do we know which antibiotics are most likely to cause Clostridium difficile diarrhea? Also, what is the correct pronunciation of “difficile?”—James Nahlik, MD, St. Louis Any antibiotic can cause C. difficile-associated diarrhea, but the most common are penicillins, clindamycin, cephalosporins, and more recently quinolones. I use the common U.S. pronunciation “dif-i-seal,” which is the French…

CK LEVELS AND STATINS

From time to time, a patient taking a statin is found to have an elevated creatine kinase (CK) that does not normalize when the statin is withdrawn and does not seem to be associated with symptoms. What is the highest CK level at which an asymptomatic patient could resume the statin?—Steven B. Matfis, MD, Quincy,…

CONFIRM ALL POSITIVE PPD TESTS?

Ten years ago, a colleague’s purified protein derivative (PPD) test was read by several physicians as being positive at 13-mm induration. Disturbed by the results, we tried testing with PPD again. The area became red but not indurated. Since then, yearly PPD tests have been nonreactive. I presume that the original response was just a…

PLASMA DONATION AND THYROXINE DOSING

A 41-year-old woman has been stable on the same dose of l-thyroxine (0.1 mg) for years, but her thyroid-stimulating hormone recently rose significantly. It turns out she has been donating plasma twice a week for the past five months. Could this be increasing her thyroid replacement needs?—Kevin Jessen, MD, Fond du Lac, Wis. Frequent plasma…

OPTIMAL SCHEDULE FOR COUMADIN DOSES

We tell our patients to take their warfarin (Coumadin) in the afternoon, but our hospital pharmacist says that this medication may be taken at any time of day as long as the patient is consistent. Are prothrombin times (PTs) and international normalized ratios (INRs) affected by variations in dosing intervals?—Kevin M. Harvey, MD, Midlothian, Va.…

Acrylic-nail infections

How does one diagnose and treat infections that develop under acrylic nails?—Abigail H. Faerber, DO, Delaware, Ohio Artificial fingernails are more likely to harbor pathogens, especially gram-negative bacilli and yeasts, than native nails. The longer artificial nails are worn, the more likely it is that a pathogen can be isolated. Signs of a fungal or…

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