Nederlands tijdschrift voor geneeskunde
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[Adverse drug reactions of a slimming product contaminated with sibutramine].
On the internet numerous diet pills and weight loss courses are advertised. These products may contain active ingredients or contaminants that are not mentioned on the pack or in the patient information leaflet. ⋯ The slimming product Green Coffee 800 may contain sibutramine and may cause severe adverse reactions. This product is still advertised on the Internet.
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Phlebitis is a very common complication of the use of intravenous catheters. Two patients with an i.v. catheter complicated by thrombophlebitis are described. Patient A was immunocompromised due to chronic lymphatic leukaemia and developed septic thrombophlebitis with positive blood cultures for S. ⋯ Risk factors include: female sex, previous episode of phlebitis, insertion at (ventral) forearm, emergency placement and administration of antibiotics. Until recently, routine replacement of peripheral intravenous catheters after 72-96 h was recommended, but randomised controlled trials have not shown any benefit of this routine. A recent Cochrane Review recommends replacement of peripheral intravenous catheters when clinically indicated only.
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Ned Tijdschr Geneeskd · Jan 2011
Comment[Practice guideline 'Medically unexplained physical symptoms (MUPS) and somatoform disorders': a step in the right direction].
The Dutch multidisciplinary practice guideline 'Medically unexplained physical symptoms (MUPS) and somatoform disorders' provides information on non-specific somatoform complaints, hypochondriasis, conversion disorders and a limited number of specific functional syndromes. Much attention is given in the guideline to the role of doctor-patient communication and empathy in the treatment of patients with somatoform complaints. ⋯ Firstly, an undesirable side-effect of the Dutch nomenclature of unexplained symptoms is that it implies a duality of body and mind. Secondly, the value of screening for depression or an anxiety disorder as a secondary step in primary care is doubtful.
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Ned Tijdschr Geneeskd · Jan 2011
Case Reports[Camphor poisoning following ingestion of mothballs 'for headache'].
Camphor is a toxic hydrocarbon, found in numerous over-the-counter medicinal products and chemist-shop items. The consequences of camphor poisoning depend on the dose, and severe poisoning can result in death. Ingestion of camphor can cause seizures, apnoea, renal insufficiency, raised hepatic enzyme levels, and vomiting resulting in chemical pneumonitis due to aspiration. ⋯ Many every-day products contain camphor. Poisoning can lead to an acute clinical picture, and immediate intensive care department treatment is obligatory. As there is no antidote available, supportive care is the only available option when poisoning occurs.
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Ned Tijdschr Geneeskd · Jan 2011
[Population-based breast cancer screening is not worthwhile. Screening has little effect on mortality].
Comparison of breast cancer mortality between pairs of similar countries (Sweden and Norway, Northern Ireland and the Irish Republic, the Netherlands and Belgium or Flanders), each of which had implemented its population-wide breast cancer screening programme at a different point in time, demonstrated little effect of screening on mortality. In the Netherlands, a well-organised population-wide screening programme was started in the early nineties, ten years before such a programme was introduced in Flanders. We used the 1989-1992 period as a baseline and compared breast cancer mortality in the Netherlands with that in Flanders during the 2005-2008 period. ⋯ A total of 5000 screening mammograms were needed to prevent one death from breast cancer. Breast cancer screening is not a public health priority. Impartial and transparent information on the disadvantages and benefits of breast cancer screening is urgently needed.