Duodecim; Laaketieteellinen Aikakauskirja[JOURNAL]
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200 papers
Recurrent pericarditis.
Lehtonen J
Duodecim · 2017 · PMID 29205987
Recurrent pericarditis is the most common and problematic complication of acute pericarditis. After acute pericarditis, the pericarditis recurs in 20 to 50% of the patients. In most cases the etiology of pericarditis rem...
Recurrent pericarditis is the most common and problematic complication of acute pericarditis. After acute pericarditis, the pericarditis recurs in 20 to 50% of the patients. In most cases the etiology of pericarditis remains unclear, although it is generally thought to arise by an immunological mechanism. NSAID medication in combination with colchicine is the cornerstone of the treatment. Corticosteroids should be used mainly for those in whom the first-line drug treatment is not sufficient or first-line treatments are contraindicated.
Acute pericarditis.
Kytö V, Matti Niemelä M
Duodecim · 2017 · PMID 29205986
Acute pericarditis is typically associated with a viral infection. Chest pain appearing in connection with or soon after the symptoms of infection is the characteristic symptom. Diagnosis is based on the recognition of t...
Acute pericarditis is typically associated with a viral infection. Chest pain appearing in connection with or soon after the symptoms of infection is the characteristic symptom. Diagnosis is based on the recognition of two characteristic findings (pericardial chest pain, pericardial friction rub, new ECG changes or new pericardial effusion). Medication with an anti-inflammatory analgesic for 1 to 2 weeks is the first-line treatment. A longer course of colchicine is recommended for the prevention of recurrence of the disease. The use of glucocorticoids should be avoided due to the associated risk of recurrence. Exercise and physical activity are harmful during pericarditis.
Current Care Guideline: Age-related macular degeneration (AMD).
Duodecim · 2017 · PMID 29205985
Age-related macular degeneration (AMD) is the main cause of visual impairment in developed countries. Several improvements in the visualization of posterior segment of the eye together with the introduction of intravitre...
Age-related macular degeneration (AMD) is the main cause of visual impairment in developed countries. Several improvements in the visualization of posterior segment of the eye together with the introduction of intravitreal anti-VEGF treatment have revolutionized the prognosis of the wet form of AMD (wAMD). Increasing incidence of wAMD together with the limited resources of the healthcare systems pose challenges for the provision and development of care. In context of these current aspects, we aim to set evidence-based guidelines for diagnosis, treatment and follow-up of patients with wAMD.
Liver trauma in a young woman.
Saarinen T, Mäkisalo H
Duodecim · 2017 · PMID 29205984
A young woman fell off a horse, leaving her right flank contused by a hoof. This resulted in a severe liver trauma that seemed to require surgical treatment. After fluid resuscitation and five units of red blood cells th...
A young woman fell off a horse, leaving her right flank contused by a hoof. This resulted in a severe liver trauma that seemed to require surgical treatment. After fluid resuscitation and five units of red blood cells the patient's status, however, stabilized upon entering the operating room. The operation was avoided, but intensive care follow-up was continued for six days. The patient made a complete recovery. Conservative treatment of liver trauma is successful in 90% of mild and almost 70% in severe traumas.
Treatment of proximal humerus fractures in the elderly.
Launonen AP, Sumrein BO, Lepola V
Duodecim · 2017 · PMID 29205983
A proximal humerus fracture typically occurs when an elderly woman falls directly onto her shoulder or on her outstretched arm. Local pain in the shoulder and immobility of the upper arm raise a suspicion of a significan...
A proximal humerus fracture typically occurs when an elderly woman falls directly onto her shoulder or on her outstretched arm. Local pain in the shoulder and immobility of the upper arm raise a suspicion of a significant injury. Other bone and tendon injuries in the shoulder region as well as dislocation of the shoulder should be considered on differential diagnosis. Diagnosis is achieved by plain X-ray. Most fractures can be treated conservatively. Consultation with an orthopedist is needed, if there are several fracture fragments with extensive dislocation.
Pregnancy and delivery after a cesarean section.
