Duodecim; Laaketieteellinen Aikakauskirja[JOURNAL]
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200 papers
[Birds' sense of direction].
Hohtola E
Duodecim · 2016 · PMID 27522832
Birds utilize several distinct sensory systems in a flexible manner in their navigation. When navigating with the help of landmarks, location of the sun and stars, or polarization image of the dome of the sky, they resor...
Birds utilize several distinct sensory systems in a flexible manner in their navigation. When navigating with the help of landmarks, location of the sun and stars, or polarization image of the dome of the sky, they resort to vision. The significance of olfaction in long-range navigation has been under debate, even though its significance in local orientation is well documented. The hearing in birds extends to the infrasound region. It has been assumed that they are able to hear the infrasounds generated in the mountains and seaside and navigate by using them. Of the senses of birds, the most exotic one is the ability to sense magnetic fields of the earth.
[Horse, cow and reindeer were converted into arctic domestic animals].
Kantanen J
Duodecim · 2016 · PMID 27522831
Domestic animal production in the arctic region is often thought to be based exclusively on reindeer herding. There are, however, regions in Northern Europe and Siberia having a long tradition in rearing breeds of cattle...
Domestic animal production in the arctic region is often thought to be based exclusively on reindeer herding. There are, however, regions in Northern Europe and Siberia having a long tradition in rearing breeds of cattle and horse adapted to the northers conditions also. The development of these arctic animal breeds has been largely founded on old tradition rather than on the programs of breeding organizations. As a result of the selection carried out by nature and man, the domestic animals of arctic regions express characteristics that are metabolic, structural, associated with reproductive physiology and conducive to the adaptation to arctic conditions.
[One Health--mutual health of humans, animals and the environment].
Sukura A, Hänninen ML
Duodecim · 2016 · PMID 27522830
The detection in the early 2000's of new, pandemically spreading viral diseases and threats led to "One Health", a holistic concept of the inevitability of collaboration between human and animal health and the protection...
The detection in the early 2000's of new, pandemically spreading viral diseases and threats led to "One Health", a holistic concept of the inevitability of collaboration between human and animal health and the protection of the ecosystem. The movement initiated by physicians and veterinarians emerges form the idea that the health of humans and animals is interconnected and connected with the environment and that changes occurring in the environment will have a significant impact on health. Problems associated with health, such as antimicrobial resistance or zoonoses, require global solutions.
[Dogs as a diagnostic tool--utopian dream or unexploited possibility?].
Klockars T
Duodecim · 2016 · PMID 27522829
The dog's sense of smell has been estimated to be as much as 100 000 times more sensitive than that of man. While the dog's sense of smell is utilized by various authorities, medical exploitation of dogs is scarce. A dis...
The dog's sense of smell has been estimated to be as much as 100 000 times more sensitive than that of man. While the dog's sense of smell is utilized by various authorities, medical exploitation of dogs is scarce. A disorder causes in the body metabolic changes, which could possibly be detected by using trained dogs. Promising studies have been published in recent years about the use of diagnostic dogs in identifying cancers or antibiotic-associated diarrhea, for example.
[What will determine the first-line treatment of a patient with rectal cancer?].
Lepistö A, Kouri M, Savolainen R … +1 more , Ristimäki A
Duodecim · 2016 · PMID 27483636
Treatment of a rectal cancer patient is devised by a multidisciplinary expert team. The first thing to be solved is whether a curative treatment, one slowing the progression of the disease, or a symptomatic treatment is...
Treatment of a rectal cancer patient is devised by a multidisciplinary expert team. The first thing to be solved is whether a curative treatment, one slowing the progression of the disease, or a symptomatic treatment is aimed at. The extent of the disease is assessed by using whole body CT scan and MR imaging of the rectum. When aiming at curative treatment, the need for preoperative radiation therapy and the surgical technique is assessed on the basis of MRI and clinical examination. The patient's physical condition, associated diseases or pelvic radiotherapy previously applied due to other diseases may restrict the choice of treatment. In an advanced disease, cytostatic chemotherapy is usually the first-line therapy, unless the tumor is obstructing the bowel.
[Multidisciplinary tailoring of therapy of metastatic colon cancer].
Österlund P, Isoniemi H, Scheinin T … +2 more , Ristimäki A, Lantto E
Duodecim · 2016 · PMID 27483635
Treatment of colon cancer requires multidisciplinary team work. The multitude of therapies in metastatic colon cancer have led to longer overall survival with fewer symptoms. Median survival has increased from 5 months w...
