Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Aug 2003
Comment[Percutaneous vertebroplasty in the treatment of osteoporotic vertebral compression fractures: first short term results].
To describe the technique of percutaneous vertebroplasty and the short-term results in patients with symptomatic, osteoporotic vertebral compression fractures. ⋯ Percutaneous vertebroplasty was a technically feasible treatment in these patients with symptomatic, therapy-resistant, osteoporotic vertebral fractures. The first short-term results were comparable with results in the literature. A prospective randomised intervention study will be needed to compare percutaneous vertebroplasty with optimal conservative treatment.
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Ned Tijdschr Geneeskd · Aug 2003
[Cardiovascular disease in those aged 55 years and over controlled with a combined pill against 4 risk factors: some brief comments].
It was recently proposed that people with a high absolute cardiovascular risk, for example those aged 55 years and over, might considerably benefit from a combined pill that includes proven treatments such as a statins, antihypertensives, antiplatelet therapy and folic acid. Although conceptually attractive, certain negative effects need to be considered. A strategy to treat the population aged 55 years and over might yield large benefits in high-risk patients with fairly normal values for risk factors that are currently often left untreated. ⋯ In these low-risk patients, the side effects of aspirin and blood-pressure lowering treatment might outweigh the benefits. Due to the high costs and also the availability of generic drugs, it is difficult to envision trials that will address these issues. Therefore, the acceptance and implementation of this intriguing concept by health authorities and insurance companies remains doubtful.
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Ned Tijdschr Geneeskd · Aug 2003
Case Reports[Ulcers on the legs and feet: a seldom recognised side effect of hydroxyurea].
Three male patients aged 52, 49 and 74 years who were treated with hydroxyurea for chronic myeloid leukaemia (CML) or essential thrombocytosis developed severely painful ulcers on the lower legs and feet after an interval varying from 4 months to 2.5 years. These ulcers only healed after discontinuation of the drug. This is an adverse effect of hydroxyurea that is not infrequently seen but is difficult to recognise. ⋯ Often, the drug has already been used for several years before the ulcers develop. They are resistant to treatment unless the hydroxyurea is stopped. Alternatives to hydroxyurea are imatinib for the treatment of CML and interferon alpha-2a or anagrelide for essential thrombocytosis.
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Ned Tijdschr Geneeskd · Jul 2003
Review[Neuromonitoring of patients following severe brain trauma].
To a considerable extent, the neurological outcome of patients with severe brain trauma is determined by the primary injury caused by the accident. Substantial progress has been made in our understanding of the pathophysiological processes resulting in secondary brain damage after brain trauma, partly as a result of the introduction of advanced techniques of neuromonitoring. ⋯ Methods that are also reliable and readily applicable, but less relevant clinically, include cerebral microdialysis of fluid from the extracellular space, determination of the parenchymal oxygen tension, and determination of the venous oxygen saturation. Other techniques that are not clinically applicable include: determination of the cerebral blood flow, the cortical tissue perfusion or the regional cerebral oxygenation.