Vääräsmäki M, Raudaskoski T
Duodecim · 2017 · PMID 29205981
One out of seven of all parturients and one out of five primigravid women deliver by caesarean section. Of four women having undergone caesarean section, three will give birth vaginally, provided that the indication for...
One out of seven of all parturients and one out of five primigravid women deliver by caesarean section. Of four women having undergone caesarean section, three will give birth vaginally, provided that the indication for surgery has been temporary by nature. Spontaneous beginning of labor and a previous vaginal delivery improve the chances of succesful of vaginal delivery. Rupture of the uterus in subsequent pregnancies is the most feared sequel to a caesarean section, with an occurrence of 0.2 to 1.5%. Delivery by caesarean is indicated in case of previous rupture of the uterus, hysterotomy through vertical incision, and more than two previous caesarean sections.
Retinopathy of prematurity - from recognition of risk factors to treatment recommendations.
Fagerholm R, Vesti E
Duodecim · 2017 · PMID 29205980
Retinopathy of prematurity is a proliferative retinal disorder diagnosed exclusively in prematurely born infants. In retinopathy of prematurity, growth of the retinal vasculature is disturbed, leading to hypoxia-induced...
Retinopathy of prematurity is a proliferative retinal disorder diagnosed exclusively in prematurely born infants. In retinopathy of prematurity, growth of the retinal vasculature is disturbed, leading to hypoxia-induced pathological changes typical of retinopathy of prematurity, in the worst case resulting in retinal detachment. The most typical risk factors predisposing to the disease include hyperoxemia, low levels of insulin-like growth factor 1 (IGF-I), and low birth weight in relation to weeks of pregnancy. Laser therapy of peripheral retina is the currently established form of treatment. Screening is applied in order to recognize the pathological changes in retinopathy of prematurity early enough.
Update on Current Care Guideline: Periodontitis.
Duodecim · 2017 · PMID 29205979
Periodontitis is common in the adult Finnish population. Also the prevalence of peri-implant diseases increases. As symptoms are rare, affected patients seldom seek dental care but require attention through the health ca...
Periodontitis is common in the adult Finnish population. Also the prevalence of peri-implant diseases increases. As symptoms are rare, affected patients seldom seek dental care but require attention through the health care system. A careful periodontal screening, including risk assessment, is essential. Individual brushing and interdental cleaning instructions, as well as tobacco counseling, are important in preventing and treating these diseases, Early signs of periodontitis are indication for treatment, including necessary maintenance visits, preventing the severe periodontitis and its harmful consequences for the patient's dentition and general health.
Antipsychotic drug-induced hypoglycemia and hypothermia.
Käräjämäki A, Lauri T, Ebeling T
Duodecim · 2017 · PMID 29205832
This case report comprises three cases of antipsychotic drug-induced hypoglycemia and hypothermia. The mechanisms behind these side-effects are not known, but in hypoglycemia we describe signs of inappropriate insulin se...
This case report comprises three cases of antipsychotic drug-induced hypoglycemia and hypothermia. The mechanisms behind these side-effects are not known, but in hypoglycemia we describe signs of inappropriate insulin secretion. We assume that antipsychotic drug-induced hypoglycemia and hypothermia are underdiagnosed. Antipsychotic drugs are, however, widely used and these rare adverse-effects may occur in the clinical practice. It is of utmost importance to measure blood glucose and body temperature of patients taking these drugs who have unspecific symptoms.
The use of services due to problems related to mental health and substance abuse problems in Finland from 2012 to 2015.
Viertiö S, Partanen A, Kaikkonen R … +3 more , Härkänen T, Marttunen M, Suvisaari J
Duodecim · 2017 · PMID 29205545
INTRODUCTION: Improving primary care services for mental health and substance abuse problems was one of the major goals of the Finnish national plan for mental health and substance abuse work. METHODS: The study data are...