Treatment of colon cancer requires multidisciplinary team work. The multitude of therapies in metastatic colon cancer have led to longer overall survival with fewer symptoms. Median survival has increased from 5 months with the best supportive care to 30-40 months in randomized studies, even with curative treatment in some patients. Tailoring of the treatment is best done by a multidisciplinary team considering radiotherapy and operation of the primary tumor, resection of liver, lung and peritoneal metastases, medical treatment alternatives, palliative care, ablative methods etc. Without skillful surgeons, oncologists, pathologists, geneticists, radiologists etc. the best treatment opportunities may be missed.
[Imaging of rectal cancer--key to treatment decisions].
Savolainen R
Duodecim · 2016 · PMID 27483634
The current guidelines (EURECCA consensus statement 2013) for preoperative imaging of rectal cancer recommend MRI for local staging and CT of the chest, abdomen and pelvis for detection of distant metastases. High resolu...
The current guidelines (EURECCA consensus statement 2013) for preoperative imaging of rectal cancer recommend MRI for local staging and CT of the chest, abdomen and pelvis for detection of distant metastases. High resolution MR enables preoperative identification of poor prognostic features. These poor prognostic features are correlated with an increased risk of local recurrence and/or metastatic disease. MRI enables the preoperative multidisciplinary team to decide whether a patient benefits from adjuvant therapy and which surgical technique should be used. A radiological structured report helps clinicians get the most out of the report and increases the number of optimal reports.
[Streamlined treatment pathway for a colorectal cancer patient].
Rantala A, Ristamäki R, Keränen U
Duodecim · 2016 · PMID 27483633
The organization of colorectal cancer patient treatment, the pathway, is an important component of the quality of care of a large patient group as nearly 3000 colorectal cancer patients are diagnosed and treated annually...
The organization of colorectal cancer patient treatment, the pathway, is an important component of the quality of care of a large patient group as nearly 3000 colorectal cancer patients are diagnosed and treated annually in Finland. By designing and describing the whole pathway, the more streamlined approach can be made and thus improve patient care. Multidisciplinary team work between colorectal surgeons, oncologists, pathologists and radiologists is flexible team work, having been proven to improve overall treatment results. This method of working together is also a good tool for the development of the pathway to a better organized treatment.
[Novel techniques in the treatment of rectal cancer].
Rautio T, Kairaluoma M, Sand J
Duodecim · 2016 · PMID 27483632
Rectal cancer is the eighth and tenth most common kind of cancer in men and women, respectively, with an increasing frequency of occurrence. Together with cancer of the large intestine it forms the third most common canc...
Rectal cancer is the eighth and tenth most common kind of cancer in men and women, respectively, with an increasing frequency of occurrence. Together with cancer of the large intestine it forms the third most common cancer entity. Surgical therapy is the most important form of treatment of rectal cancer; in combination with adjuvant therapy it will cure a significant proportion of the patients and provide relief for tumor-induced hemorrhagic and obstructive symptoms. The operation has usually been conducted as an open surgery with the use of simple instruments. In recent times, the operative techniques have become more versatile, and mini-invasive techniques have resulted in quicker recovery of the patients from the operation.
[Principles of oncologic drug therapy following surgery for bowel cancer].
Ristamäki R, Ålgars A
Duodecim · 2016 · PMID 27483631
Adjuvant chemotherapy for 6 months following curative resection of colorectal cancer (CRC) reduces recurrence risk and improves survival in lymph node positive, stage III disease. In stage II CRC the benefit of adjuvant...
Adjuvant chemotherapy for 6 months following curative resection of colorectal cancer (CRC) reduces recurrence risk and improves survival in lymph node positive, stage III disease. In stage II CRC the benefit of adjuvant chemotherapy is smaller and only recommended if high risk prognostic factors are present. Microsatellite instability in stage II CRC is associated with a favourable prognosis and when present adjuvant chemotherapy is not needed. Adjuvant chemotherapy improves disease outcome also in elderly patients (≥ 70 years) with stage III CRC, but is not recommended in stage II disease. Adjuvant chemotherapy should be started within 8 weeks following surgery.
[Risk factors and possibilities of prevention of bowel cancer].
Mecklin JP, Malila N, Kääriginen H … +2 more , Pajari AM, Färkkilä M
Duodecim · 2016 · PMID 27483630
The incidence of bowel cancer has doubled over the past 50 years. Although the treatment outcome has improved, 40% of those affected with the disease still die from it. Treatment in the terminal phase of the disease is e...
