September 01, 2009 Archives - Clinical Advisor

Print Issue: September 01, 2009

Excess iron is stored in the liver, heart, and pancreas (cross-section shown here)

Unconfirmed history of TB

A 70-year-old African American woman comes as a new patient to request clearance for her job as a day-care worker. She reports that she underwent partial lung resection and thoracoplasty to treat pulmonary TB in 1953, but she never received anti-TB therapy. We have no medical records. The patient declines purified protein derivative (PPD) testing,…

When to test for hereditary hemochromatosis

At what age should a child be tested for hemochromatosis if the disorder has been diagnosed in the paternal grandfather? —ARLYN WASCO, MSN, CRNP, Lawrence, Pa. I assume your question refers to primary hemochromatosis (a form of hereditary hemochromatosis [HH]), which is an autosomal recessive disorder. HH is one of the most common genetic disorders,…

Herbal options for hot flushes

What advice should I give women seeking information on herbal remedies for menopausal hot flushes? Is there any evidence that rhubarb extract ERr 731 is more effective than black cohosh at controlling hot flushes? What are the contraindications for the use of such treatment?—ROSEMARY TROTTA, FNP, Wadsworth, Ill. Clinical trials using standardized scales for measuring…

Alzheimer's disease has caused atrophy (brown areas) in both halves of this patient's brain

Alzheimer’s demands multiple diagnostics

Cognitive tests can identify mental decline, but they do not do a very good job of differentiating Alzheimer’s disease (AD) from vascular dementia, the American Psychological Association suggests.

A large infarct (red) is visible on MRI of the brain of a stroke patient

Time window for rt-PA following stroke expanded for some patients

Level 1: Likely reliable evidence and Level 2: Mid-level evidence In 2007, guidelines published by the American Heart Association/American Stroke Association (AHA/ASA) recommended recombinant tissue plasminogen activator (rt-PA, Alteplase) within three hours of symptom onset for selected adults with ischemic stroke (Stroke. 2007;38:1655-1711; available at stroke.ahajournals.org/cgi /reprint/38/5/1655. accessed August 12, 2009). The AHA/ASA has now…

Preventing helminthic zoonoses

As a veterinarian in general practice, I frequently counsel pet owners on preventing GI parasitism in their pets, especially since some of these parasites can also infect people. But do family clinicians and pediatricians make a point to discuss zoonoses with their patients?—Tracy Revoir, DVM, Lenexa, Kan. Although no strict guidelines exist, it is recommended…

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