Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Dec 2002
Review[Sequential analysis in clinical and epidemiological research].
In clinical trials and epidemiological studies, interim analyses are usually performed for ethical or economical reasons, although efficiency aspects can also be a reason. The analysis is referred to as group-sequential analysis or continuous-sequential analysis, dependent on the number of interim analyses performed. Repeated testing of cumulative data requires an adjustment to the significance level or type I error alpha of a statistical test. On average a (group-)sequential analysis of a clinical or epidemiological study requires less patients than the analysis of a fixed-sample study.
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Ned Tijdschr Geneeskd · Nov 2002
Review[The possible suppression of Alzheimer's disease by nonsteroidal anti-inflammatory drugs].
Ever since inflammatory mediators were detected in and around amyloid plaques in the brain of patients with Alzheimer's disease, there has been great interest in the inflammatory hypothesis and the possibility of treating Alzheimer's disease with anti-inflammatory drugs. Various epidemiological studies have now demonstrated that the use of nonsteroidal anti-inflammatory drugs (NSAIDs) is indeed associated with a reduced risk of developing Alzheimer's disease. The effect of NSAIDs in Alzheimer's disease is probably mediated by activation of the peroxisome proliferator-activated receptor-gamma. ⋯ These findings suggest that NSAIDs may also be able to slow down Alzheimer's disease progression. So far, only one small clinical trial has shown that treatment with NSAIDs significantly delayed cognitive decline in Alzheimer's disease patients. Large randomized double-blind placebo-controlled trials are needed to provide definitive evidence that NSAIDs have a therapeutic effect on Alzheimer's disease.
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Ned Tijdschr Geneeskd · Aug 2002
Review[Medical maintenance treatment of chronic obstructive pulmonary disease (COPD)].
Chronic obstructive pulmonary disease (COPD) is a chronic disorder of the lungs and airways that imposes a huge socioeconomic burden on both the patients and society. COPD is the only major chronic disease for which both the incidence and mortality are still rising worldwide. From the literature evidence-based insights can be obtained about maintenance medication for reducing symptoms and disease progression. ⋯ A reduction in exacerbation frequency seems to exist in some studies, yet this has not yet been conclusively demonstrated. Acetylcysteine has been proven to reduce exacerbation frequency. There is no place for maintenance therapy with antibiotics.
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Ned Tijdschr Geneeskd · Jun 2002
Review[Oral fluoropyrimidines registered for the treatment of metastatic colorectal carcinoma: a possible gain].
Up until now the standard treatment for metastasized colorectal carcinoma has been fluorouracil (5-FU) in combination with folonic acid in low doses administered intravenously, even after the recent registration of a number of new intravenously administered cytostatics, such as irinotecan and oxaliplatin. Meanwhile there are oral alternatives for 5-FU: capecitabine and the combination of tegafur and uracil with folonic acid. In four randomised studies it was shown that these drugs were globally just as effective as the combination of 5-FU with folonic acid (in accordance with the 'Mayo Clinic' scheme). ⋯ An examination of the serious side effects (grade 3 and 4) revealed that the total incidence was generally comparable. These data, together with the ease of oral administration, form the basis for the registration of capecitabine and tegafur-uracil-folonic acid. The definitive place of these drugs in the treatment of metastasized colorectal carcinoma is not yet clear.
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Ned Tijdschr Geneeskd · Jan 2002
Review[Procalcitonin concentrations in the diagnosis of acute inflammatory reactions].
Procalcitonin is a calcitonin prohormone. During systemic inflammatory response it has the characteristics of an acute-phase protein. However, plasma levels rise more rapidly than those of the parameter (i.e. ⋯ This makes procalcitonin a valuable addition to the current diagnostic work-up for acutely ill patients. Procalcitonin can be used as a marker of inflammation, to differentiate serious bacterial infections from other generalised inflammatory diseases, to differentiate bacterial from viral infections, to differentiate infection from disease activity in patients with autoimmune diseases, to differentiate infection from rejection in transplant patients, and as a prognostic marker in critically ill patients. Procalcitonin may prove to be a valuable adjunct in diagnosing and treating patients with a variety of inflammatory disorders.