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Aan de hand van een literatuuronderzoek werd nagegaan wat er bekend is over de interacties tussen valproaat en fluoxetine, alsook tussen valproaat en antidepressiva in het algemeen. Er bestaan enkele aanwijzingen voor interacties tussen enerzijds valproaat en anderzijds fluoxetine, amitriptyline, nortriptyline en clomipramine, maar de wetenschappelijke evidentie hiervoor is globaal genomen beperkt en omvat voornamelijk enkele farmacokinetische studies en gevalsbeschrijvingen. Het lijkt desalniettemin raadzaam om bij de combinatie van valproaat en antidepressiva de bloedspiegels te controleren.

De afgelopen jaren is op veel verschillende manieren geprobeerd sturing te geven aan natuurbeleid. Op basis van een analyse van de verschillende vormen van sturing pleiten de auteurs voor een benadering waarin participatie, verbreding en leerprocessen een hoofdrol spelen. Daarvoor is een goed samenspel nodig tussen overheidsbeleid en lokale participatie, en tussen de natuur van burgers en die van ecologen

Study Design. In 100 consecutive patients who underwent surgery because of soft cervical disc herniation, the sagittal and transverse diameters, the area of the bony cervical spinal canal, the sagittal diameter of the hernia, and the minimal bony intervertebral foramen diameter were measured by computed tomography. The data were compared with measurements from a control group of 35 matched healthy individuals. Objectives. To evaluate the relation between the severity of concurrent neurologic symptoms and the sagittal and transverse diameters, the cross-sectional area of the bony spinal canal, the sagittal diameter of the hernia, and diameter of the minimal bony intervertebral foramen in patients with soft cervical disc herniation. Summary of Background Data. Traumatic injury and spondylotic changes have a far greater impact on the spinal cord and nerve roots if the sagittal diameter of the bony cervical spinal canal is small. However, in the case of soft cervical disc herniation, no computer tomographic measurements are available for sagittal and transverse diameters, cross-sectional area of the bony spinal canal, sagittal diameter of the hernia, and diameter of the minimal bony intervertebral foramen in relation to the severity of concurrent neurologic symptoms. Methods. Computed tomography was used to measure sagittal and transverse diameters, cross-sectional area of the bony cervical spinal canal, sagittal diameter of the hernia, and diameter of the minimal bony intervertebral foramen in 100 patients with symptomatic monosegmental cervical soft disc herniation. All patients had undergone an anterior discectomy with removal of the hernia and subsequent interbody fusion using an autologous bone graft taken from the iliac crest. Results. A mean sagittal diameter of the bony cervical spinal canal of 12.9 mm was found, indicating a certain degree of developmental stenosis. Patients with motor disturbances had a significantly smaller sagittal diameter of the bony spinal canal than did patients without motor disturbances. There was a linear correlation between the sagittal diameter of the bony cervical spinal canal and that of the hernia. The sagittal diameter, the area of the bony spinal canal, and diameter of the minimal bony intervertebral foramen were significantly smaller in patients with soft cervical disc herniation than in the control group. Conclusions. Results from this study strongly suggest that the degree and severity of neurologic symptoms accompanying cervical soft disc herniation are inversely related to the sagittal diameter and the area of the bony cervical spinal canal. The latter area is reduced in cases of developmental stenosis or because of soft disc herniation. Moreover, patients with soft cervical disc herniation have a significantly smaller sagittal diameter of the bony spinal canal, a significantly smaller minimal bony intervertebral foramen diameter, and a significantly smaller cross-sectional area of the bony cervical canal than do healthy matched individuals.