Print Issue: May 01, 2009

Iron deficiency anemia in a vegetarian

What is the best way to treat true iron deficiency anemia in a vegetarian without inducing constipation or epigastric discomfort? The patient, a 24-year-old woman, has been diagnosed with rheumatoid arthritis and underwent gastric bypass surgery more than a year ago. I usually recommend that my patients take iron 325 mg with vitamin C 500…

In tubal ligation, the fallopian tubes are cut and tied to prevent eggs from reaching the uterus.

Sterilization vs. tubal ligation

Would you recommend the permanent sterilization procedure Essure, which involves insertion of flexible coils to create blockage of the fallopian tubes, over tubal ligation? Have there been any reports of severe infection or rejection of the coils?—STEPHANIE RETHABER, RN, MSN, FNP, Floresville, Tex. Introduced in 2002, Essure consists of flexible “micro-inserts” placed in the fallopian…

A pressing need for nail disorders

When lancing a nailfold affected by paronychia or using a hot paper clip to drain a nail-bed hematoma, have the patient press his finger as hard as he can against the table. This aids with drainage and results in minimal discomfort for the patient.—Louis Gianvito, MD, Staten Island, N.Y. (127-14)

Midwife-led care recommended as an option for pregnant women

Level 1: Likely reliable evidence A recent Cochrane review of 11 randomized trials involving 12,276 pregnant women has recommended midwife-led care as a safe and effective option for childbirth (Cochrane Database Syst Rev. 2008;[4]:CD004667; accessed April 8, 2009). Compared with other models, midwife-led care was associated with significantly lower rates of antenatal hospitalization, instrument birth,…

Photomicrograph shows fatty metamorphosis of a human liver. The clear vacuoles indicate fat droplets

What to do for fatty liver

How would you treat fatty liver in a middle-aged overweight woman with the following profile: liver function tests normal; HDL 70 mg/dL; LDL 160 mg/dL; and triglycerides 170 mg/dL. The patient uses alcohol occasionally, takes no medications, and complains of right upper-quadrant discomfort. One clinician recommends aggressive statin treatment. A second clinician says to treat…

Periorbital rash with angioedema

A 56-year-old white woman with poorly controlled type 2 diabetes presented with unilateral periorbital angioedema. Topical steroid ointment and oral antihistamines were ineffective. After skipping her two-week follow-up appointment, the patient returned six months later when the rash became bilateral. As at the previous visit, there was a bright red rash that occasionally oozed serous…

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