Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Sep 2004
Review[Diagnostic and pharmaco-therapeutic options in acute severe blood loss].
In patients with excessive blood loss, coagulation is compromised by hypothermia, metabolic acidosis due to impaired tissue perfusion, loss of coagulation factors and platelets while their consumption is increased, and by massive infusion with plasma expanders. Currently available laboratory tests are insufficiently reliable and too time-consuming to enable the evaluation of the effect of pharmaco-therapeutic interventions during severe blood loss. Several haemostatic drugs appear to be effective in the treatment of blood loss after elective surgery, but have been insufficiently investigated in patients with severe bleeding. A rational transfusion policy entailing the use of sufficient amounts of plasma is necessary in the treatment of patients with severe bleeding.
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Ned Tijdschr Geneeskd · Sep 2004
Review[From gene to disease; familial hemiplegic migraine as a result of mutations in a sodium-potassium pump gene].
Familial hemiplegic migraine (FHM) is a rare, autosomal dominant subtype of migraine, associated in half of the families with mutations in the CACNA1A gene located on chromosome 19p13, which encodes the Cav2.1-subunit of brain-specific P/Q-type calcium channels. Recently, mutations in a second gene, ATP1A2 on chromosome 1q23, which encodes a sodium-potassium exchange pump subunit, have been identified. The first functional studies indicate that A TP1A2 FHM mutations result in a loss of function of the pump, leading to an increase in extracellular potassium. This is known to evoke cortical spreading depression, the underlying mechanism of migraine aura.
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Ned Tijdschr Geneeskd · Sep 2004
[Registration of clinical trials: a statement from the International Committee of Medical Journal Editors].
Altruistic motives and trust are central to scientific investigations involving people. These prompt volunteers to participate in clinical trials. ⋯ The International Committee of Medical Journal Editors has issued a statement to the effect that the 11 journals represented in the Committee will not consider publication of the results of trials that have not been registered in a publicly accessible register such as www.clinicaltrials.gov. Patients who voluntarily participate in clinical trials need to know that their contribution to better human healthcare is available for decision making in clinical practice.