Kauppila JH, Raatiniemi L, Isokangas JM
… +2 more, Martikainen M, Piironen K
Duodecim
· 2017 · PMID 29205017
Thrombolysis with tissue plasminogen activator is the mainstay in the treatment of acute stroke. Reducing the delay of thrombolysis treatment improves patient prognosis and reduces the incidence of complications. Variabl...Thrombolysis with tissue plasminogen activator is the mainstay in the treatment of acute stroke. Reducing the delay of thrombolysis treatment improves patient prognosis and reduces the incidence of complications. Variable telestroke regimens have improved the availability of stroke thrombolysis, especially in rural settings, where neurologists are not readily available. In the drip-and-ship strategy, stroke thrombolysis is initiated in a peripheral hospital and the patient is then transferred to a tertiary care unit. We report the first case of drip-and-ship stroke thrombolysis in a rural health care center in Northeastern Finland.
Gissler M, Ojamo M, Ritvanen A
… +1 more, Uusitalo H
Duodecim
· 2017 · PMID 29205016
INTRODUCTION: There is no published data from the last few years on the frequency of pediatric ocular disorders and visual handicap in Finland. METHODS: We surveyed the registers of THL (National Institute for Health and...INTRODUCTION: There is no published data from the last few years on the frequency of pediatric ocular disorders and visual handicap in Finland. METHODS: We surveyed the registers of THL (National Institute for Health and Welfare) and statistics of Kela (The Social Insurance Institution of Finland). RESULTS: The majority of visual defects are neurologic or congenital. Retinopathic lesions were reported in 11% of small premature infants. In the years from 1993 to 2011, significant abnormalities of the eye or its accessory organs were on the average registered annually in 94 liveborn infants, and the number of corresponding cancers was less than five. CONCLUSIONS: Ocular disorders in children are rare. They are significant because of the special attention required in everyday life.
Acute mesenteric ischemia resulting from mesenteric arterial thrombosis is a life-threatening cardiovascular complication with symptoms ranging from sudden-onset abdominal pain to vague symptoms of several days' duration...Acute mesenteric ischemia resulting from mesenteric arterial thrombosis is a life-threatening cardiovascular complication with symptoms ranging from sudden-onset abdominal pain to vague symptoms of several days' duration. Although contrast-enhanced computed tomography is an excellent diagnostic tool, detection of the disease before the development of permanent intestinal injury is still difficult. Endovascular treatment is usually successful in restoring intestinal blood flow acutely. Chronic mesenteric ischemia requires urgent detection and therapy in order to prevent irreversible intestinal ischemia.
Sequeiros RB, Joronen K, Komar G
… +1 more, Koskinen SK
Duodecim
· 2017 · PMID 29205014
HIFU (high intensity focused ultrasound) is a method in which high-frequency ultrasound is focused on a tissue in order to achieve a thermal effect and the subsequent percutaneously ablation, or tissue modulation. HIFU i...HIFU (high intensity focused ultrasound) is a method in which high-frequency ultrasound is focused on a tissue in order to achieve a thermal effect and the subsequent percutaneously ablation, or tissue modulation. HIFU is non-invasive and results in an immediate tissue destruction effect corresponding to surgery, either percutaneously or through body cavities. HIFU can be utilized in the treatment of both benign and malignant tumors. In neurological diseases, focused HIFU can be used in the treatment of disorders of the basal ganglia.
The Finnish guideline on endodontics emphasizes good quality of endodontic treatment and coronal seal of the restoration. For prevention of endodontic treatment need caries control is essential. For deep carious lesions...The Finnish guideline on endodontics emphasizes good quality of endodontic treatment and coronal seal of the restoration. For prevention of endodontic treatment need caries control is essential. For deep carious lesions stepwise excavation or partial caries removal are recommended. Partial pulpotomy can be used if bleeding can be controlled. The decision for root canal treatment is based on prognosis, occlusion and general health of the patient. The use of kofferdam is essential in aseptic working. Chemomechanical preparation with NaOCI and root canal filling within 0-2 mm from the apex improve prognosis. Healing should be controlled annually up to four years.
Severe psoriasis can lead to erythroderma, which is a widespread inflammatory condition of the skin. Erythroderma increases the amount of water evaporating from the skin and heat loss. We present a case of severe hypothe...Severe psoriasis can lead to erythroderma, which is a widespread inflammatory condition of the skin. Erythroderma increases the amount of water evaporating from the skin and heat loss. We present a case of severe hypothermia with rectal temperature of 29.3 °C caused by psoriasis and a septic infection.
In addition to medical expertise, competence-based medical training comprises communication and collaboration skills, professionalism, and leadership skills. Continuous feedback is essential for learning and development,...In addition to medical expertise, competence-based medical training comprises communication and collaboration skills, professionalism, and leadership skills. Continuous feedback is essential for learning and development, and feedback only from the medical specialist examination taken in the end of training does not ensure thorough specialist training. Entrustable professional activity (EPA) is a unit of professional practice, defined as tasks or responsibilities typical of the specialty. EPA translates competence-based training into manageable and meaningful entities and provides tools for the evaluation of medical competence.
