Duodecim; Laaketieteellinen Aikakauskirja[JOURNAL]
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200 papers
[Gynecological ultrasound examination at the general health care emergency department].
Forsbom O, Väyrynen T, Hurskainen R
Duodecim · 2016 · PMID 27244937
Vaginal ultrasound examination is a possible addition for the general health care emergency department. It gives additional information of gynecological illnesses and pregnancy. Ultrasound can guide treatment and make co...
Vaginal ultrasound examination is a possible addition for the general health care emergency department. It gives additional information of gynecological illnesses and pregnancy. Ultrasound can guide treatment and make consulting the right specialty easier when treating women with acute abdominal pain. Correctly used ultrasound can also reduce the need for consultation and speed up treatment, especially in early pregnancy. The physician performing the ultrasound should know the diagnostic capabilities of ultrasound and compare findings to the clinical status and history. Ultrasound can't replace clinical history and status in any situation. A pregnancy test, hemoglobin or CRP are often required to achieve diagnosis.
[Ultrasonography-guided procedures of the doctor on call].
Lehtimäki TE
Duodecim · 2016 · PMID 27244936
The use of ultrasonography in guiding minor procedures reduces the possibility of procedural complications. Fluid is easy to identify, enabling the utilization of ultrasonography even with a lesser experience. In skilled...
The use of ultrasonography in guiding minor procedures reduces the possibility of procedural complications. Fluid is easy to identify, enabling the utilization of ultrasonography even with a lesser experience. In skilled hands, drainage of ascitic fluid, pleurocentesis and insertion of a suprapubic catheter are safe procedures. Careful planning of the procedure in advance will contribute to safety. Before undertaking the procedure, one should confirm the patient's coagulation status and appropriate interruption of possible antithrombotic medication. The injection site is chosen on anatomical grounds, avoiding any blood vessels. The ultrasound view is adjusted optimally so that the route of injection can be seen as clearly as possible on the screen.
[Ultrasound in the hands of emergency physicians].
Lukkarinen T, Palomäki A
Duodecim · 2016 · PMID 27244935
Emergency ultrasound (US) offers additive value in the diagnosis and treatment of emergency and/or critically ill patients. Emergency Medicine (EM) became a new specialty in Finland in the beginning of 2013. Since then,...
Emergency ultrasound (US) offers additive value in the diagnosis and treatment of emergency and/or critically ill patients. Emergency Medicine (EM) became a new specialty in Finland in the beginning of 2013. Since then, the training of emergency US has dramatically increased. We discuss the current situation of emergency US as a part of specialist training of EM in Finland and compare it with that in the United States and Canada. Practical indications, limitations and future prospects of emergency US are also presented.
[Update on current care guidelines. Pain].
Mäntyselkä P, Haanpää M, Hagelberg N … +6 more , Helin-Salmivaara A, Kokki H, Komulainen J, Pohjolainen T, Saikkonen K, Salanterä S
Duodecim · 2016 · PMID 27244934
Management of patients suffering from chronic pain is based on long-term therapeutic relationship. The main objectives of the treatment are pain relief, restoration of function and improvement of quality of life. Interve...
Management of patients suffering from chronic pain is based on long-term therapeutic relationship. The main objectives of the treatment are pain relief, restoration of function and improvement of quality of life. Interventions for treatment and rehabilitation need to be planned in agreement with the patient. Non-pharmaceutical interventions form the basics of the treatment. If medication is needed, it should be tailored to meet the individual needs of the patient according to the etiology and intensity of pain, comorbidities and psychosocial situation.
[Herpes zoster in the pharynx].
Sipari S, Koivula I, Löppönen H
Duodecim · 2016 · PMID 27244933
A 74-year-old woman was suspected of having a peritonsillar abscess. She had a light-coloured coating on the pharynx and the larynx, bordering to the left of the median line, as well as laryngeal edema on the side of the...
