May 29, 2008 Archives - Clinical Advisor

Print Issue: May 29, 2008

SELF-EXAMS FOR MEN

Remind male patients to do testicular self exam as often as you recommend breast self-exam to female patients.—Samy B. Gergis, MD, Lebanon, Pa. (115-28)

PAIN-FREE HIP INJECTION

To administer a nearly painless injection in the hip of an ambulatory patient, have him stand with his hands on the exam table and all of his weight on the leg opposite the injection site. This forces the patient to relax the muscle in the hip for the injection and gives him something to concentrate…

Revisiting non-group A strep

Cedric W. Spak, MD, MPH, says non-group A streptococcal pharyngitis should always be treated “to be on the safe side” (Item 114-25). But group A strep is treated primarily to avoid rheumatic fever, which the other groups don’t cause, and treatment of non-group A strep apparently doesn’t prevent glomerulonephritis, so why should we treat?—Russel W.…

HOW DOES HDL REDUCE PLAQUE FORMATION?

By what mechanism does HDL reduce plaque formation? Is the pharmaceutical industry working on medications that will raise HDL?—Chagai Dubrawsky, MD, Houston The anti-atherogenic effect of HDL may involve reversal of LDL transport, inhibition of lipoprotein oxidation, and anti-inflammatory endothelial activity, all of which can turn lipid-rich plaques into more stable fibrotic lesions as demonstrated…

HIGH FERRITIN, PHOSPHATASE, AND CALCIUM

A 47-year-old black man has had elevated ferritin levels ranging from 500-800 ng/mL for the past two years. Physical examination shows nothing out of the ordinary. His rheumatoid profile is negative. C-reactive protein levels and erythrocyte sedimentation rate are normal. Iron saturation is 30%. Liver enzymes are within normal limits. His alkaline phosphatase is 50%…

WORKING UP AN OLD POSITIVE PPD

A 40-year-old woman tested positive for purified protein derivative (PPD) six years ago. A chest x-ray at the time was negative. After completing the required course of isoniazid (INH), she has had negative chest x-rays for the past five years. Now, as she is preparing to enroll in college, her chest x-ray shows hilar adenopathy.…

POSTPARATHYROIDECTOMY CALCIUM

What is the best way to manage calcium supplementation (dosage, duration, etc.) in a 15-year-old female who underwent parathyroidectomy for parathyroid adenoma?—Arun Kannan, MD, Cochin, Kerala, India According to Davies et al, up to “70%” of patients may have transient hypoparathyroidism immediately post parathyroidectomy (Clin Endocrinol. 2002;57:145-155). Calcium generally reaches its lowest level at 24-36…

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