The incidence of bowel cancer has doubled over the past 50 years. Although the treatment outcome has improved, 40% of those affected with the disease still die from it. Treatment in the terminal phase of the disease is expensive and requires plenty of resources without resulting in patient recovery. Bowel cancer could theoretically be reduced by changing the living habits. Focusing of endoscopy resources to screening of symptomless patients would be a more realistic means. Because bowel cancer develops through an endoscopically detectable and slow-growing precancerous adenoma, it is possible to reduce massive disease burden through screening.
[Update on current care guidelines: Self-medication, Current Care Guideline].
Duodecim · 2016 · PMID 27483629
Self-medication should always be temporary. Self-medication can be used to relief or treat many symptoms and conditions. In general self-medication is safe when used properly. However all medicines may cause adverse even...
Self-medication should always be temporary. Self-medication can be used to relief or treat many symptoms and conditions. In general self-medication is safe when used properly. However all medicines may cause adverse events or have interactions with other drugs. It is important to consider all used drugs and other self-medication products when new drugs are added to the medication list. Persons using the drugs as well as health care personnel should be aware of benefits and harms of drugs.The guideline has recommendations for 10 symptoms that are typically treated with self-medication.
[The latest antipsychotics--novelties or reiteration of the old?].
Koponen H, Lappalainen J, Leinonen E
Duodecim · 2016 · PMID 27483628
Both conventional and more recent antipsychotics are effective in the treatment of hallucinatory and delusional symptoms in psychotic patients. With the exception of clozapine, no major differences in the efficacy of dif...
Both conventional and more recent antipsychotics are effective in the treatment of hallucinatory and delusional symptoms in psychotic patients. With the exception of clozapine, no major differences in the efficacy of different antipsychotics have been found in clinical drug trials. There are, however, significant differences between drugs in their adverse effects, and the new antipsychotics or dosage forms introduced over the past ten years actually provide novel alternatives for the treatment of patients having body weight issues or cardiometabolic risk factors. Long-acting injections in turn reduce the need for psychiatric hospital care.
[Pyrophosphate in medicine].
Goldman A, Boije af Gennis G, Xhaard H … +2 more , Meri S, Yli-Kauhaluoma J
Duodecim · 2016 · PMID 27483627
In all organisms from bacteria to humans, specific hydrolases--pyrophosphatases--hydrolyse inorganic pyrophosphate to phosphate. Without this, DNA, RNA and protein synthesis stops. Pyrophosphatases are thus essential for...
In all organisms from bacteria to humans, specific hydrolases--pyrophosphatases--hydrolyse inorganic pyrophosphate to phosphate. Without this, DNA, RNA and protein synthesis stops. Pyrophosphatases are thus essential for all life. In humans, disorders in pyrophosphate metabolism cause chondrocalcinosis and hypophosphatasia. Currently, pyrophosphate analogues, e.g. alendronate, are in clinical use in osteoporosis and Paget's disease but also for e.g. complications of prostate cancer. In bacteria and protozoan parasites, membrane-bound pyrophosphatases (mPPases), which do not occur in humans, convert pyrophosphate to a proton or sodium gradient. mPPases, which are crucial for protozoan parasites, are thus promising drug targets e.g. for malaria and leishmaniasis.
[Myocardial infarction in a patient free of coronary artery disease].
Ekström K, Lönnberg A, Anttonen O
Duodecim · 2016 · PMID 27400593
Triptans are widely used for treating migraine attacks. Their mechanism of action is attributable to cerebrovascular vasoconstriction. Vasoconstriction can occur also in the coronary arteries. Mild chest symptoms not rel...
Triptans are widely used for treating migraine attacks. Their mechanism of action is attributable to cerebrovascular vasoconstriction. Vasoconstriction can occur also in the coronary arteries. Mild chest symptoms not related to myocardial ischemia have been reported among triptan users. Severe cardiovascular events have also been reported, but they are extremely rare. There are few observational studies focusing on the cardiovascular risks of triptans. Triptans are nevertheless considered contra-indicated in patients with coronary artery disease. We report a case of zolmitriptan-induced myocardial infarction in a patient free of coronary artery disease.
[Severe trampoline injuries and their risk factors among children and the young].
Sinikumpu JJ, Salokorpi N, Suo-Palosaari M … +2 more , Pesälä J, Serlo W
Duodecim · 2016 · PMID 27400592
BACKGROUND: Although the majority of trampoline injuries in children are minor, severe injuries occur as well. METHODS: We have analyzed the risk factors, treatment and outcome of severe trampoline injuries treated in th...
