Duodecim; Laaketieteellinen Aikakauskirja[JOURNAL]
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200 papers
[Laparoscopic appendectomy].
Sallinen V, Mentula P
Duodecim · 2017 · PMID 29243452
Laparoscopic appendectomy has practically replaced open surgery. Appendectomy, i.e. surgical excision of the appendix, is one of the most common procedures of a specializing surgeon, and serves to help learn the basics o...
Laparoscopic appendectomy has practically replaced open surgery. Appendectomy, i.e. surgical excision of the appendix, is one of the most common procedures of a specializing surgeon, and serves to help learn the basics of laparoscopy - first by following and later independently performing the operation. Properative preparation, precise diagnosis, correct surgical technique and follow-up treatment are the cornerstones of successful care. The anatomy of the patient must be considered in the placement of trocars. The appendix is usually easily found, but its position and location may vary. In the operation, the base and the artery of the appendix are ligated, and the appendix removed in a plastic bag. Also a healthy appendix should be removed, but in this case other causes of the symptoms should be searched for. Surgical excision of a perforated appendix is considerably more challenging, and peritonitis should be operated without delay. Surgery of a periappendicular abscess requires experience and should be postponed until daytime. Most patients having undergone an excision of non-perforated appendix can be discharged within 23 hours after the operation.
[Gestures facilitate interaction in multicultural primary care consultations].
Paananen J
Duodecim · 2017 · PMID 29243451
Using gestures simultaneously with speech prevents and solves problems of understanding in consultations where the doctor and the patient do not share the same cultural and linguistic background. Gestures illustrate what...
Using gestures simultaneously with speech prevents and solves problems of understanding in consultations where the doctor and the patient do not share the same cultural and linguistic background. Gestures illustrate what is being said, and highlight the essential information. As gestures are used globally, and can also be interpreted despite limited vocabulary, they make the speech easier to follow. In primary care consultations, the topics are easily expressed by gestures, as they are often related to physical matters such as body parts, symptoms, examinations and treatment. Furthermore, gestural mimicry conveys empathy and willingness to collaborate.
[[Pathogenesis of age-related macular degeneration - dialogue between autophagy and inflammasomes] ].
Kivinen N, Koskela A, Kauppinen A … +1 more , Kaarniranta K
Duodecim · 2017 · PMID 29243450
Age-related macular degeneration is a condition affecting central vision, and is the leading cause of blindness and visual impairment in the western countries. For a long time, inflammation has been associated with the p...
Age-related macular degeneration is a condition affecting central vision, and is the leading cause of blindness and visual impairment in the western countries. For a long time, inflammation has been associated with the pathogenesis of the condition, and according to current knowledge, inflammation in the retinal pigment epithelial cells (RPE) results from an impairment of intracellular cleansing systems. In combination with the degeneration of RPE cells, this eventually leads to the destruction of light-sensing cells. By influencing the accumulation or elimination of waste material or the inflammatory reaction following its accumulation we may in the future possibly slow the progression of the disease or, in the best case, even cure it.
Data systems, genomic data and expertise of doctors.
Snell K, Helén I
Duodecim · 2017 · PMID 29240350
Introduction of genomic data into health care requires willingness from physicians to adopt decision support systems as well as genomic information as part of their work. In the interview study, doctors' expectations abo...
Introduction of genomic data into health care requires willingness from physicians to adopt decision support systems as well as genomic information as part of their work. In the interview study, doctors' expectations about data systems and genomic data, as well as challenges for their utilization, are brought into light. Besides technical functionality, linking of data systems and the new knowledge mediated by them for clinicians also requires that doctors understand them as part of their professional expertise and thus useful.
Genomic data into everyday work of a medical practitioner - digital tools for decision-making.
Jokiranta S, Hotakainen K, Salonen I … +4 more , Pöllänen P, Hänninen KP, Forsström J, Kunnamo I
Duodecim · 2017 · PMID 29240347
Recent technological development has enabled fast and cost-effective simultaneous analyses of several gene variants or sequence of even the whole genome. For medical practitioners this has created challenges although gen...
