Clinical Advisor back issues from February 2007:
Another herbal delusion.(IN THIS ISSUE)(black cohosh)(Editorial)
Feb 01, 2007; ... <Pre> "As one of the leading herbs for women's health, black cohosh is famous for its ability to promote menopausal health. Studies document its ability to help support the physical changes that occur in a woman's body over time." "Black cohosh has been successfully researched and used ...
Drug slows progression of diabetes.(Newsline)
Feb 01, 2007 ... IN A RARE head-to-head study, rosiglitazone (Avandia) proved better than either metformin (Glucophage) or glyburide (Micronase) in controlling glucose levels in patients with newly diagnosed type 2 diabetes. [ILLUSTRATION OMITTED] In an international trial, ...
Can osteoporosis therapy end after 5 years?(Newsline)(Brief article)
Feb 01, 2007 ... HOW LONG should patients take a bisphosphonate? For most women, the answer seems to be five years. In a 10-center trial, investigators followed 1,100 older women with osteoporosis who had already taken alendronate (Fosamax) for five years. The patients, aged 55-81, were ...
Dieting without exercise causes bone loss.(Newsline)(Brief article)
Feb 01, 2007 ... IF YOUR patients are trying to lose weight, recommend both diet and exercise, not just diet, say researchers. In a study by a team of nutritionists, physicians, and others at the University of Washington School of Medicine in Seattle, 30 postmenopausal women and 18 men, all ...
Kidney patients at risk for heart disease.(Newsline)(Brief article)
Feb 01, 2007 ... PATIENTS with chronic kidney disease (CKD) are at a sharply heightened risk of cardiovascular disease (CVD), according to a team of researchers from NIH and several Boston-area institutions. The team examined 3,258 grown children and spouses of children of the original ...
Male infertility linked to diet.(Newsline)(Brief article)
Feb 01, 2007 ... A LOW intake of dietary antioxidants correlates with poor sperm motility, research shows. The finding led the investigators to conclude that eating more fruits and vegetables might improve male fertility. "I was somewhat surprised by the strength of the correlation," said lead ...
Moderate drinking extends life.(Newsline)(Brief article)
Feb 01, 2007 ... Repeated studies have shown that moderate alcohol consumption reduces the risk of cardiovascular disease. Now a new look at the accumulated evidence shows that it does even more, cutting the risk of death from all causes in both men and women. Epidemiologists in Italy pooled ...
Black cohosh flunks menopause-relief test.(Newsline)(Brief article)
Feb 01, 2007 ... BLACK cohosh, soy, and other naturopathic products failed to relieve menopausal symptoms in a large, yearlong, double-blind trial. A research team from several medical centers in the Seattle area recruited 351 volunteer peri- or postmenopausal women (aged 45-55) and randomly ...
Two incontinence drugs are better than one.(Newsline)(Brief article)
Feb 01, 2007 ... INCONTINENT men will do better on both tolterodine (Detrol) and tamsulosin (Flomax) than on either drug alone, urologists report. In the first study of its kind, urologists enrolled 754 men aged 40 years or older who had benign prostatic hyperplasia (BPH) and overactive bladder ....
Folic acid may not cut CV risk.(Newsline)(Brief article)
Feb 01, 2007 ... FOLIC acid, widely touted as a heart-healthy supplement, neither increases nor decreases the risk of cardiovascular events or all-cause mortality in patients with a history of cardiovascular disease (CVD) or end-stage renal disease (ESRD), according to just-published data. ...
Massage relieves arthritic knee.(Newsline)(Brief article)
Feb 01, 2007 ... MASSAGE reduces pain and improves function in patients with symptomatic osteoarthritis (OA) of the knee, according to a new trial. Although massage is known to relieve various painful musculoskeletal conditions, this is the first prospective, randomized trial assessing the therapy for knee ...
