Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Aug 2005
[Sentinel lymph node biopsy for melanoma: prognostic value and disadvantages in 300 patients].
The aim of this study was to evaluate the advantages and disadvantages of sentinel lymph node biopsy (SLNB) in patients with cutaneous melanoma. ⋯ SLNB in patients with cutaneous melanoma is still only of prognostic value since survival benefit is not proven. Disadvantages of SLNB were the false-negative rate, the possibility of an increased risk of in-transit metastases in SLNB-positive patients, and postoperative complications. These must be kept in mind when offering patients SLNB.
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Ned Tijdschr Geneeskd · Aug 2005
Letter[Atenolol or metoprolol as beta-blocker in the treatment of hypertension].
Recently the guideline committee of the Dutch College of General Practitioners advocated the use of metoprolol instead of atenolol in patients with an indication for beta-blockers. This recommendation was based on a recent meta-analysis in The Lancet in which no effect was observed in favour ofatenolol compared with placebo on all-cause mortality, cardiovascular mortality and myocardial infarction. Atenolol also had a higher total mortality and stroke risk compared with other antihypertensive agents. ⋯ Comparative trials between atenolol and metoprolol in the treatment of hypertension have not been performed with regard to cardiovascular endpoints. We conclude that there is no evidence that atenolol is better or worse than metoprolol in the treatment of the hypertensive patient. For the treatment of patients with heart failure, however, lipophilic beta-blockers such as metoprolol may be preferred, as these drugs have been more thoroughly evaluated for this indication.
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Ned Tijdschr Geneeskd · Jul 2005
[The polypill: optimal strategy for reduction of cardiovascular disease].
Treating all persons above 55 years of age with a polypill for primary and secondary cardiovascular-disease prevention may reduce cardiovascular events by more than 80%. This strategy is expected to be cost-effective and the associated risk of side effects is estimated to be low.
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Ned Tijdschr Geneeskd · Jul 2005
Comment[The polypill: not an effective strategy for reduction of cardiovascular disease].
The implementation of the intriguing concept of the polypill to prevent cardiovascular events remains doubtful due to a lack of evidence, expected adherence problems, the inevitable overtreatment and undertreatment of individuals, and potential side effects. Lifestyle changes and individual interventions are more preferable strategies.