Recent technological development has enabled fast and cost-effective simultaneous analyses of several gene variants or sequence of even the whole genome. For medical practitioners this has created challenges although genomic information may be clinically useful in new applications such as finding out individual risk for diseases influenced by as many as 50,000 variable DNA regions or in detecting pharmacogenetic risks prior to prescribing a medicine. New digital tools have paved the way for utilization of genomic data via easy access and clear clinical interpretation for both doctor and patient. In this review we describe some of these tools and applications for clinical use.
Applications of genomic medicine in the treatment of diseases.
Porkka K, Niemi M, Leppä E … +5 more , Västrik I, Partanen J, Ihalainen J, Jokiranta S, Pöllänen P
Duodecim · 2017 · PMID 29240345
Individualized medicine, based on a detailed mapping of the patient's disease mechanisms, is becoming an essential part of treatment for an increasing number of diseases. In the past few years, the possibility to determi...
Individualized medicine, based on a detailed mapping of the patient's disease mechanisms, is becoming an essential part of treatment for an increasing number of diseases. In the past few years, the possibility to determine the abnormal genome and transcriptome of diseased cells at a reasonable cost has been the major advance. The vast amount of data accumulated from one patient will set requirements for data extraction tools, in order to have the essential information affecting the treatment of the patient information quickly and reliably at the disposal of attending physicians. A computerized decision support system connected to the information systems of the hospital is an integral part of individualized treatment. Although the application of genomic and other profiling information is challenging, individualization of medication provides great promises more effective and safer treatment.
Assessment of multifactorial coronary artery disease by utilizing genomic data.
Widén E, Ripatti S
Duodecim · 2017 · PMID 29240343
The scientific advances in the past few years have enabled individualized prevention and treatment of diseases on the basis of genome-wide information. For example, dozens of genomic regions affecting the risk for corona...
The scientific advances in the past few years have enabled individualized prevention and treatment of diseases on the basis of genome-wide information. For example, dozens of genomic regions affecting the risk for coronary artery disease have been identified. Both Finnish and international longitudinal studies show that the risk assessment of coronary artery disease can be significantly improved if the estimate is based both on the newly discovered hereditary risk factors and the long-recognized traditional risk factors, e.g. age, gender, smoking, blood pressure, and serum lipid levels. In this review, by using coronary artery disease as an example, we present recent research aiming at enhancing the use of genome information in combination with traditional risk factors for the assessment of the risk for common disease of public health importance. We introduce the KardioKompassi tool, developed by us, which comprehensively utilizes the genetic profile of an individual in combination with conventional health information to assess the risk for coronary artery disease. We also discuss the prospects and opportunities provided by the newly developed next-generation risk prediction tools to promote health."
Finland establishing the internet of genomics and health data.
Palotie A, Ripatti S
Duodecim · 2017 · PMID 29240341
Genomic data, i.e. measurement of variation in the complete genome has revolutionized genetic research and changed our understanding of the pathogenetic mechanisms of diseases. Genomic data in combination with Finnish sp...
Genomic data, i.e. measurement of variation in the complete genome has revolutionized genetic research and changed our understanding of the pathogenetic mechanisms of diseases. Genomic data in combination with Finnish special strengths - population history, the nation's comprehensive health records and a strong research tradition in genetic epidemiology - has made Finland a testing laboratory for diseases of public health importance. At the same time, genomic research has changed into statistical evaluation of large masses of data - big data. New research knowledge is now descending to the prevention and treatment of diseases, and this will affect future medical practices. In this reform, Finland has a chance to be a key player. The change is, however, global, and the world will not wait that Finland is ready, but instead we have to take care of it ourselves. When successful, new kind of research will help better allocate health care resources, provide more individualized care and stimulate businesses based on new technology.
