Question of the week

A 77 year old woman is admitted to the hospital because of weakness. She has a history of iron deficiency anemia diagnosed and treated 8 months prior. At that time she was referred to a local colon and rectal surgeon. The upper gastrointestinal endoscopy revealed gastritis, negative for H pylori. The colonoscopy revealed mild diverticular disease. The study could not be carried out to the ceacum because the sigmoid colon was very tortuous. A barium enema performed immediately after the limited colonoscopy was found to be negative for masses, colitis or obstruction. She was transfuse at that time to a hemoglobin of 11 gm./dl. At this time she is admitted with a hemoglobin at 6.7 gm/dl. She has heme negative stools. A CT of the abdomen and pelvis is negative for mass or inflammatory change. The patient is being transfused again.

What plans would you now undertake?

A 79 old gentleman with diabetes mellitus type 2 inquires about the contents of the pharmacy educational handout on Actos (pioglytazone). He had a glycohemoglin at 8.5% on a sulfonylurea and his primary care physician placed on pioglytazone 30 mg daily. He has a history of hypertension, obstructive sleep apnea and cancer of the colon treated surgically 2 year prior.

The patient inquires: "Doctor, I am concerned that this new drug I am taking may cause cancer of the bladder".


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