March 03, 2007 Archives - Clinical Advisor

Print Issue: March 03, 2007

Too much watchful waiting?

Years of elevated liver enzymes failed to raise concern about a teenager’s condition. Ms. U, 36, completed a master’s program to become a physician assistant four years ago. Although her specialty was pediatrics, she found a position in a general practice in the Pacific Northwest and gave up her specialty to live and practice there.…

FOLLOW UP- ROLE OF ALBUMIN IN EDEMA?

In a follow-up to my own earlier question about a patient with extravascular expansion secondary to congestive heart failure (CHF) and simultaneous intravascular depletion (Item 100-14), is there any indication for albumin in CHF or edema of any other cause?—Ed Soumi, MD, Las Vegas Aside from the rare situation in which the serum albumin is…

FOLLOW UP- SAFE USE OF HYDROGEN PEROXIDE FOR HALITOSIS

I was surprised to read the recommendation to combat bad breath by gargling with half-strength hydrogen peroxide (Item 99-1). My dental hygienist advised me against this and cited reports of increased oral and throat cancers with regular use of peroxide gargles. Is there anything in the literature regarding this?—TINA BAUM, RN, CNS, CWOCN, Elyria, Ohio…

FOLLOW UP- SLOW-HEALING SPLIT LIP

Another consideration in the case of the boy with a split lip that wouldn’t heal (Item 99-6) is an allergic reaction to the continued use of bacitracin/ neomycin/polymyxin B cream (Neosporin). A number of my patients have used Neosporin first, only to come in later with worsening symptoms. Once they stop using the cream, the…

USING C-REACTIVE PROTEIN TO ASSESS CAD RISK

What role does C-reactive protein (CRP) play in assessing the risk of CAD in patients with borderline cholesterol indices?—Traci Hartsfield-McIntyre, PA-C, Augusta, Ga. Elevated levels of CRP are reflective of inflammation. Factors that can elevate CRP, such as rheumatoid disease, a common cold, or smoking, should be identified and treated or eliminated. Epidemiologic and laboratory…

PARTIAL CELLULITIS RESOLUTION

Two months ago, a patient with controlled type 2 diabetes developed cellulitis, with two small ulcers on her left lower leg. Since then, she has been on a 10-day course of cephalexin (Keflex) and a seven-day course of ciprofloxacin (Cipro). Her symptoms have improved but not totally resolved. The overall color of her leg and…

BENEFITS OF MANAGING TSH?

A healthy 36-year-old woman complains of eye fatigue that worsens as the day wears on, especially in the week before her menses, which are regular. Laboratory evaluations reveal a thyroid-stimulating hormone (TSH) level of 4 µIU/mL, thyroxine 6.2 µg/dL, free thyroxine index 1.8, and triiodothyronine uptake 29.5%. Her TSH, along with a low LDL, has…

FIVE OR 10 DAYS FOR SINUSITIS ANTIBIOTICS?

In the treatment of routine sinus infections, some European studies have shown three to five days of “basic” antibiotics to be effective, so why do so many clinicians in this country still recommend 10 days? Studies also show that at 14 days, the cure rate is the same as with placebo, so how do we…

LIPOPROTEIN AND PRERETINAL

What is the best way to manage a high lipoprotein(a) and preretinal membrane in a 70-year-old woman with mild, controlled hypertension, moderate exogenous obesity, and mild type 2 diabetes? She also has multinodular goiter, which was negative for cancer on biopsy. The patient’s maternal grandmother developed type 2 diabetes at age 80. Current medications include…

Next post in Advisor Forum