Print Issue: May 29, 2008

FOLLOW-UP FOR HYSTERECTOMIES?

For how long should women who had hysterectomies in the 1960s and 1970s for cervical cancer and dysplasia continue to have yearly Pap smears?—Anne Brockman, MD, Conifer, Colo. A woman who has had a hysterectomy for cervical dysplasia or cancer should have annual Pap smears of the vaginal fornices for 10 years. If all these…

ACUTE MI SEQUELAE

In what sequence do fever, leukocytosis, ECG changes, and cardiac markers, such as creatine kinase MB, appear in a patient who has suffered an acute MI? What is the range of fever that can reasonably be linked to MI? What is the expected level of post-MI leukocytosis?—Antonio B. Martins, MD, Berlin, Md. ECG changes are…

INSULIN-SULFONYLUREA COMBO FOR BETTER GLYCEMIC CONTROL

For better glycemic control in diabetic patients, some studies recommend using the combination of NPH or insulin lispro with sulfonylurea. What is the rationale behind such combinations, given that the sulfonylureas are insulin secretagogues? Why not increase the insulin dosage or add metformin, rosiglitazone (Avandia), or pioglitazone (Actos) instead?—Fadi I. Jabr, MD, Florence, Ore. Data…

WHY IS THIS PATIENT’S CK ELEVATED?

During an evaluation for myasthenia gravis, a 67-year-old white man on statin therapy was found to have a creatine kinase (CK) of 600 mg/dL (normal <200). Although the statin was discontinued, the CK remains at about 600; an aldolase determination is also slightly elevated. Except for drooping eyelids, the patient is asymptomatic; he has no…

Erectile dysfunction workup

An otherwise healthy, nonsmoking 53-year-old man complains of erectile dysfunction (ED). His testosterone level is low (237 ng/dL), and his prolactin is slightly elevated (36.7 ng/dL). Complete metabolic panel as well as prostate-specific antigen, follicle-stimulating hormone, thyroid-stimulating hormone, and luteinizing hormone levels are normal. He is self-pay and I don’t want to commit to unnecessary…

RETESTING FOR H. PYLORI

How often do patients who have been treated for Helicobacter pylori infections have to be retested? I know the antibodies can persist, and I hate for patients to have repeat endoscopy for this purpose. Is it possible just to retest at specified intervals?—Neal M. Davis, DO, Carbondale, Pa. Serology for H. pylori can remain positive…

CALCIUM CHANNEL BLOCKERS FOR RENAL INSUFFICIENCY

What is the best approach for a patient with worsening renal insufficiency and intolerance of ACE inhibitors or angiotensin receptor blockers (ARBs)?—Ann Marchetta, MS, ARNP-C, FNP, Waupaca, Wis. Calcium channel blockers (CCBs) are considered next in line for these patients. CCBs (specifically the nondihydropyridines) also have some angiotensin II-blocking activity. The degree of proteinuria determines…

PLASTIC ADHESIVE DRAPES DURING SURGERY MAY NOT PREVENT INFECTION

Level 2: Mid-level evidence A systematic Cochrane review of seven randomized trials evaluated the use of plastic adhesive drapes (through which an incision is made) in 4,195 patients who were undergoing any type of surgery (Cochrane Database Syst Rev. 2007[4]:CD006353). Surgical-site infection occurred in 13.8% of the adhesive-drape patients compared with 11.2% of patients on…

MULTIPLE MICRONUTRIENTS MAY REDUCE INFANT MORTALITY

Level 1: Likely reliable evidence Maternal multiple micronutrient (MMN) supplementation reduces infant mortality compared with iron and folic-acid supplement alone in undernourished and/or anemic women, based on a cluster-randomized trial of 262 midwives in Indonesia (Lancet. 2008;371:215-227). Participating midwives were randomized to distribute an MMN supplement vs. an iron and folic-acid supplement as part of…

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