November 06, 2007 Archives - Page 2 of 6 - Clinical Advisor

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WHY TERM LIMITS FOR TORADOL?

What is the rationale for limiting toradol to short-term use? I have seen much more harm from other nonsteroidal anti-inflammatory drugs (NSAIDs).—Frank Seck, DO, Gladwin, Mich. NSAIDs can be classified by anti-inflammatory potency and GI toxicity. Toradol has very potent anti-inflammatory properties and carries a higher risk of complications (GI bleeding and renal failure) than…

WHICH AGENT FOR PSVT?

The vasopressor phenylephrine (Neo-Synephrine) is indicated for paroxysmal supraventricular tachycardia (PSVT). Have there been any studies comparing phenylephrine with adenosine?—Manuel A. Fonseca, DO, Florence, S.C. Phenylephrine can be an effective treatment for PSVT. There are several case reports of its use for PSVT in patients with Wolff-Parkinson-White syndrome, including cases in which the tachycardia was…

KETAMINE FOR LP IN CHILDREN?

Are there any studies on or protocols for the use of ketamine for sedation in children, specifically for lumbar puncture (LP)?—Craig Holland, DO, Hemlock, Mich. Ketamine is used in children to provide sedation for brief procedures, including laceration repair, LP, or fracture reduction. Administration is either via the IV route at a dose of 1.0-1.5…

Fatty liver disease: To treat or not

Should nonalcoholic fatty liver disease (NAFLD) be treated? If so, what is the best treatment? What alternative functional medical treatments are effective?—C.D. Ford Jr, MD, Sugar Land, Tex. NAFLD has become the wastebasket term for chronic liver disease associated with the cluster of metabolic risk factors (obesity, diabetes, hyperlipidemia, etc.) that are quickly reaching epidemic…

Treating resistant dermatits

What is the best way to treat a morbidly obese man with bilateral stasis dermatitis and ulcers that are resistant to local antibiotics?—Elizabeth Oommen, MD, Hicksville, N.Y. Leg elevation and use of emollients are important first steps. If there is pruritus and erythema of the skin, a topical corticosteroid may be indicated. For the ulcers,…

CAN VIRUSES UNLEASH CYTOKINE STORM?

To what extent do severe viral infections, e.g., influenza, result in a catabolic state such that cytokines like tumor necrosis factor, interleukin (IL)-2, and IL-6 cause bone marrow suppression, elevated liver aminotransferases, and rapid weight loss?—Joseph Chersky, MD, Beverly Hills, Calif. Influenza, like most viruses, is capable of stimulating the production of cytokines. These mediators…

THE ETHICS OF HEALTH-CARE MARKETING

I am concerned about the marketing strategies some retail-based health clinics use. Clinicians are encouraged to stroll through the aisles wearing lab coats and asking shoppers about their health-care needs. It is suggested that we approach customers in the OTC aisle and offer to explain different products and schedule appointments for them in the clinic.…

ETIOLOGY OF HALITOSIS

What causes halitosis? Is there any association between Helicobacter pylori and chronic bad breath? Will eradication of H. pylori eliminate chronic halitosis?—Felix N. Chien, DO, Newport Beach, Calif. The exact incidence of halitosis is not known, but a preliminary report of a study that measured oral malodor in 88 adults before breakfast and morning toothbrushing,…

Anticoagulation after hip fracture

A 97-year-old white female with a history of CAD and dementia was hospitalized 10 months ago for a hip fracture. She was discharged back to the nursing home where she resides on dalteparin (Fragmin), which was discontinued after a few weeks. For at least the past six months, she has been ambulating with assistance to…

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