Print Issue: February 09, 2007

WHICH PATIENTS NEED BACTERIAL ENDOCARDITIS PROPHYLAXIS?

What are the current selection criteria to receive bacterial endocarditis (BE) prophylaxis? Are those with implanted cardioversion devices eligible?—James K. Eldridge, PA-C, Harstel, Colo. The risk for BE in patients with pre-existing cardiac disorders is classified as relatively high, moderate, or low. High-risk patients include those with prosthetic heart valves, previous BE, and complex cyanotic…

TEMPERATURE-DEPRESSION THYROID LINK?

Is there a relationship between basal body temperatures, depression, and thyroid disorders? A 52-year-old man, who had previously monitored his first morning temperatures on occasion, recently followed them for 20 days. On a few occasions, his temperature was <97.0°F, although he felt comfortable. Recently, he has been comfortable at a consistent temperature of 97.4°F. In…

CAN DIURETICS TREAT TINNITUS?

I have come across anecdotal evidence that diuretics will improve tinnitus. Is there any truth to this?—Kimberly Fleek, MMSc, PA-C, Atlanta Diuretics have been used to treat Ménière’s disease, a syndrome of deafness, vertigo, and tinnitus. However, the use of diuretics in this debilitating disorder is aimed at treating the vertigo, not the tinnitus (the…

WHAT’S CAUSING THIS MAN’S CHRONIC SORE THROAT?

A 46-year-old man has had a chronic sore throat for eight years. He travels frequently, particularly to India, where he spends his time in a large city not endemic for any specific diseases. In January 2001, a throat culture was positive for Hemophilus influenzae. The ear, nose, and throat specialist who saw him at that…

DESIPRAMINE FOR POSTHERPETIC NEURALGIA

A man came to my office complaining of an extensive rash. On examination, I discovered herpes zoster covering nearly his entire left upper leg. Astonishingly, the patient told me that it did not hurt at all. According to his chart, he had been taking desipramine 50 mg b.i.d. for 10 years to treat adult attention-deficit…

CAN EATING NUTS LOWER BP?

Does eating walnuts lower BP? If so, how many walnuts have to be consumed each day? How long does it take before the BP starts to fall?—Gerard K. Nash, DO, Amarillo, Tex. There has been one excellent controlled trial of walnuts and BP (N Engl J Med. 1993;328:603-607). Results showed that when 20% of caloric…

WHEN TO BEGIN PAP SMEARS

The latest guidelines recommend beginning Pap smear screening within three years after the onset of sexual activity or at age 21. I have encountered two teenagers, aged 18 and 15, who have developed low-grade squamous intraepithelial lesions (LSILs) within one year of first intercourse. Both patients have required colposcopy, and one has yet to return…

AN AGE LIMIT FOR STATIN THERAPY?

Is there an age at which patients no longer benefit from statin therapy? Should there be an upper limit for starting statins or an age at which their use should be discontinued?—Ron Reese, MPAS, PA-C, Bellevue, Neb. As always, risk needs to be balanced against potential benefits, and individual circumstances — not just age —…

WHY IS GROWTH HORMONE SO CONTROLLED?

I have read that elderly patients given growth hormone have improved muscle mass/fat ratios. Why is this agent so tightly controlled if the elderly as well as the obese might benefit from its effects?—Craig Freyer, MD, Fort Worth, Tex. Growth hormone has beneficial effects on body composition in the presence of documented growth hormone deficiency,…

SALMETEROL REDUCES COPD EXACERBATIONS

Level 1: Likely reliable evidence Salmeterol (Serevent) and formoterol (Foradil Aerolizer) are two long-acting beta2-agonists that are FDA-approved for maintenance treatment of chronic obstructive pulmonary disease (COPD), including emphysema and chronic bronchitis. A systematic review of 23 published and unpublished randomized placebo-controlled trials evaluated the efficacy of salmeterol or formoterol in 6,061 patients with stable…

Next post in Evidence-Based Medicine