Update on Current Care guideline: Memory Disorders.
Duodecim · 2017 · PMID 29240340
Any complaint about memory should be examined. Diagnosis is based on international criteria. Basic evaluation consists of medical history, clinical evaluation, cognitive tests and brain imaging. When a diagnosis of Alzhe...
Any complaint about memory should be examined. Diagnosis is based on international criteria. Basic evaluation consists of medical history, clinical evaluation, cognitive tests and brain imaging. When a diagnosis of Alzheimer's disease (AD), AD with cerebrovascular disease or with Lewy Body disease (LBD), or Dementia associated with Parkinson's disease or LBD is made, evidence-based medical therapy (acetylcholine esterase inhibitor or memantine) is indicated as a part of comprehensive care. In frontotemporal degenerations, these drugs are ineffective. For severe behavioural disorders, other psychoactive medications can be applied if non-pharmacological treatments are not sufficient.
Traumatic hip dislocation in pediatric patients.
Stenroos A, Laaksonen T, Nietosvaara Y
Duodecim · 2017 · PMID 29240339
Traumatic hip dislocations constitute approximately 5% of all pediatric dislocations and typically result from high-energy trauma. However, pediatric hip dislocations can also occur as a result of minor energy due to fle...
Traumatic hip dislocations constitute approximately 5% of all pediatric dislocations and typically result from high-energy trauma. However, pediatric hip dislocations can also occur as a result of minor energy due to flexibility of the joint structures of the immature hip. Children with a posteriorly dislocated hip present with the injured hip in flexion, adduction and internal rotation. Spontaneous relocation of hip dislocation is frequent and a thorough physical examination of the whole lower extremity is always required to reduce the chance of missing hip dislocation/subluxation. Dislocated hips should be emergently repositioned under general anesthesia. MRI is indicated after reduction and in patients after spontaneous relocation if labral interposition is suspected in plain radiographs.
Nucleic acid diagnostic approaches in parasitology.
Kerttula AM, Lavikainen A
Duodecim · 2017 · PMID 29240337
Nucleic acid diagnostic technologies are partly replacing traditional microscopy and antigen detection methods in parasitological diagnostics. In particular, the diagnostics of parasitic diarrhea is undergoing a transfor...
Nucleic acid diagnostic technologies are partly replacing traditional microscopy and antigen detection methods in parasitological diagnostics. In particular, the diagnostics of parasitic diarrhea is undergoing a transformation due to the application of polymerase chain reaction (PCR) tests. Diagnostics of malaria is still based on microscopy, but rapid nucleic acid tests are emerging. Laboratories of clinical microbiology in Finland currently provide PCR tests e.g. for intestinal protozoa, Toxoplasma and Trichomonas. Nucleic acid diagnostic methods are superior in specificity and sensitivity, but may give false positive results after a treated infection.
Caring communication - The impact of interpersonal communication between physician and patient. Can smileys measure the quality of communication?
Köhler H, Rautava P, Vuorinen V
Duodecim · 2017 · PMID 29240335
The importance of communication in medical practice is widely recognized, but what is good communication in patient encounter? Feedback and surveys based on patient experience or "smileys" provide a narrow and often too...
The importance of communication in medical practice is widely recognized, but what is good communication in patient encounter? Feedback and surveys based on patient experience or "smileys" provide a narrow and often too insignificant view of communication. In addition to patient experience, communication benefits the information gathering by the physician and the patient, the patient's ability to promote his/her recovery, the physician's coping with workload, and the effectiveness of health care. In order to evaluate communication and improve it, one has to recognize the criteria and objectives of good communication. Medical communication that supports the rehabilitation of patients is reasonably good and responsible communication.
Do in vitro fertilization treatments result in healthy babies?
Kaartinen N, Tinkanen H
Duodecim · 2017 · PMID 29240334
In Finland, the proportion of children born as a result of in vitro fertilization treatments is annually approximately 3.3%, and the percentage proportion of the population is growing. Their general somatic health status...
