January 10, 2007 Archives - Page 2 of 6 - Clinical Advisor

Print Issue: January 10, 2007

NEXT STEP FOR PATIENT WITH HEADACHE, DIZZINESS, AND TINNITUS

A 50-year-old black woman with headaches was diagnosed with dural arteriovenous malformation located in the clival vein with extensive feeders in the contralateral right petrous jugular, ascending pharyngeal arteries, meningeal vessels, and right and left internal and external carotid arteries. She underwent embolization with polyvinyl alcohol particles and Guglielmi detachable coils. She continues to complain…

STOP THE WARFARIN BEFORE EYE SURGERY?

A patient who takes warfarin (Coumadin) for atrial fibrillation and valve replacement is about to undergo cataract surgery. Should I stop the warfarin?—Girish L. Sharma, MD, Rockville, Conn. According to my colleagues who perform this procedure, contemporary techniques use very small incisions and do not require special warfarin precautions to keep the field bloodless. However,…

LIVER AILMENTS WITH HEMATURIA

How would you treat a patient who has hepatitis C, cirrhosis, and gross hematuria? A platelet count is 50,000/µL. Cystoscopy and abdominal CT are negative.—Filadelfo V. Oandasan Jr, MD, Palo Alto, Calif. The differential diagnosis for gross hematuria includes urinary tract malignancy, nephrolithiasis, and renal disease (glomerular). In this patient, the cystoscopy and CT have…

DIABETES AND CHRONIC KIDNEY DISEASE

Many well-controlled diabetes patients who have stage-3 chronic kidney disease (CKD) do very well with metformin, but lately I’ve noticed a trend to stop the metformin in such patients. Is there any evidence of increasing adverse effects in this population? Would it be appropriate to continue use?—Jason Collins, MD, Canton, Ohio Metformin is an attractive…

REDUCING FAT NECROSIS AT

Is there a way to reduce the risk of fat necrosis at the injection site when using an IM corticosteroid? I’ve heard that rubbing the site after injecting can make fat necrosis more likely. Once fat necrosis has occurred, are there treatments to make it less unsightly?—Jon Malan, DO, Red Bluff, Calif. Corticosteroid injections can…

LOWERING BP ON THE SPOT

I frequently see patients who have JNC-7 stage-2 pressures >180/110 mm Hg but few symptoms. With so many antihypertensive medications available, are there any that can safely lower BP during an office visit and allow the patient to follow up in two to three days? Are there JNC 7-approved BP ranges that allow patients to…

HEALTH BENEFITS OF COLLOIDAL SILVER?

One of my patients drinks homemade colloidal silver solution every day. He is convinced it has a potent antibiotic effect as well as other health benefits. His wife reports that she has been cured of sinusitis when traditional therapy has failed; she also takes it to prevent recurrent sinusitis. What risks, if any, are there…

SLOW-HEALING SPLIT LIP

A four-year-old boy had a split in a crease in his lower lip that had not healed for more than six weeks. There were no signs of bacterial infection; application of bacitracin/neomycin/polymyxin B (Neosporin) cream had no effect. Every time the boy smiled, the split would open and bleed again. It finally healed with a…

WHAT’S WRONG WITH COMPUTER-GENERATED ECG INTERPRETATION?

What are the sensitivity and specificity of computer-generated ECG interpretation? What is the most common reason cardiologists disagree with such interpretation?—Harry Ballantyne, PA-C, Odenton, Md. Computer-generated ECG interpretations have shown lower accuracy than those of clinician interpreters and should be relied on only as an adjunct tool for a trained provider. Among expert electrocardiographers, interpretations…

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