INTRODUCTION: Improving primary care services for mental health and substance abuse problems was one of the major goals of the Finnish national plan for mental health and substance abuse work. METHODS: The study data are drawn from the Regional Health and Well-being Study samples. Participants reported their health service use. RESULTS: Women and young adults used more mental health services than did men and older citizens. However, a significant proportion of those with mental health problems had not used any health services. CONCLUSIONS: More attention should be paid on reducing the stigma associated to mental health and substance abuse problems both within the health care system and the society.
Dysmenorrhea in teenagers.
Suvitie P
Duodecim · 2017 · PMID 29205027
Dysmenorrhea affects quality of life, but is often inadequately treated in teenagers. The mainstay of treatment is NSAID, which must be started pre-emptively and in adequate dose. If NSAID provides insufficient pain reli...
Dysmenorrhea affects quality of life, but is often inadequately treated in teenagers. The mainstay of treatment is NSAID, which must be started pre-emptively and in adequate dose. If NSAID provides insufficient pain relief, or when contraception is required, combined oral contraceptives can be prescribed concomitantly. Hormonal IUD can also be used in teenagers. If dysmenorrhea persists despite appropriate treatment, the patient must be referred to a gynecologist. Endometriosis, the most common cause of severe dysmenorrhea, can manifest already during adolescence.
Prevalence, risk factors and prognosis of depressive disorders.
Markkula N, Suvisaari J
Duodecim · 2017 · PMID 29205026
In Finland, one out of ten adults had a depressive disorder on 2011, and compared to year 2000, the prevalence increased especially in women. Risk factors for recurrent depressive episodes included female gender, young a...
In Finland, one out of ten adults had a depressive disorder on 2011, and compared to year 2000, the prevalence increased especially in women. Risk factors for recurrent depressive episodes included female gender, young age, childhood adversities, and prior mild depressive symptoms. During follow-up, 75% of patients recovered, and the risk for prolonged depression was increased in those living alone or with severe symptoms. Depressive disorders are associated with a two-fold risk of death, which can only partly be explained by physical illness and negative health behavior.
Can we prevent post-ERCP pancreatitis?
Siiki A, Laukkarinen J
Duodecim · 2017 · PMID 29205025
Endoscopic retrograde cholangiopancreatography (ERCP) is the primary method for treating cholestasis and biliary tract gallstones. Although noninvasive imaging has replaced ERCP in diagnostics, ERCP remains the mainstay...
Endoscopic retrograde cholangiopancreatography (ERCP) is the primary method for treating cholestasis and biliary tract gallstones. Although noninvasive imaging has replaced ERCP in diagnostics, ERCP remains the mainstay in collecting diagnostic specimens from the biliary tract. ERCP carries a risk of post-ERCP pancreatitis, which can vary from mild to life-threatening. Difficult cannulation is the most important risk factor for pancreatitis. Careful patient selection and adequate endoscopy training are the foundation of safe ERCP practice. Current evidence supports the routine use of prophylactic rectal NSAID in all patients to prevent post-ERCP pancreatitis.
Disorders of DNA repair mechanisms and their clinical significance.
Kansikas M, Nyström M, Peltomäki P
Duodecim · 2017 · PMID 29205024
DNA repair mechanisms maintain genome stability by preventing the multiplication of genetic errors, caused by environmental factors and intracellular processes, during cell division. Unrepaired damage may permanently alt...
DNA repair mechanisms maintain genome stability by preventing the multiplication of genetic errors, caused by environmental factors and intracellular processes, during cell division. Unrepaired damage may permanently alter genome and cell functions, and even minor changes in DNA strand may initiate malignant transformation of the cell. Up to 25 000 changes in DNA are occur daily in a single, actively dividing, cell, and these changes are continuously repaired. If DNA repair mechanisms are impaired, errors will accumulate into the genome. As numerous factors of different nature can cause genetic errors, and thus several different DNA repair mechanisms are necessary to ensure genomic stability.
Graft-versus-host disease in stem cell transplantation.
Taskinen M, Ryhänen S, Vettenranta K
Duodecim · 2017 · PMID 29205023
Graft-versus-host disease (GvHD) remains a major treatment-related risk in patients undergoing stem cell transplantation. Although advances in HLA-typing and graft types have reduced the risk of GvHD, a breakthrough in t...