Nurkkala M, Korpelainen R, Teeriniemi AM
… +2 more, Keinänen-Kiukaanniemi S, Vanhala M
Duodecim
· 2017 · PMID 29200237
BACKGROUND: Eating disorders in boys are poorly detected in health care. MATERIAL AND METHODS: Among 922 boys attending evaluation for military service in Oulu, In 2013, disordered eating behavior was assessed by the SCO...BACKGROUND: Eating disorders in boys are poorly detected in health care. MATERIAL AND METHODS: Among 922 boys attending evaluation for military service in Oulu, In 2013, disordered eating behavior was assessed by the SCOFF and Eating Disorder Inventory questionnaires (Drive fir thinness and Bulimia). RESULTS: Disordered eating behavior was present in 129 (14%) boys, of whom 57 (44%) were overweight. Every fourth overweight by had symptoms of eating disorders, typically constant thoughts of weight loss. CONCLUSIONS: Screening of eating disorders should be included in medical examinations, especially in overweight boys.
Endometriosis affects about 2 to 10% of women in fertile age, It causes pain and infertility. In the ovaries, endometrios causes endometriomas. The disease may spread into the abdominal cavity and even result in ileus. D...Endometriosis affects about 2 to 10% of women in fertile age, It causes pain and infertility. In the ovaries, endometrios causes endometriomas. The disease may spread into the abdominal cavity and even result in ileus. Deep endometriomas are located under the peritoneal surface, typically behind the uterus and in the region of uterosacral ligaments. History, clinical examination and transvaginal ultrasound scanning usually lead to the diagnosis. Magnetic resonance imaging is in particular utilized prior to surgery. It provides a comprehensive view of endometriosis lesions in the pelvis, including deep foci.
Ketamine infusions administered intravenously 1 to 3 times per week are the quickest and most effective treatment for depression. Short-course ketamine medication is established treatment both for unipolar depression and...Ketamine infusions administered intravenously 1 to 3 times per week are the quickest and most effective treatment for depression. Short-course ketamine medication is established treatment both for unipolar depression and depressive episodes of bipolar affective disorder. Ketamine is suitable for initiating the treatment for treatment-resistant depression, alleviation of suicidal tendencies, and treatment of depressive patients suffering from simultaneous pain. The safety of prolonged treatment with ketamine is not known to sufficient degree. However, even long periods (up to 1.5 years) of ketamine treatment have not been associated with adverse effects. It would be appropriate to use short-course ketamine treatment more often than is currently done.
Sarajärvi P, Kubin M, Tasanen K
… +1 more, Huilaja L
Duodecim
· 2017 · PMID 29199808
DRESS (drug reaction with eosinophilia and systemic symptoms) is a rare, severe multiorgan adverse drug reaction. Antiepileptic age's and antibiotics are the most frequently reported causative agents. Compared with other...DRESS (drug reaction with eosinophilia and systemic symptoms) is a rare, severe multiorgan adverse drug reaction. Antiepileptic age's and antibiotics are the most frequently reported causative agents. Compared with other drug reactions, DRESS demonstrates a long latency period thus complicating recognition and diagnosis. DRESS is defined as presence of fever, skin eruption, hematologic abnormalities and systemic involvement, especially liver injury. Withdrawal of the culprit drug, commencement of systemic corticosteroid and supportive care are the mainstay of treatment. The majority of patients recover completely after drug withdrawal and appropriate therapy. Some patients suffer from chronic sequelae or even death.
In the HUUTI consortium research project, the illicit use of drugs and consequences thereof among Finnish people were studied, also seeking possible new pharmacological therapies for dependency problems. The epidemiologi...In the HUUTI consortium research project, the illicit use of drugs and consequences thereof among Finnish people were studied, also seeking possible new pharmacological therapies for dependency problems. The epidemiological part included 4,817 persons, who attended the services for drug users at Helsinki Deaconess Institute between 1997 and 2008. The majority were below 35 years of age. The average level of education was low and the proportion of employed was small. On the average, 3.5 different substances were being used, of which buprenorphine and amphetamine were the most common primary drugs, cannabis being the most common secondary drug. An almost tenfold mortality was observed in the follow-up comparison with the reverence population.
Sarvilinna N, Unkila-Kallio L, Härkki P
… +2 more, Tiitinen A, Heikinheimo O
Duodecim
· 2017 · PMID 29199806
Progesterone regulates several female reproductive functions. Progesterone and synthetic progestins derived from it have long been utilized in gynecology. The effects of these steroids in target cells are mediated via pr...Progesterone regulates several female reproductive functions. Progesterone and synthetic progestins derived from it have long been utilized in gynecology. The effects of these steroids in target cells are mediated via progesterone receptors, Progesterone receptors are also the target of action of selective progesterone receptor modulators. Of the molecules of this newer group of drugs, two are presently in clinical use. Mifepristone is used in nonsurgical abortion, in softening of the cervix before surgical abortion, and in the induction of labor in cases of intrauterine death. The indications of ulipristal acetate are postcoital contraception and treatment of uterine myomas and the resulting symptoms.
