July 05, 2007 Archives - Page 3 of 7 - Clinical Advisor

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GASTRIC BYPASS FOLLOW-UP

Patients who undergo such procedures as gastric bypass for weight control are often left with chronic intestinal malabsorption and may have increased risk for anemia, osteoporosis, and a host of other deficiency-related illnesses. Is there a recommended schedule of supplementation and screening for the prevention and management of these post-bypass problems?—Sarah R. Edmonson, MD, Houston…

INCIDENCE OF LATEX ALLERGY DECREASING

Has there been a decrease in the incidence of latex allergy since the institution of latex precautions in high-risk populations?—E. Rosellen Dedlow, MSN, BC, ARNP, Gainesville, Fla. A dramatic decrease in the prevalence of latex allergy after switching to low-allergen, powder-free latex gloves has been shown in two studies (Clin Infect Dis. 2004;38:252-256 and Curr…

DIFFERENTIAL DIAGNOSES FOR PATIENT WITH HEMATOSPERMIA

What are the diagnostic possibilities for a patient with hematospermia of several months’ duration whose physical examination and lab studies are normal?—Mario E. Palacious, MD, Egg Harbor Twp, N.J. Hematospermia almost always results from the nonspecific inflammation of the prostate and/or seminal vesicles. The condition generally resolves spontaneously, usually within several weeks. If it persists,…

WHAT CAUSES RECURRENT CELLULITIS?

In a patient with recurrent cellulitis of the thigh, can the punctum of a follicular cyst in the buttock serve as a portal of entry for the causative bacteria? There appears to be no other identifiable cause.—Edwin Kellerman, MD, Merion, Pa. An inflamed, infected cyst can be the source of cellulitis, particularly on the face.…

ON-PUMP VS. OFF-PUMP CORONARY BYPASS

What determines whether a patient will have “on-pump” or “off-pump” coronary artery bypass surgery (CABG)?—Elissa Internicola Lebow, PA-C, Staten Island, N.Y. Patients may achieve an excellent outcome with either procedure. Outcomes are likely to depend more on factors other than whether patients underwent standard CABG utilizing the cardiopulmonary bypass machine (on-pump) or if they had…

MANAGING A FIRST-TRIMESTER FLARE OF SYSTEMIC LUPUS ERYTHEMATOSUS

Is it safe to treat a flare of systemic lupus erythematosus during the first trimester of pregnancy?—Abul Rahman, MD, Gulfport, Miss. A lupus flare during the first trimester should be treated, although some medications, such as cyclophosphamide, and experimental regimens should be avoided. Corticosteroids are the best therapy. These agents are weak teratogens (one to…

CLASSIFYING ACANTHOSIS NIGRICANS IN A DIABETIC

What workup, if any, is required to classify acanthosis nigricans (AN) in a known diabetic? Is there a treatment?—Cconnie Walker, PA-C, Port Angeles, Wash. AN can occur in several settings: benign, obesity-associated, cancer-associated, acral, unilateral, medication-induced, and mixed (in which two types are evident). AN-associated diabetes mellitus may be unrelated to other concurrent conditions, noninsulin-dependent,…

REPORT ALL DRUGS DISPENSED?

Should family clinicians be required to report to a central organization all drugs of any class given or sold to patients for the sole purpose of helping public health officials keep track of medication use? Is this a constitutionality issue?—Bryant H. Hudson 3rd, MD, Montgomery, Ala. I can see the usefulness of this suggestion from…

GALACTORRHEA IN A TEENAGER

Recently a teenage girl presented with galactorrhea. A pregnancy test was negative. She was not using hormonal contraceptives, nor was she taking opiates or methyldopa. I ordered a serum prolactin and a thyroid-stimulating hormone (TSH) level. What further workup would you recommend? Should I check for marijuana, cocaine, or methamphetamine use? How common is malignancy…

OPTIONS TO RESOLVE SCALP PICKING

An elderly nursing-home patient with early Alzheimer’s disease picks the front of her scalp (to the point of bleeding and infection) and pulls out her hair. There is no apparent skin pathology in the area. I have asked the nursing home staff to trim her nails and have tried potent topical corticosteroids and doxepin (Zonalon)…

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