Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Sep 2002
Case Reports[Increased perioperative blood loss during treatment with paroxetine].
A 63-year-old man who took paroxetine for depression developed massive peroperative haemorrhage during a pancreaticoduodenectomy as a result of paroxetine-induced thrombocytopathy. He lost 4 litres of blood. After administration of 8 units of fresh frozen plasma and 2 times 5 units of thrombocyte concentrate, hemostatic control was obtained and the operation could be continued. ⋯ Because serotonin promotes platelet aggregation, too low an amount of serotonin in the platelets can result in thrombocytopathy. Before major surgery, it is advised to perform extensive clotting tests if there is any hint of haemorrhagic diathesis in the anamnesis. In case of a prolonged bleeding time, paroxetine treatment should be stopped perioperatively.
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Ned Tijdschr Geneeskd · Sep 2002
[Novel therapeutic approach to amyloidosis: no implications as yet for patients with Alzheimer's disease].
Many disorders, such as Alzheimer's disease and diabetes, are characterised by the misfolding and aggregation of proteins. Pepys et al. described a new approach of destabilizing these aggregates by removing an associated protein, serum amyloid P. This offers opportunities for treating amyloidosis and possibly other protein folding diseases. Understanding the mechanism of this unique disease process and the different elements involved is necessary for future drug development.
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Three patients, one woman aged 22 and two men aged 54 and 28, presented with scapular winging. In the first patient amyotrophic plexus neuralgia was diagnosed. The second patient most probably suffered from a stretch injury of the long thoracic nerve. ⋯ Usually the prognosis for recovery from a neuropraxia and an idiopathic lesion of the N. thoracicus longus within a two-year period is good. The prognosis for an isolated lesion of the N. accessorius is much less favourable. An EMG is essential for establishing a diagnosis.