In Finland, the proportion of children born as a result of in vitro fertilization treatments is annually approximately 3.3%, and the percentage proportion of the population is growing. Their general somatic health status and cognitive development do not differ from spontaneously fertilized children. In vitro fertilization treatments are, however, associated with a slightly elevated risk of preterm delivery, low birth weight and structural abnormalities. The risk of childhood cancer does not appear to be increased in IVF children. The in vitro fertilization process affects the embryonic epigenome, which organizes itself during early embryonic development. These changes may influence the phenotype and health profile of the unborn child. The effect of in vitro fertilization treatments on an individual's long-term health is poorly understood, requiring prospective follow-up studies with sufficiently large datasets. In vitro fertilization treatments are the most effective way to treat infertility, and the treatments are generally safe both for the future mother and the baby being born.
[Current Care Guideline: Heart failure].
Duodecim · 2017 · PMID 29240324
Treatment of heart failure depends on etiology, left ventricular function and severity of symptoms. Appropriate diagnosis and treatment requires close collaboration between health care providers. In heart failure with re...
Treatment of heart failure depends on etiology, left ventricular function and severity of symptoms. Appropriate diagnosis and treatment requires close collaboration between health care providers. In heart failure with reduced ejection fraction, pharmacological treatment and device therapies are based on solid scientific evidence. Less data exist on treatment of heart failure with preserved ejection fraction, where management of underlying diseases contributing to the syndrome is the primary goal. Patient education and self-care may reduce the need for hospitalizations and improve quality of life. Physical exercise reduces symptoms and improves exercise tolerance.
[Osteosclerosis associated with hepatitis C].
Miettinen HE, Sane T, Lamminen A … +1 more , Välimäki MJ
Duodecim · 2017 · PMID 29240322
We describe the first Finnish case of hepatitis C associated osteosclerosis. In which the patient's bone symptoms and bone density were resolved with hepatitis C treatment. Suspecting the possibility of osteosclerosis un...
We describe the first Finnish case of hepatitis C associated osteosclerosis. In which the patient's bone symptoms and bone density were resolved with hepatitis C treatment. Suspecting the possibility of osteosclerosis underlying bone pains in a hepatitis C patient is well-founded, although osteoporotic fractures are a more common problem.
[Time has not passed for the tilt table test].
Pirinen J, Walamies M
Duodecim · 2017 · PMID 29240320
INTRODUCTION: The tilt table test is used for determining the loss of consciousness, and in the case of reflex syncope, for gaining insight into the circulatory mechanism. In 2015, all tilt tests within the Hospital Dist...
INTRODUCTION: The tilt table test is used for determining the loss of consciousness, and in the case of reflex syncope, for gaining insight into the circulatory mechanism. In 2015, all tilt tests within the Hospital District of Helsinki and Uusimaa (HUS) were performed in the clinical physiology unit of the HUS Medical Imaging Center at Peijas Hospital. METHODS: The patients' medical history, circulation monitor printouts, and medical reports were recorded from all tilt tests carried out during 2015. Positive tilt tests were classified according to the VASIS classification and the elapsed time to loss of consciousness was observed. RESULTS: Among a total of 133 patients, abnormal upright tolerance was found in 30 per cent of the patients. The average time to loss of consciousness was 35.2 minutes. The most common mechanism of syncope was mixed reaction (60.0%), whereas vasovagal reaction (22.5%), cardioinhibitory reaction (10.0%), and lacking stroke volume response (7.5%) were less common. CONCLUSIONS: Practices of referral for the tilt table test vary among the different units of HUS. In our material, the cardioinhibitory reaction was less common than in previous studies.
[Ketamine in the treatment of acute pain].
Brinck E, Kontinen V
Duodecim · 2017 · PMID 29240318
Ketamine is an old anesthetic agent that relieves pain by reducing central sensitization in the central nervous system. This is advantageous for patients suffering from severe pain prior to surgery or are using a strong...