COPD Rx: antidepressants.(Newsline)(chronic obstructive pumonary disease)(Brief article)
Feb 01, 2007 ... When asthma patients are depressed, the effectiveness of their medical care greatly diminishes. The same holds true for chronic obstructive pumonary disease (COPD) patients, a new study shows. Investigators in Singapore enrolled 367 consecutive patients with COPD who were ...
Two diabetes meds in one daily tablet.(New drug information from the publishers of MPR)(Drug overview)
Feb 01, 2007 ... Product: Duetact Company: Takeda Pharmacologic class: Antidiabetic (thiazolidinedione + sulfonylurea) Active ingredients: Pioglitazone (as HCl) 30 mg, glimepiride 2 mg; tabs. Also: Duetact 30 mg/4 mg Active ingredients: Pioglitazone ...
Antifungal skin gel relieves scaly rash.(New drug information from the publishers of MPR)
Feb 01, 2007 ... Product: Xolegel Company: Barrier Therapeutics Pharmacologic class: Topical antifungal (azole) Active ingredient: Ketoconazole 2%; topical gel (anhydrous). Indication: Topical treatment of seborrheic dermatitis in immunocompetent patients. ...
Zelapar reduces "off time" in Parkinson's.(New drug information from the publishers of MPR)(Drug overview)
Feb 01, 2007 ... Product: Zelapar Company: Valeant Pharmacologic class: Antiparkinson agent (MAOB inhibitor) Active ingredient: Selegiline 1.25 mg; orally-disintegrating tabs; contains phenylalanine. Indication: Adjunct in Parkinson's disease in patients with ...
Liquid agent for Candida, Aspergillus.(New drug information from the publishers of MPR)(Drug overview)
Feb 01, 2007 ... Product: Noxafil Company: Schering Pharmacologic class: Antifungal (triazole) Active ingredient: Posaconazole 40 mg/mL; oral suspension; cherry flavor. Indication: Prophylaxis against invasive Aspergillus and Candida infections, in patients at ...
When beautification of the body turns ugly: faced with a mostly unregulated industry of tattooists and piercers, clinicians need to be on the lookout for infections and other complications.(FEATURE)
Feb 01, 2007; ... Though their popularity has skyrocketed over the past two decades, tattoos, piercings, and other forms of body modification date back thousands of years. A recent study found that 20% of college students had one or more tattoos and/or piercings of body parts other than the earlobes. (1) ...
Don't give up on an addicted patient: you may be tempted to ignore the addiction or quickly pass the patient on to someone else. But if you follow this advice, you can provide real help.(FEATURE)
Feb 01, 2007; ... Most interactions with patients "flow" purposefully forward like rivers, from initial recognition and diagnosis of the problem to treatment and, hopefully, resolution. However, it is rare that interactions with patients addicted to drugs flow so smoothly. In fact, most visits with these ...
How to control BP in older patients: the elderly are different when it comes to managing blood pressure. A physician spells out the differences and tells how to handle them.(FEATURE)
Feb 01, 2007; ... Hypertension is almost inevitable as we age. The famous Framingham Heart Study suggests that those who are normotensive at age 55 face a 90% lifetime risk for developing high BP. (1) This is no small matter. Uncontrolled hypertension is linked to atrial fibrillation, MI, heart failure, and ...
More than a drug is required for insomnia: persistent sleeplessness stems from a variety of factors, all of which should be addressed if a treatment plan is to succeed long-term.(FEATURE)(Disease/Disorder overview)
Feb 01, 2007; ... While many patients (10%-40% of the population) complain about insomnia, few actually seek help. In a recent survey, almost 30% of respondents complained about symptoms of insomnia, yet only 13% discussed them with their clinicians. (1) [ILLUSTRATION OMITTED] ...
Choosing the best test for colon cancer: there are five to select from, and each has its advantages and drawbacks. Two physician specialists help you sort through the options.(FEATURE)
Feb 01, 2007; ... Nothing elicits a groan from patients as quickly as discussion of uncomfortable screening procedures. Yet those discussions must take place. Colorectal cancer is the third-most common cancer in the United States, with an estimated 150,000 new cases every year. It is also the second leading ...