Graft-versus-host disease (GvHD) remains a major treatment-related risk in patients undergoing stem cell transplantation. Although advances in HLA-typing and graft types have reduced the risk of GvHD, a breakthrough in the treatment of severe GvHD is still lacking. Allogenic stem cell transplant has potentially beneficial immunological effects on the malignant disease necessitating transplantation, and the importance of these effects must be considered when treating GvHD.
Changing world, changing old age.
Finne-Soveri H
Duodecim · 2017 · PMID 29205022
Every fifth Finn has turned 65. Most of them live an active life that does not differ from that of the working-age population. Long-term illnesses and the resulting disability are accumulating to the late senescence. The...
Every fifth Finn has turned 65. Most of them live an active life that does not differ from that of the working-age population. Long-term illnesses and the resulting disability are accumulating to the late senescence. The need for help from other people and the resulting financial pressures on municipalities are targeted to the elderly having a memory disorder as one of their diseases. Is normal old age thus disappearing, and will the group of those having lost their brain health and requiring care be the only thing that is left from old age?
Health mind in a health brain.
Korkeila J
Duodecim · 2017 · PMID 29205021
The last few years have seen an increase in the research of psychic well-being and positive mental health. A positive point of view refers not only to pleasure but also to the ability to act in a constructive manner in c...
The last few years have seen an increase in the research of psychic well-being and positive mental health. A positive point of view refers not only to pleasure but also to the ability to act in a constructive manner in challenging situations, and effectively regulate negative feelings and stress. Although a positive state of mind is often a passing experience, it can also be developed. Analogously, effective methods tested in a controlled manner have been established for the development of positive capabilities. It is furthermore possible to promote psychic well-being through exercise, healthy diet and practicing mindfulness.
"Genetic code" of brain ageing.
Tienari P, Myllykangas L
Duodecim · 2017 · PMID 29205020
Neurons are more susceptible than other cells to the effects of ageing, since most of them are not capable of dividing, and they consume plenty of energy. In the "genetic code of brain ageing", central role is played by...
Neurons are more susceptible than other cells to the effects of ageing, since most of them are not capable of dividing, and they consume plenty of energy. In the "genetic code of brain ageing", central role is played by the genes that regulate the risk of Alzheimer's disease and vascular diseases. Genes have been recognized underlying memory disorders and longevity. Genetic studies have revealed metabolic routes, including fat and energy metabolism, that can be influenced by an individual through living habits, and also through structures maintaining social activity.
Healthy habits - healthy brain.
Strandberg T, Kivipelto M
Duodecim · 2017 · PMID 29205019
A multifactorial memory disease with old-age onset forms a continuum having at one end a "clear" Alzheimer-type form, with a pathophysiology involving a central role played by the accumulation of amyloid protein, and a p...
A multifactorial memory disease with old-age onset forms a continuum having at one end a "clear" Alzheimer-type form, with a pathophysiology involving a central role played by the accumulation of amyloid protein, and a purely arterial disease at the other end. Most of the cases exhibit a mixed form. As the options of prevention of arterial diseases are well known, this will also provide possibilities for extensive prevention of memory diseases. Central measures include physical activity, a healthy diet and intervention in risk factors - early enough, of course. What is good for the heart is generally good for the brain as well.
Update on current care guideline: Cytological changes in the cervix, vagina and vulva.
Duodecim · 2017 · PMID 29205018
Annually approximately 160 new cervical cancers are diagnosed in Finland. Screening has decreased both incidence and mortality by 80%. Both primary HPV-testing and Pap smear can be used in screening. In the future HPV va...
Annually approximately 160 new cervical cancers are diagnosed in Finland. Screening has decreased both incidence and mortality by 80%. Both primary HPV-testing and Pap smear can be used in screening. In the future HPV vaccination will decrease the number of cervical cancers. Abnormal findings in Pap smears indicate management. LSIL lesions are followed up especially among young women and HSIL lesions treated. Follow-up after treatment should be reliably arranged, because increased risk of cancer remains ever after treatment.
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