Ketamine is an old anesthetic agent that relieves pain by reducing central sensitization in the central nervous system. This is advantageous for patients suffering from severe pain prior to surgery or are using a strong opioid. The S enantiomer of ketamine used for anesthesia is more powerful than racemic ketamine. The ideal dose of ketamine for pain relief is not yet known, and its adverse effects on the central nervous system, including hallucinations, sedation, and diplopia have limited its use in pain management. The significance of these effects at low doses is probably less than expected, particularly if benzodiazepines or an alpha-2 agonist, such as dexmedetomidine, are administered in addition to ketamine.
[Inflammations of the mammary gland].
Meretoja T, Ihalainen H, Leidenius M
Duodecim · 2017 · PMID 29240317
Breast inflammation, i.e. mastitis is an entity with a variable etiology and severity, typically affecting women of fertile age. In most cases, anamnesis reveals the etiology of the disease, bacterial puerperal mastitis...
Breast inflammation, i.e. mastitis is an entity with a variable etiology and severity, typically affecting women of fertile age. In most cases, anamnesis reveals the etiology of the disease, bacterial puerperal mastitis associated with breastfeeding being the most common. Periductal mastitis is a breast inflammation typically associated with smoking in women of 40 to 50 years of age, localized to the region of the areola. Granulomatous mastitis and other rare breast inflammations usually require specialized care. Regardless of etiology, treatment of acute inflammation depends on the clinical picture and, with the exception of puerperal mastitis, emergency ultrasound imaging is often necessary in order to detect an abscess and drain it. In all cases of mastitis, the possibility of underlying malignancy as well as inflammatory breast cancer should be kept in mind. If specialized care is required, breast inflammation is treated in a breast, general or plastic surgery unit.
[Treatment of incarcerated hernia in adults].
Vironen J
Duodecim · 2017 · PMID 29240314
Of the 14,000 hernias operated annually in Finland, approximately 5 to 6% are treated as emergencies usually due to incarceration. Compared with elective hernia operations, emergency operations carry an increased risk of...
Of the 14,000 hernias operated annually in Finland, approximately 5 to 6% are treated as emergencies usually due to incarceration. Compared with elective hernia operations, emergency operations carry an increased risk of complications and death, especially in elderly patients and those with comorbidities. The risk of hernia recurrence is higher after an emergency procedure. In an emergency situation, a solution resulting in the best immediate and long-term outcome should be selected for each patient. Sometimes it is best to treat only the acute incarceration, whereas in some cases a hernia repair with good and lasting outcome can be safely performed already during the acute situation. Besides the nature of the hernia itself, the decisions are affected by the general condition and underlying disease of the patient, as well as the surgeon's experience. Emergency hernia surgery requires experience, as suboptimal solutions will complicate any repair operations that may be required later.
[Clinical significance of gene defects in B-cell lymphomas].
Pasanen A, Meriranta L, Leppä S
Duodecim · 2017 · PMID 29239593
Lymphomas are a heterogenous group of malignant diseases. Identification of sub-groups has created pressure for a more detailed diagnosis and individualized treatment. Although the underlying genetic and molecular pathol...
Lymphomas are a heterogenous group of malignant diseases. Identification of sub-groups has created pressure for a more detailed diagnosis and individualized treatment. Although the underlying genetic and molecular pathologic factors of the most common B-cell derived lymphomas, i.e. diffuse large B-cell lymphoma and follicular lymphoma, have become more accurate, prognosis is evaluated and treatment options still selected mainly on the basis of clinical variables. In the future, new generation sequencing methods that are becoming more common in clinical practice will allow the assessment of prognosis and treatment on the basis of biologic and genetic risk factors. To achieve this both comprehensive basic research and clinical drug trials taking the pathogenesis of different diseases into consideration are required.
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