Tidsskrift for den Norske lægeforening : tidsskrift for praktisk medicin, ny række
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Tidsskr. Nor. Laegeforen. · Nov 2011
Antibiotics prophylaxis in connection with caesarean section--guidelines at Norwegian maternity departments.
The frequency of caesarean sections is increasing. Infection in operation wounds and/or underlying spaces and organs is a common complication. In Veileder I fødselshjelp [Clinical Guidelines in Obstetrics], 2008, antibiotic prophylaxis is recommended in the form of single dose ampicillin or first generation cephalosporins in connection with acute caesarean sections and under special conditions such as prolonged operations. We wanted to find out whether Norwegian maternity departments follow these recommendations. ⋯ Most Norwegian maternity wards have written guidelines on antibiotic prophylaxis in Caesarean section. The contents of the guidelines varied but are mainly in agreement with current Norwegian recommendations.
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Breast cancer with overexpression of the HER2 receptor is an aggressive type of breast cancer with poor prognosis. Trastuzumab (Herceptin) is a monoclonal antibody that binds to the HER2 receptor on the cell surface blocking the signals that promote cell-growth proliferation. Trastuzumab treatment has almost halved the risk of relapse, when given as an adjuvant, and has improved the overall survival in metastatic breast cancer. However, when given alone or in combination with cardiotoxic chemotherapy, especially anthracyclines, trastuzumab may lead to congestive heart failure of varying severity. ⋯ In summary, the favourable effects of trastuzumab are convincing, but cardiotoxicity is a significant challenge in treatment. Risk factors for side effects indicate extra vigilance, but the side effects are unpredictable and all patients treated with trastuzumab must undergo regular cardiac surveillance.
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Baclofen is approved for muscle spasms and cerebral spasticity. Several studies have recently investigated the use of baclofen for alcohol withdrawal symptoms and as an abstinence-promoting agent in alcohol-dependent subjects. The evidence is too weak to recommend baclofen for alcohol withdrawal, and drugs with better documentation such as benzodiazepines and carbamazepine should be preferred for this indication. ⋯ Despite enthusiastic appraisal in case reports, the use of baclofen in high doses to suppress alcohol craving cannot be recommended due to insufficient evidence. Trials that may resolve this issue are underway.