Dyspepsia guidelines emphasize H. pylori: the updated recommendations state that recent research supports testing for and treatment of H. pylori rather than empiric acid suppression.(FEATURE)(Disease/Disorder overview)
Feb 01, 2007; ... In its revised Guidelines for the Management of Dyspepsia, the American College of Gastroenterology (ACG) defines this frequently encountered entity in broad terms: chronic upper abdominal pain or discomfort (i.e., a subjective negative feeling, which may include fullness or early ...
Is it low testosterone or something else? Men with inadequate testosterone and clinical symptoms of deficiency may have hypogonadism. Here are the signs that should prompt lab study.(FEATURE)(Disease/Disorder overview)
Feb 01, 2007; ... The diagnosis of hypogonadism demands both symptoms of testosterone deficiency and decreased blood testosterone levels. Low testosterone is traditionally associated with diminished libido, fatigue, changes in body composition, impaired cognition, depressed/irritable mood, and ...
Advisor forum.
Feb 01, 2007 ... These are letters from practitioners around the country who want to share their clinical problems and successes, observations, and pearls with their colleagues. Responding consultants are identified below. We invite you to participate. Consultations AN AGE LIMIT FOR ...
Case #1 Thick ridges and valleys found on a newly shaved scalp.(Test your clinical acumen with our monthly quiz)(Clinical report)
Feb 01, 2007; ... Distraught after breaking up with his girlfriend, a 58-year-old African-American man decided to have his head shaved. When the shaving was completed, the patient was alarmed to find that his scalp had many "ridges and valleys" and presented to the dermatology clinic for further evaluation ....
Case #2 Crusted erosions on a toddler's face and extremities.(Test your clinical acumen with our monthly quiz)(Clinical report)
Feb 01, 2007; ... A 2-year-old Hispanic boy experienced a recent severe flare of a rash. When he was just a few months old, itchy patches had appeared on his face, arms, and legs. These lesions had been well controlled with petrolatum (Aquaphor) and hydrocortisone. Over the past three days, however, he had ...
Case #3 Blisters on the hands of a man with darkened urine.(Test your clinical acumen with our monthly quiz)(Clinical report)
Feb 01, 2007; ... This 45-year-old man with a history of hepatitis C and cirrhosis presented with tense blisters that had been present on the backs of his hands for the past year. Blistering was worse in summer and after sun exposure. Increased hair growth on his face as well as diffuse facial ...
Case #4 Spreading scaly patches on the trunk and limbs.(Test your clinical acumen with our monthly quiz)(Clinical report)
Feb 01, 2007; ... A 58-year-old man complained of an asymptomatic scaly, erythematous rash that had been present for five years. The presumptive diagnosis was eczema or psoriasis. Prior biopsies had been nondiagnostic and topical corticosteroids had been only sporadically beneficial. Early lesions had ...
Nocturnal leg cramps.(A quick review of common conditions, using the best global evidence)(Disease/Disorder overview)
Feb 01, 2007; ... Description * Involuntary nighttime painful leg muscle contraction that does not relax * Also called muscle cramps, nocturnal muscle cramps, age-related cramps ICD-9 codes * 728.85 spasm of muscle * 729.82 cramp of limb ...
Case #1 Headache patient ends up disabled: a case of migraine that ended in brain surgery provides a lesson in how to handle a return patient.(LEGAL ADVISOR)(Clinical report)
Feb 01, 2007; ... As a recent graduate of a prestigious physician assistant master's degree program, Ms. D's first job was with a busy urgent-care facility in which she rapidly accumulated clinical skills in a variety of areas. One of her patients was a 40-year-old woman from Honduras who worked as a ...
Case #2 When a loss at trial isn't a loss: the jury ruled malpractice, but then it provided a surprise to the plaintiff and clinician-defendant.(LEGAL ADVISOR)(cases of medical negligence)
Feb 01, 2007; ... Over the course of his 25 years as a primary-care physician, Dr. G has noted an increase in the recognition of gastroesophageal reflux disease (GERD) as a cause of chest pain. He wondered how many cases of GERD had been treated as CAD before accurate diagnostic testing could differentiate ...