BACKGROUND: Although the majority of trampoline injuries in children are minor, severe injuries occur as well. METHODS: We have analyzed the risk factors, treatment and outcome of severe trampoline injuries treated in the Oulu University Hospital in children and the young between April and November 2105. RESULTS: There was a total of eight severe injuries. Five injuries involved a danger of death. Almost all severe trampoline injuries resulted from an unsuccessful trick. A safety net was in use in half of the cases. CONCLUSIONS: All cervical spine injuries would have been avoided provided that the children would have refrained from doing a somersault on the trampoline.
[Osteoporosis: a clinical perspective].
Matikainen N
Duodecim · 2016 · PMID 27400591
Osteoporosis is defined by decreased bone density and microarchitectural deterioration that predispose to fragility fractures. The WHO diagnostic criteria of osteoporosis require bone densitometry but treatment is possib...
Osteoporosis is defined by decreased bone density and microarchitectural deterioration that predispose to fragility fractures. The WHO diagnostic criteria of osteoporosis require bone densitometry but treatment is possible on the basis of high clinical fracture risk and can be assessed by the FRAX risk algorithm. All those subject to fracture risk should be advised about proper basic treatment of osteoporosis, including exercise, prevention of falls, smoking cessation, avoidance of alcohol intake, and dietary or supplemental abundance of calcium and vitamin D. Underlying diseases must be studied after diagnosis of osteoporosis even if treatment is initiated without densitometry. When indicated, specific osteoporosis therapy includes bisphosphonates, denosumab, teriparatide, strontium ranelate or SERMs. In hypogonadism, gonadal steroids may be indicated alone or in addition to a specific treatment. Treatment effect and continuation are assessed after 2 to 5 years.
[Prophylactic platelet transfusions].
Ilmakunnas M, Remes K, Hiippala S … +2 more , Mäkisalo H, Åberg F
Duodecim · 2016 · PMID 27400590
The consumption of platelet products in Finland is exceptionally high. For the most part, platelets are transfused pre-operatively to thrombocytopenic patients in order to prevent hemorrhage. Most of the minor procedures...
The consumption of platelet products in Finland is exceptionally high. For the most part, platelets are transfused pre-operatively to thrombocytopenic patients in order to prevent hemorrhage. Most of the minor procedures could, however, be conducted even if the patients'platelet levels would be lower than usual. In cardiac surgery, platelets are used because of the hemorrhagic diathesis associated with platelet inhibitors. Platelet inhibitors will, however, also bind to transfused platelets, whereby instead of prophylactic platelet transfusions it would be more sensible to leave the thorax open and not carry out ineffective platelet transfusions until the effect of the inhibitors has run out. We outline the prophylactic use of platelets based on recent international clinical practice guidelines.
[Diagnosis and follow-up observation of granulosa cell tumor of the ovary are becoming more precise].
Färkkilä A, Unkila-Kallio L
Duodecim · 2016 · PMID 27400589
Granulosa cell tumor of the ovary is a rare, hormonally active ovarian cancer, typical symptoms of which include various gynecological bleeding disorders. Adult granulosa cell tumor is most commonly detected at stage I,...
Granulosa cell tumor of the ovary is a rare, hormonally active ovarian cancer, typical symptoms of which include various gynecological bleeding disorders. Adult granulosa cell tumor is most commonly detected at stage I, whereupon the prognosis is good. The disease, however, recurs in one third of stage I patients and leads to death in half of these. Conventional cytotoxic agents may be ineffective in the treatment of relapsed tumors. Inhibin B and anti-Müllerian hormone have proven to be sensitive and accurate markers. Knowledge about the disease mechanisms has improved the diagnostics and follow-up observation of the patients.
[Pediatric orthopedic cervical spine problems].
Helenius I
Duodecim · 2016 · PMID 27400588
Treatment-requiring diseases of the cervical spine in children are rare. The most common cases requiring medical assessment and treatment are acute torticollis and various accidents. A torticollis having lasted for more...
Treatment-requiring diseases of the cervical spine in children are rare. The most common cases requiring medical assessment and treatment are acute torticollis and various accidents. A torticollis having lasted for more than a week should be recognized, because it can be treated by skull traction. Cervical spine fractures in children under school age are very rare, the most common being a fracture of the base of the dens of the second cervical vertebra. Cervical spine instability is almost always associated with an underlying disease.
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