Imipramine has been used for years in the treatment of enuresis. Are there any studies of treatment based on increasing antidiuretic hormone (ADH) or on higher levels of sleep with normalization of the diurnal ADH cycle?—Roderic A. Smith, MD, Garland, Tex. Normally, about 50% less urine is excreted during the night than the daytime. This…
Is the increasing incidence of community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) infections related to the rise in body modifications, such as piercing and tattooing? Besides wearing masks, gloves, etc., what can I do to protect myself and my staff? What can I say to patients who are concerned about transmission after sitting between infected patients in…
What is the best treatment for persistent cough in a patient with Wegener’s granulomatosis (WG) who has a normal chest x-ray?—James A. Skrabak, DO, Greenwood, Ind. A patient known to have active WG should be referred to a subspecialist for appropriate treatment, most commonly with cyclophosphamide and corticosteroids. If the patient’s WG status is unknown,…
What is the current thinking about treatment of chronic idiopathic urticaria?—Lester N. Ploss, MD, Freeport, N.Y. Chronic idiopathic urticaria (CIU) is defined as the daily or almost daily occurrence of wheals and itching for at least six weeks, with no obvious cause. The major advance in our understanding of CIU in recent years has been…
Besides total cholesterol and LDL, should we not also consider non-HDL cholesterol a predictor of future coronary heart disease (CHD), especially with regard to our female patients?—James L. Steward, MD, Hyattsville, Md. Non-HDL cholesterol is defined as total serum cholesterol minus HDL and has the same predictive value as LDL. Non-HDL cholesterol is useful when…
Is there any evidence that supports the work of chiropractors, i.e., alignment of the spinal column, for muscle spasm, chronic back pain, or other condition? Although I don’t recommend it, many of my patients say a “bear hug” from a friend is a less expensive way to get the same relief.—Ferdinand M. Rivera, MD, Salinas,…
How many serial stool guaiac tests would a patient have to have to obtain results equivalent to screening colonoscopy for colorectal cancer?
Should a 30-year-old woman who had carcinoma in situ (CIS) and a transvaginal hysterectomy (TVH) receive the human papillomavirus vaccine (HPV) (Gardasil)?—Teresa Tullos, ARNP-C, Tallahassee, Fla. Gardasil is currently approved for use in women aged 9-26 years. Neither safety nor efficacy has been studied in older women or in women who no longer have a…
Level 1: Likely reliable evidence Intrapartum fetal pulse oximetry to assess the fetus during labor is “noninvasive” to the fetus but requires ruptured membranes for sensor placement. A randomized trial evaluated what, if any, effect knowing the fetal pulse oximetry readouts had on rates of cesarean delivery and other clinical outcomes (N Engl J Med.…
Level 2: Mid-level evidence The Towards a Revolution in COPD Health (TORCH) trial evaluated the effect of treatments for chronic obstructive pulmonary disease (COPD) on morbidity and mortality outcomes. The study randomized 6,184 patients with COPD aged 40-80 years to placebo vs. salmeterol (Serevent) 500 µg vs. fluticasone (Flovent Diskus) 50 µg vs. salmeterol/fluticasone combination…
