Print Issue: June 01, 2009

Assessing chronic pelvic pain

A 43-year-old woman has a one-year history of chronic pelvic pain that sometimes radiates to the thighs. She also experiences pelvic pain when the abdomen is palpated. Menstrual cycles are normal, with moderate-to-heavy flow. The pain is somewhat relieved with naproxen or propoxyphene and acetaminophen (Darvocet). No cysts or other abnormalities are seen within the…

Anti-anxiety effect of zolpidem

A 67-year-old patient currently being treated for anxiety secondary to narcotic withdrawal was started on three anti-anxiety medications that were subsequently tapered to diazepam only. Because the patient also reported insomnia, we added controlled-release zolpidem (Ambien CR) 12.5 mg at bedtime. When the patient returned to the clinic, he reported relief of severe anxiety symptoms…

Adolescent urinary retention

What causes sudden urinary retention in a teenager?—FELIX N. CHIEN, DO, Newport Beach, Calif. Except when associated with an acute dysuria, sudden urinary retention in teenagers is not common. Medications may be the most frequent reason I have observed. Other causes include neurogenic bladder (due to a variety of causes) as well as obstruction along…

Boosting pancreatic beta cells

Is it true that sitagliptin (Januvia) preserves or increases pancreatic beta-cell function or quantity over a period of time?—Shah Niranjan, MD, Roslyn Heights, N.Y. Yes, there are data to suggest that the dipeptidyl peptidase IV (DPP-IV) inhibitors, which include sitagliptin, may preserve beta-cell mass to some extent. The implications of this fact for therapy in diabetes,…

Help for a lichen planus patient

A 75-year-old man has had oral lichen planus for three years. Dry mouth has resulted in multiple dental cavities and extractions. Trials of oral hydroxychloroquine (Plaquenil), triamcinolone 0.1% (Oralone) dental paste, dexamethasone 4 mg IM, and tacrolimus (Protopic) have been unsuccessful. He takes fluconazole (Diflucan) for periodic bouts of moniliasis.—Kenneth G. Wong, MD, Bakersfield, Calif. Oral lichen planus…

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