Print Issue: October 09, 2007

SUPERFICIAL VENOUS THROMBOSIS THERAPY

What are the treatment options for superficial thrombosis of the femoral vein?—Jay Kerr, MD, Hanford, Calif. Superficial vein thrombosis is relatively benign, except for possible extension into deep veins, the frequency of which is not known and must be rare. There may be topical discomfort requiring localized relief. In general, anticoagulant therapy for superficial vein…

CAN HDL BE TOO HIGH?

Is a significantly elevated HDL (90-100 mg/dL) cause for concern?—Kelly VanWagner, MD, Henderson, Nev. In general, high levels of HDL are associated with decreased cardiovascular risk. However, the different constituents of HDL have qualitative effects on its function and metabolism, and the composition of HDL particle size relates to its antiatherosclerotic properties. The same HDL…

CONTRACEPTION FOR A SEIZURE PATIENT

A 32-year-old woman (gravida 0) who is hypothyroid and takes phenytoin (Dilantin) for a seizure disorder wants contraception. A second method is recommended when an oral contraceptive (OC) is used. My patient doesn’t want to use condoms. I think an intrauterine device may be the best choice, but I’m not familiar with the sponge. What…

A HEALTHIER FRUIT?

I was recently given a publication extolling the value of the tropical fruit mangosteen. Does it have health benefits other fruits do not?—S.J. Smith, MD, Wells, Nev. Mangosteen is a fruit (not to be confused with mango) that is grown in the Asian tropics and is high in antioxidants, specifically xanthones. Mangosteen is also one…

COLD HAND AT THE COMPUTER

A patient who does a great deal of computer work complains of extreme coldness in the fingers of her right (mouse) hand. Could this be a positional or vascular problem?—Diana Koon, MS, FNP-C, Plano, Tex. Is the coldness strictly sensory, or is it palpable? Is the rest of her neurovascular exam normal (i.e., grip, sensation,…

PREDNISOLONE AS EFFECTIVE AS NSAIDs FOR ACUTE GOUT

Level 1: Likely reliable evidence Nonsteroidal anti-inflammatory drugs (NSAIDs) are frequently used for the treatment of acute gout. The efficacy of NSAIDs compared with prednisolone was evaluated in a randomized trial of 90 patients older than 17 years with a clinical diagnosis of goutlike arthritis (Ann Emerg Med. 2007;49:670-677). Patients were randomized within three days…

RIZATRIPTAN EFFECTIVE FOR RELIEF OF MENSTRUAL MIGRAINE

Level 1: Likely reliable evidence Two similar randomized trials show that rizatriptan (Maxalt) relieves menstrual migraine (Cephalalgia. 2007;27:414-421). Both trials evaluated women 18 years and older with menstrual migraine (based on International Classification of Headache Disorders-II 2004 definition) for at least six months who were randomized to rizatriptan 10 mg vs. placebo to treat a…

BETA BLOCKERS NOT INDICATED AS FIRST-LINE THERAPY FOR HYPERTENSION

Level 2: Mid-level evidence Beta blockers as monotherapy or first-line therapy were evaluated in a Cochrane review of 13 randomized trials with a total of 91,561 adults (Cochrane Database Syst Rev. 2007;[1]:CD002003) and were generally found no better or inferior to other antihypertensive medications. Compared with placebo or no treatment, beta blockers were associated with…

COMPUTER-AIDED MAMMOGRAMS SEEM TO OFFER LITTLE ADVANTAGE

Level 2: Mid-level evidence The use of computer-aided detection in screening mammograms was evaluated in a study of 222,135 women who had 429,345 screening mammograms at 43 separate facilities (N Engl J Med. 2007;356:1399-1409). The reference standard for breast cancer diagnosis was based on clinical diagnosis made within one year subsequent to screening mammography. During…

PROLONGED-EXPOSURE THERAPY REDUCES PTSD SYMPTOMS IN FEMALE VETERANS

Level 1: Likely reliable evidence Female veterans with post-traumatic stress disorder (PTSD) and clear memory of the trauma that caused it at least three months before (N=284) were randomized to prolonged exposure (a type of cognitive-behavioral therapy) vs. present-centered therapy (a type of supportive therapy) for 10 weeks (JAMA. 2007;297:820-830). Both groups had therapy delivered…

Next post in Evidence-Based Medicine