Print Issue: November 03, 2006

Alternative to estrogen for hot flushes

Gabapentin (Neurontin) and estrogen have been found equally effective in reducing the frequency and severity of menopausal hot flushes. Gynecologists at the University of Rochester in New York randomized 60 postmenopausal women to daily regimens of conjugated estrogens 0.625 mg, gabapentin 2,400 mg, or placebo. The women recorded the frequency and severity of their hot…

Cell-phone use linked to male infertility

Heavy use of a cell phone may damage semen quality, according to a large Cleveland Clinic study presented at the American Society of Reproductive Medicine meeting in New Orleans. During the year ending October 2005, doctors tested 361 infertile men, median age 32 years. Participants were divided into four groups according to cell-phone usage, ranging…

Horse chestnut seed extract

An herb with the unlikely name of horse chestnut may prove to hold some of the keys to managing chronic venous insufficiency (CVI). Approximately 10%-15% of men and 20%-25% of women are afflicted by this condition, which causes leg heaviness, aching, varicose veins, significant edema, and, in more severe cases, chronic ulcerations, skin changes, and…

Empathy can’t prevent litigation

Personal experience led to the effective treatment of a fellow sufferer, but the clinician was sued anyway. Mr. B is a family clinician who truly empathized with those who have troublesome hemorrhoids —his own hemorrhoids had made him a minor expert on the subject. Nevertheless, a fellow sufferer sued him for misdiagnosis, claiming that his…

Lawsuit over nipple position

Unexpected scarring that altered the appearance of a cancer patient’s prosthesis led to bitter dissatisfaction. Dr. P, age 52, is an experienced plastic surgeon specializing in breast reconstruction after mastectomy. This procedure provides aesthetic and psychological benefits to breast cancer patients. Early in Dr. P’s career, augmentations and reductions made up the bulk of his…

Clinic misses abdominal infection

The ED’s diagnosis didn’t sit right with the clinician, but her supervising physician did not act quickly enough. Ms. F is a physician assistant in a family practice clinic. One of her patients was a 30-year-old man who worked as a laborer and liked to relax with a few drinks after work. While generally healthy,…

We can slow the meth epidemic

After examining 15-year-old Janie, I sat down to chat. “We’re going to discuss some things I talk about with everyone,” I said. Then I asked Janie what she thought of a methamphetamine arrest that had just taken place at her high school. Janie just laughed, but when I asked whether anyone had ever offered her…

PROTEIN RESTRICTION REDUCES RISK OF END-STAGE RENAL DISEASE

Level 1: Likely reliable evidence In adults with moderate-to-severe chronic renal failure, reduced protein intake decreases the risk of end-stage renal disease, based on a systematic review of eight randomized trials with 1,524 patients who were followed for at least one year (Cochrane Database Syst Rev. 2006;[2]:CD001892). The trials compared different levels of protein intake…

CHARACTERISTICS OF CHEST-PAIN HISTORY ASSOCIATED WITH LIKELIHOOD OF CORONARY EVENT

Level 2: Mid-level evidence Specific elements of chest-pain history are associated with a patient’s likelihood of acute MI or acute coronary syndrome, based on a systematic review of observational studies (JAMA. 2005;294:2623-2629). Chest-pain factors found to increase the likelihood of acute MI include radiation to the right arm or shoulder (positive likelihood ratio [LR] 4.7),…

Next post in Evidence-Based Medicine