January 30, 2008 Archives - Page 3 of 12 - Clinical Advisor

Print Issue: January 30, 2008

RESISTANT FUNGAL INFECTION

A patient has an unidentified fungal infection that resembles Alternaria on microscopic examination and is resistant to multiple topical fungicides. The infection may be related to chronic contact with sheepskin furniture covers. What do you advise?—Barbara A. Fannin, MD, Benbrook, Tex. Begin by establishing the nature of the infection. Alternaria identified by culture may represent…

MICRODOSE THERAPY?

Recently a patient asked about microdose therapy for arthritis, but I was unfamiliar with the term. Can you help?—Jerome J. Kastrul, MD, Glendale, Ariz. The patient may mean minidose therapy—commonly used with prednisone to minimize side effects. Prednisone (1-4 mg) is utilized, especially for osteoarthritis when use of nonsteroidal anti-inflammatory drugs would be difficult, as…

GOING AFTER GENITAL WARTS

What are the treatment options for genital warts on the vaginal walls?—Bela L. Aneja, MD, Greenville, N.C. Effective treatment options for vaginal condylomata acuminata include laser vaporization and cryotherapy. Electrocautery and surgical excision can also be used. It is difficult to apply localized podophyllin because collapse of the vaginal walls after the speculum is removed…

RHEUMATICA-ARTERITIS LINK?

What proportion of patients with polymyalgia rheumatica develop temporal arteritis? Is the erythrocyte sedimentation rate (ESR) elevated in both conditions?—Frank V. Monti, DO, Virginia Beach, Va. Approximately 10%-15% of patients with polymyalgia rheumatica develop temporal arteritis, usually when low-dose steroids are tapered or discontinued. The ESR is elevated in both conditions during active inflammation, but…

IS SURGERY SAFE FOR PREGNANT WOMEN?

Have there been any research studies on the necessity and safety of doing loop electrosurgical excision procedures (LEEP) in pregnant women who have severe dysplasia and test positive for human papillomavirus 16 or 18?—Lane Reed, MD, Dallas It is best to avoid doing either LEEP or conization of the cervix during pregnancy because of the…

WHEN TO DO ENDOCERVICAL CURETTAGE

When is endocervical curettage (ECC) recommended as part of the evaluation of postmenopausal vaginal bleeding?—Mary McCrossan, MD, Wilmington, Del. ECC is warranted in a woman with postmenopausal uterine bleeding if the clinician suspects cervical cancer or if endometrial biopsy or curettage has revealed the presence of endometrial cancer, in order to determine whether there is…

The CVD risk of aortic calcification

Incidental calcification in the aorta has been commonly ignored. A 42-year-old white man with a family history of CVD (the father suffered an MI in his 50s) demonstrated calcium of the aorta on x-ray of the lumbar spine. While the patient is a smoker, he is not overweight, hypertensive, or diabetic, and he has normal…

A CALL TO ARMS FOR RETIRED CLINICIANS

Thanks to David S. Starr, MD, JD, for his answer to my question concerning retired clinicians’ desire to serve the needy in a volunteer capacity (Item 109-15). The Veterans Administration (VA) allows clinicians to practice without a license in all states. A volunteer clinicians’ service could exist under the auspices of the VA or the…

In search of diarrhea relief

Celiac disease is diagnosed by upper endoscopy with duodenal biopsy, not colonoscopy as recommended in Item 103-3.—Judith Conway, APRN, Cromwell, Conn. You are correct. Unfortunately, I inadvertently left out a few key words in my response. Celiac disease is diagnosed with upper endoscopy, during which biopsies are obtained from the duodenum to assess for villous…

CURIOUS LDH ELEVATION

A 60-year-old asymptomatic woman has shown progressive elevation in her lactate dehydrogenase (LDH) levels (230-350 units/L) over the past year. She takes hydrochlorothiazide for hypertension. Until recently, she was also taking atorvastatin (Lipitor) for hyperlipidemia, but she discontinued it on her own when told that her LDH was high. Could atorvastatin have caused this elevation…

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