Archive | February, 2012

Colace and cerumen impaction

29 Feb
BOTTOM LINE (at the top):
–two randomized controlled trials below both comparing Cerumenex and Colace show that Colace is superior to Cerumenex.  And its cheaper!

PMID: 10969225
–Prospective, randomized, controlled, double-blind trial comparing Cerumenex and Colace. 
–50 Patients enrolled, 23 with cerumenex and 27 with colace.

–Groups were similar in age, sex, and proportion of completely obscured tympanic membranes at presentation (78%).
ability to completely visualize the tympanic membrane was significantly greater after treatment with docusate sodium versus triethanolamine polypeptide (81% versus 35%; 95% confidence interval [CI], 22 to 71) particularly in children aged 5 or less (90% versus 0%; 95% CI 50 to 100).

PMID: 11132053
–Immediately after ceruminolytic instillation there was no difference between the 2 treatments.
–However, after 2 irrigations with normal saline, complete clearing was achieved in 82% of the docusate-treated patients and 35% of the triethanolamine-treated patients (95% confidence interval [CI], 22%-71%).
–In other words, every other patient treated with docusate instead of triethanolamine would have benefited (number needed to treat=2.13).
–Although this difference was markedly greater in children younger than 5 years (95% CI, 51%-100%), there were only 4 very young children who received triethanolamine.
–No adverse events were reported.
BOTTOM LINE(again):
colace (docusate sodium) works; helps remove earwax
–it works better than ceruminex (triethanolamine polypeptide)

–no adverse events reported

Submitted by J. Gullo.

Reference(s): article 1, article 2, picture

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Fleshing out the history of monoarthritis

28 Feb

Submitted by K. Sullivan.

Reference(s): aafp article

nerve block for occipital neuralgia

27 Feb

Submitted by K. Sullivan.

Reference(s): on the slide

the blown pupil

24 Feb

Submitted by E. Hawkins.

infection in the asplenic patient

23 Feb

Submitted by E. Hawkins.

Oral Naloxone for opioid associated constipation

22 Feb
NALOXONE:
–Oral administration of naloxone block enteric mu receptor
–but due to high first pass metabolism has low systemic effect. (2% systemic bioavailability taken orally)

SMALL STUDY DATA (N=22) 
By day 6 of using naloxone compared to the control period, the mean number of days with laxation increased from 2.1 to 3.5 (P<0.01)
–the number of days with other laxative medication decreased from 6 to 3.8 (P<0.01).
–the mean naloxone dose in the naloxone period was 17.5 mg/day.
–some side effects: (yawning, sweating, shivering and abdominal cramps) lasting 30 min to 6 hrs.
–Recommend starting at 2 mg and titrating upward.
Submitted by K. Sullivan.

Reference(s): Pain. 2000 Jan;84(1):105-9. http://www.ncbi.nlm.nih.gov/pubmed/10601678, picture

vertigo and the head thrust test

21 Feb

QUICK RECAP:
–quick head movement toward defunct canal…
–patient loses the target, needs a “catch up” saccade to re-fixate

Submitted by. K. Sullivan.

Reference(s): bmj article