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BMJ 1994; 309 doi: (Published 24 September 1994) Cite this as: BMJ 1994;309:820

One of the reasons that doctors are reluctant to give thrombolytic drugs to patients who have had a pulmonary embolism is fear of bleeding from the site of the puncture used for pulmonary angio-graphy. The conclusion of a decision analysis (Annals of Internal Medicine 1994;121:313-7) is that patients with suspected pulmonary embolism who are candidates for thrombolysis should be investigated with non-invasive tests such as ventilation-perfusion lung scanning.

An update on the risks associated with the use of diethylstilboestrol in pregnancy appears in the “British Journal of Obstetrics and Gynaecology” (1994;101:748-50). To date, 361 cases of clear cell adenocarcinoma of the vagina have been reported in the United States in women whose mothers were given the drug. In Britain the total number of pregnant women treated was around 7500: five cases of clear cell adenocarcinoma have been reported, with a further six “anecdotal cases.” The risk up to the age of 34 seems to be one in every thousand women exposed in utero.

A meta-analysis of psychological treatments for insomnia (American Journal of Psychiatry 1994;151:1172-80) found that most were effective: the best results came from stimulus control therapy (no reading, watching television, eating, or working in bed …

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