Haahtela T, Hanski I, von Hertzen L
… +9 more, Jousilahti P, Laatikainen T, Mäkelä M, Puska P, Reijula K, Saarinen K, Vartiainen E, Vasankar T, Virtanen S
Duodecim
· 2017 · PMID 29199805
The prevention of many diseases has significantly improved by intervening in known risk factors. However, the causes of the increase in allergy and type 1 diabetes are unknown. These diseases are often associated with a...The prevention of many diseases has significantly improved by intervening in known risk factors. However, the causes of the increase in allergy and type 1 diabetes are unknown. These diseases are often associated with a low-grade inflammation and immunological imbalance. The lifestyle and environment of urbanized populations have changed causing imbalance in the human normal flora and affecting immune regulation. We discuss everyday factors affecting immune regulation, using allergy as an example. Health may be promoted through the "nature step", by supporting the connection between humans and nature.
Luxatio erecta, inferior dislocation of the glenohumeral joint, is a rare type of injury (1% of shoulder dislocations). In most cases the injury is caused by falling while the upper extremity is hyperabducted. We introdu...Luxatio erecta, inferior dislocation of the glenohumeral joint, is a rare type of injury (1% of shoulder dislocations). In most cases the injury is caused by falling while the upper extremity is hyperabducted. We introduce two cases of consecutive patients with the same rare type of injury--walking the dog. According to the literature, the most frequently used method for the reduction of inferior shoulder dislocation is tractioncountertraction under sedation. If the patient has no other reason to be under general anesthesia or sedation, we recommend, however, administration of local anesthetics and using a less traumatic two-step manoeuvre to reduce inferior shoulder dislocation--luxatio erecta.
Riding therapy is a comprehensive and functional form of rehabilitation, in which the rehabilitee, the horse and the riding therapist collaborate in order to achieve individually assigned goals that support rehabilitatio...Riding therapy is a comprehensive and functional form of rehabilitation, in which the rehabilitee, the horse and the riding therapist collaborate in order to achieve individually assigned goals that support rehabilitation. In Finland, riding therapy is therapeutic rehabilitation carried out by riding therapists who have undergone approved training. The therapy is mainly implemented in an individual form, but small group working is also applied, e.g. in the form of pair therapy and therapeutic vaulting. In Europe, this form of rehabilitation has been divided into hippotherapy supporting motor functions and heilpedagogical riding therapy functioning in support of upbringing.
Finland has committed to follow the international biodiversity agreement, which among other things also applies to the preservation of genetic resources of domestic animals. In Finland, the preservation of genetic resour...Finland has committed to follow the international biodiversity agreement, which among other things also applies to the preservation of genetic resources of domestic animals. In Finland, the preservation of genetic resources within agriculture andforestry is implemented through programs on national gene resources. The particular aim of the Finnish National Animal Genetic Resources Program is to preserve our original breeds and gene resources thereof and encourage a sustainable use of the domestic breeds. In addition to the protective value, an economic, social and cultural historical significance can be assigned to the original breeds.
The number of ticks, members of the acarids, is increasing in the Finnish nature, and the risk of tick-borne infections has therefore increased as well. The incidence of Lyme borreliosis and tick-borne encephalitis has a...The number of ticks, members of the acarids, is increasing in the Finnish nature, and the risk of tick-borne infections has therefore increased as well. The incidence of Lyme borreliosis and tick-borne encephalitis has also increased over the past few years. Possible recently discovered tick-borne infectious organisms include Borrelia miyamotoi and Anaplasma phagocytophilum bacteria and the babesia protozoon. Although infections caused by these microorganism are presumed to be rare in Finland, they should be considered in the differential, diagnosis of a febrile patient following a detected or suspected tick bite.
Although the opinions about animals and animal allergies may be extreme, animals can even be indispensable for the well-being of humans. The immune tolerance of many modern city dwellers is insufficiently developed, pred...Although the opinions about animals and animal allergies may be extreme, animals can even be indispensable for the well-being of humans. The immune tolerance of many modern city dwellers is insufficiently developed, predisposing the skin and mucous membranes to allergic inflammation. There is no need in infancy to avoid animals, and animal contacts in early childhood rather protect from the development of allergies. Pet allergens are present in small amounts everywhere, not only in places where they live. General instructions on avoidance do not exist. New forms of desensitization therapy may in the future bring relief for those having strong symptoms.
Koljonen V, Söderlund T, Mäkisalo H
… +1 more, Gissler M
Duodecim
· 2016 · PMID 27522833
Contacts between humans and animals inevitably involve encounters possibly resulting in the human being injured. During the period of 2000 to 2014 almost 90 people died in this kind of conflict in Finland. Of these death...Contacts between humans and animals inevitably involve encounters possibly resulting in the human being injured. During the period of 2000 to 2014 almost 90 people died in this kind of conflict in Finland. Of these deaths, one third were associated with horses. In addition, over the same period 85 people died in traffic accidents in which an animal was hit by a car. Accidents requiring hospitalization occurred for approx. 8 000 people.