July 02, 2009 Archives - Clinical Advisor

Print Issue: July 02, 2009

Are patients being exposed to too much radiation?

With repeated requests from patients for more and more radiologic studies, are there any data documenting the side effects of radiation due to continued and increased exposure to CT scans, x-rays, etc.? —FELIX N. CHIEN, DO, Newport Beach, Calif. There are limited data. I did find one study that predicted the absolute number of cancer…

Benefit of intensive glucose control questionable in critically ill patients

Level 2: Mid-level evidence Intensive glucose control has been suggested for critically ill patients to improve outcomes. Two recent reports, a systematic review and a new randomized trial, found this treatment was associated with increased hypoglycemia and unclear benefits on mortality. A review of 26 randomized trials compared intensive glucose control with conventional glucose management…

Options when estrogen-containing contraception is contraindicated

Is long-term use of medroxyprogesterone acetate (Depo Provera) safe in perimenopausal women for whom estrogen-containing contraceptives are contraindicated (e.g., smokers)? At what age would you recommend a dual energy x-ray absorptiometry (DEXA) scan for these patients? —NICOLE McHUGH, MSN, CRNP, Narberth, Pa. While depot medroxyprogesterone acetate (DMPA) provides highly reliable birth control and can alleviate…

Intracranial bleeding (left)

Clopidogrel plus aspirin for atrial fibrillation may decrease stroke but increase hemorrhage

Level 2: Mid-level evidence Patients with atrial fibrillation (AF) who are unable to take warfarin for stroke prophylaxis frequently take aspirin instead. The Atrial Fibrillation Clopidogrel Trial with Irbesartan for Prevention of Vascular Events (ACTIVE A) evaluated the addition of clopidogrel to daily aspirin for stroke prophylaxis in 7,554 patients with AF (mean age 71…

Evaluation for proximal muscle weakness and rash

What is the differential diagnosis for a formerly active and healthy 70-year-old woman with worsening proximal weakness, torticollis, and a widespread raised red rash across her cheeks bilaterally? What tests do you recommend? —LINDA SCHWAB, CNP, St. Cloud, Minn. Dermatomyositis should be considered in the differential diagnosis of a patient with a facial rash and…

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