Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Aug 2001
Review[Uneasiness about the safety of bupropion as an aid to smoking cessation unjustified ].
A report in a national newspaper on Thursday 26 April 2001, linked the anti-smoking drug bupropion to 41 deaths. From the reports of suspected adverse reactions received by the Netherlands Pharmacovigilance Foundation, it appears that more than half the cases concerned patients at risk of developing smoking-related diseases. In 15 cases, the simultaneous use of bupropion and another antidepressant (10 patients), theophylline (1 patient) or insulin (4 patients) was reported, even though these combinations may lead to an increase in the risk of seizures. ⋯ Provided that bupropion is used according to the guidelines in the product information, this new aid in smoking cessation is considered an effective and safe drug. It is highly unlikely that bupropion has contributed to any deaths. If prescribed appropriately and in combination with counselling (e.g. minimal intervention strategy), bupropion is as yet the most effective aid in helping people stop smoking.
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Ned Tijdschr Geneeskd · Jul 2001
Review Case Reports[Three patients with massive pulmonary embolism].
Three patients presenting with massive venous pulmonary thrombo-embolism are described, who have been selected from a series of 22 patients treated with thrombolysis during a 6-year period. A 23-year-old female presented with tachycardia and dyspnoea. She had pulmonary angiography following scintigraphy with a perfusion deficit of more than 60%. ⋯ Echocardiography is often diagnostic in these patients. Thrombolysis may be life saving but there are no randomised trials to prove that survival rate is indeed better compared to heparin therapy. Streptokinase is less expensive than alteplase and there is no evidence from trials to suggest that it is inferior to more expensive thrombolytics such as alteplase or urokinase.
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Ned Tijdschr Geneeskd · Jun 2001
Review Case Reports[Subacute combined degeneration of the spinal cord: easy diagnosis, effective treatment].
Four patients, three women aged 49, 47 and 74 years, and a man aged 64 years, presented with progressive sensory deficit, pyramidal tract symptoms and postural instability. Tests revealed megaloblastic anaemia and low vitamin B12 levels. Two of the female patients had undergone gynaecological surgery with nitrous oxide anaesthesia, and the male patient had undergone a gastric resection. ⋯ As vitamin B12 deficiency is caused by malabsorption in the gastrointestinal tract, oral supplementation is insufficient. It is essential to recognise this treatable disease at an early stage, and not to reject the possible diagnosis if the MRI findings are abnormal. Simple blood tests can lead to the diagnosis and to effective treatment.