March 03, 2007 Archives - Page 3 of 8 - Clinical Advisor

Print Issue: March 03, 2007

OPTIMAL BP CONTROL vs. SIMPLIFIED MEDICATION REGIMEN

In elderly hypertensive patients, should we sacrifice optimal BP control in the interest of a simpler medication regimen?—Larissa S. Buccolo, MD, Jacksonville, Fla. This is always a judgment call. Obviously, if optimal BP control is associated with side effects, a less stringent target BP would be preferable. In a patient without side effects, there are…

WORKUP FOR MILD HYPERKALEMIA

A 63-year-old asymptomatic man has had mild hyperkalemia (5.6-6.0 mEq/L) for the past six months. His physical examination and lab work are remarkable only for an elevated cholesterol level. He is a heavy smoker. Does this patient require workup for Addison’s disease? How would you proceed?—Ashley Davis, MD, Boise, Idaho Embedded within this complex question…

DOES THIS PATIENT NEED PHLEBOTOMY?

A 33-year-old white man’s alanine aminotransferase (ALT) has been elevated for approximately two years. At initial evaluation, his ferritin level was >1,000 ng/mL. Additional laboratory studies, including a hepatitis panel and autoimmune determinations, were normal. Eventually, his liver biopsy showed marked fatty liver without fibrosis. His hepatic iron index was <1, and genetic testing for…

ADVANCED BONE AGE IN A YOUNG GIRL

A 3½-year-old girl whose height falls below the fifth percentile has an estimated bone age of 6 years. Her birth at full-term was unremarkable, and her weight and developmental milestones are all normal. There is no clinical or biochemical evidence of congenital adrenal hyperplasia or precocious puberty. What could be causing her advanced bone age?—Arun…

SAFETY OF STEROID INJECTIONS FOR SEASONAL ALLERGIC RHINITIS

Triamcinolone (Kenalog) injections are often used to control symptoms of seasonal allergic rhinitis (SAR). Many patients report good control of symptoms with treatment annually or biannually. Is there any danger in using steroids in this manner? How often can this be done?—Cathy Wayand, MSN, ANP, Statesville, N.C. While this appears to be a fairly common…

STATINS MAY BE ASSOCIATED WITH INCREASED CANCER RISK IN OLDER PATIENTS

Level 2: Mid-level evidence In a systematic review, cancer outcomes were analyzed in 35 randomized trials of statins studied for cardiovascular benefits in a total of 109,143 patients (J Clin Oncol. 2006;24:4808-4817). The Prospective Study of Pravastatin in the Elderly at Risk (PROSPER) trial was the only one to show a statistically significant increase in…

EXTENDED ANTICOAGULATION REDUCES RISK OF RECURRENT VENOUS THROMBOEMBOLISM

Level 1: Likely reliable evidence A randomized trial evaluated the efficacy of extended anticoagulation in 608 patients aged 18-85 years with first episodes of symptomatic, unprovoked venous thromboembolism (deep venous thrombosis and/or pulmonary embolism) who completed at least three months of oral anticoagulation (warfarin or acenocoumarol to a target international normalized ratio of 2-3) (N…

ACETAMINOPHEN AND HYOSCINE BUTYLBROMIDE EACH MAY IMPROVE CRAMPY ABDOMINAL PAIN

Level 2: Mid-level evidence The efficacy of acetaminophen (Tylenol and others) and hyoscine butylbromide alone and in combination was evaluated in a study of 1,935 patients aged 18-70 years who had recurrent crampy abdominal pain for at least two months (Aliment Pharmacol Ther. 2006;23:1741-1748). The single-blind trial had a one-week placebo run-in period; bowel habits…

EARLY AMBULATION FOR DVT APPEARS SAFE AND MAY BE BENEFICIAL

Level 2: Mid-level evidence Early mobilization was associated with a lower incidence of deep venous thrombosis (DVT) progression in a randomized trial of 103 patients hospitalized for proximal DVT, but the results did not reach statistical significance (Curr Med Res Opin. 2006;22:593-602). Patients were randomized to five days of strict bed rest vs. early mobilization;…

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