Case #3 Malpractice claim after office injury: a sprained ankle lands an elderly woman in the hospital. Whose version of events will jurors believe?(LEGAL ADVISOR)
Feb 01, 2007; ... Though Ms.J's specialty was pediatrics, her first job out of graduate school was in a family practice clinic with mostly elderly patients. She did not particularly enjoy the work and was especially turned off by the seemingly relentless complaining of some patients. One such ...
Persistent upper respiratory symptoms in a troubled soldier: already under treatment for panic disorder, a man returning from Iraq battles recalcitrant cough.(Clinical Challenge)(Case study)
Feb 01, 2007; ... CASE #1 Mr. Z is a 26-year-old Caucasian soldier serving in the U.S.Army.After completing a tour of duty in Iraq, he remained a member of the inactive ready reserve and was ordered to report for duty in August 2005. During his required physical exam, he informed the clinicians that he was ...
Lower-extremity deformity in a recent immigrant: the patient's legs had been bowed for 35 years, but the pain was a new development.(Clinical Challenge)(cases of bowed legs)
Feb 01, 2007; ... CASE #2 A 77-year-old Asian man presented to the community free clinic complaining of bilateral knee pain. Mr. C, one of 46 million uninsured patients in the United States, had no significant past medical problems, but also no history of prior medical care. His knee pain had developed ...
Early atherosclerosis beginning in a young menstruating woman: only 30 when her symptoms began, our patient has a 25-year history of disease progression.(Clinical Challenge)(Case study)
Feb 01, 2007; ... CASE #3 At 30 years of age, Mrs. A suffered transitory double vision and was found to have a right carotid bruit. Two years later, she underwent carotid endarterectomy. Her father had peripheral vascular disease and also underwent carotid endarterectomy. [ILLUSTRATION OMITTED] ...
An independent widow's puzzling hallucinations: the elderly woman saw people who would not respond to her, but she had no dementia or psychiatric conditions.(Clinical Challenge)(Case study)
Feb 01, 2007; ... CASE #4 Mrs. T was an 87-year-old widow whose sons were worried that she might be suffering from hallucinations. Concerned, too, about their mother's gradually increasing frailty, they had recently moved her to an apartment building for senior citizens. At our first meeting, she and the ...
Skin-fold eruptions.(Dermatologic Look-Alikes)(case report of intertrigo and inverse psoriasis)
Feb 01, 2007; ... CASE #1 The patient was a 70-year-old obese woman with diabetes. Admitted to the hospital for chest pain, she was found to have long-standing erythematous erosions in her abdominal pannus, under her breast, and in her groin. These areas were not macerated or scaly. She ...
Cranberry.(ALTERNATIVE MEDS UPDATE)
Feb 01, 2007; ... The food industry has done a marvelous job of marketing this small, tartly bittersweet fruit. Cranberry juice and juice blends, dried berries, and other forms are available in nearly every grocery store year-round. Another growing area of consumption is the use of cranberry for various ...
Tennis elbow symptoms reduced by physical therapy more than by steroids.(Evidence-Based Medicine)
Feb 01, 2007; ... TENNIS ELBOW SYMPTOMS REDUCED BY PHYSICAL THERAPY MORE THAN BY STEROIDS Level 1: Likely reliable evidence The treatment of lateral epicondylitis (tennis elbow) was evaluated in 198 patients who had the condition for at least six weeks (BMJ. 2006;333: 939; full-text ...
Duct tape may be modestly effective treatment for warts on the hand.(Evidence-Based Medicine)(Brief article)
Feb 01, 2007; ... DUCT TAPE MAY BE MODESTLY EFFECTIVE TREATMENT FOR WARTS ON THE HAND Level 2: Mid-level evidence Duct tape for warts was studied in a randomized, "placebo"-controlled trial (Arch Pediatr Adolesc Med. 2006;160:1121-1125). Children aged 4-12 years with warts (N=103) were ...
Carotid endarterectomy may reduce risk of stroke compared with carotid artery stenting.(Evidence-Based Medicine)
Feb 01, 2007; ... CAROTID ENDARTERECTOMY MAY REDUCE RISK OF STROKE COMPARED WITH CAROTID ARTERY STENTING Level 2: Mid-level evidence Stenting may be an alternative to open endarterectomy for the treatment of carotid artery stenosis. The Endarterectomy versus Angioplasty in Patients ...
Sublingual immunotherapy relieves allergic rhinitis.(Evidence-Based Medicine)
Feb 01, 2007; ... SUBLINGUAL IMMUNOTHERAPY RELIEVES ALLERGIC RHINITIS Level 1: Likely reliable evidence Immunotherapy may be effective in patients with persistent allergic rhinitis symptoms who have failed other treatments. Therapy is generally provided in the form of "allergy shots" ...
Antiseptic treatment of umbilical cord reduces omphalitis.(Evidence-Based Medicine)
Feb 01, 2007; ... ANTISEPTIC TREATMENT OF UMBILICAL CORD REDUCES OMPHALITIS ... Level 1: Likely reliable evidence ... AND MAY REDUCE MORTALITY IN DEVELOPING COUNTRIES Level 2: Mid-level evidence A previous systematic review found no evidence that doing nothing ...
Celecoxib not recommended for secondary prevention of colorectal adenomas.(Brief article)
Feb 01, 2007; ... CELECOXIB NOT RECOMMENDED FOR SECONDARY PREVENTION OF COLORECTAL ADENOMAS Level 1: Likely reliable evidence The Adenoma Prevention with Celecoxib (APC) trial evaluated 2,035 patients with a prior history of colorectal adenoma who were randomized to placebo vs ....
Tegaserod effective for women with constipation-predominant IBS.(Brief article)
Feb 01, 2007; ... TEGASEROD EFFECTIVE FOR WOMEN WITH CONSTIPATION-PREDOMINANT IBS Level 1: Likely reliable evidence A randomized, placebo-controlled trial of 2,660 women found that tegaserod (Zelnorm) was effective for initial treatment and during recurrence of irritable bowel syndrome ...
Wet wound management 12-48 hours after surgery does not appear to increase risk of infections.
Feb 01, 2007; ... WET WOUND MANAGEMENT 12-48 HOURS AFTER SURGERY DOES NOT APPEAR TO INCREASE RISK OF INFECTIONS Level 2: Mid-level evidence In a study of 870 patients who had minor skin excisions and were randomized to wet vs. dry wound management, allowing sutures to get wet 12-48 ...
Inhaled steroids may be beneficial in moderate-to-severe COPD.(Evidence-Based Medicine)(Brief article)
Feb 01, 2007; ... INHALED STEROIDS MAY BE BENEFICIAL IN MODERATE-TO-SEVERE COPD Level 2: Mid-level evidence The efficacy of inhaled corticosteroids for treating moderate-to-severe chronic obstructive pulmonary disease (COPD) was evaluated in a systematic review of 13 randomized ...
Salmeterol reduces COPD exacerbations.(Evidence-Based Medicine)
Feb 01, 2007; ... SALMETEROL REDUCES COPD EXACERBATIONS Level 1: Likely reliable evidence Salmeterol (Serevent) and formoterol (Foradil Aerolizer) are two long-acting beta2-agonists that are FDA-approved for maintenance treatment of chronic obstructive pulmonary disease (COPD), ...
We've got targets on our backs!(COMMENTARY)(medical malpractice)
Feb 01, 2007; ... I'm worried--and you should be, too. Nurse practioners are increasingly likely to be sued for malpractice. It's not because we're practicing bad medicine, of course, but because we've got targets on our backs. Let me explain. Recently, a man in his 20s showed up at a ...