A 74-year-old woman was suspected of having a peritonsillar abscess. She had a light-coloured coating on the pharynx and the larynx, bordering to the left of the median line, as well as laryngeal edema on the side of the lesion. On the basis of precisely unilateral findings we arrived at pharyngeal herpes zoster as the working diagnosis. The diagnosis was further supported by the detection of varicella-zoster virus DNA in the mucosa and the presence of positive IgM antibody levels. The patient was treated with an antiviral drug, an antimicrobial drug and a glucocorticoid. Mucosal lesions and edema returned to normal, and the patient was discharged. The precise unilaterality of the symptoms is essential to the diagnosis.
[Heterotopic pregnancy during the second trimester is a severe complication of pregnancy].
Färkkilä A, Laitinen L
Duodecim · 2016 · PMID 27244932
Heterotopic pregnancy is a rare form of ectopic pregnancy in which one gestational sac is found in the uterus and another one in an extrauterine location. The spontaneous heterotopic pregnancy of our patient continued un...
Heterotopic pregnancy is a rare form of ectopic pregnancy in which one gestational sac is found in the uterus and another one in an extrauterine location. The spontaneous heterotopic pregnancy of our patient continued until the second trimester. In the 19th week of pregnancy, undiagnosed ectopic pregnancy in the left fallopian tube ruptured into the abdominal cavity, leading to a massive intra-abdominal hemorrhage. Left-side uterine appendages were excised in open surgery, but intrauterine pregnancy continued in vital form. Histologic examination revealed the excised tumor to be an ectopic pregnancy. The hypotension experienced by the patient led, however, to severe brain damage of the intrauterine fetus and induced abortion.
[Immuno-oncology--silver bullets or mass destruction weapons?].
Utriainen M, Rämet M
Duodecim · 2016 · PMID 27244931
Modes of treatment affecting the regulatory mechanisms of cell-mediated immunity are changing the treatment practices of various types of cancer. Antibodies inhibiting regulatory molecules of the immune response, i.e. ch...
Modes of treatment affecting the regulatory mechanisms of cell-mediated immunity are changing the treatment practices of various types of cancer. Antibodies inhibiting regulatory molecules of the immune response, i.e. checkpoint inhibitors, are of particular interest. The mechanism of action is enhancement of the body's intrinsic responses to cancer cells through inhibition of negative regulation of the immune defense. Cell-mediated immunity directed to cancerous tissue can be enhanced by removing the brake associated with T-cell activation (CTLA-4 inhibitors). A more physiological mode of action is to abolish the attenuation mechanism of already activated T cells (PD-1 inhibitors). The physiological purpose of both mechanisms is to prevent an excessively strong immune reaction and thus autoimmunity.
[Possibilities of bacteriophage therapy].
Skurnik M, Kiljunen S
Duodecim · 2016 · PMID 27244930
Antibiotic resistance of bacterial pathogens has increased, and new therapies are urgently needed. Bacteriophages (phages), viruses infecting and killing bacteria, are the most abundant organisms on earth. In nature ther...
Antibiotic resistance of bacterial pathogens has increased, and new therapies are urgently needed. Bacteriophages (phages), viruses infecting and killing bacteria, are the most abundant organisms on earth. In nature there are several specific phages for every bacterium, controlling bacterial numbers and maintaining ecological balance. Phage therapy, i.e., treating bacterial infections with phages, offers an alternative complementary to antibiotics as phages infect and kill also multi-resistant bacteria. Phages possess narrow host specificity, each phage infecting only a few bacterial species or strains. Thereby phages do not harm the normal microbiota as antibiotics do. We aim to begin clinical trials of phage therapy in Finland.
[Update on Current Care Guideline: Venous thromboembolism (VTE): deep venous thrombosis and pulmonary embolism].
Duodecim · 2016 · PMID 27188093
Key recommendations in management of VTE include prompt and systematic diagnostics based on clinical probability, D-dimer testing and imaging studies, and individualized antithrombotic treatment. Outpatient management is...
Key recommendations in management of VTE include prompt and systematic diagnostics based on clinical probability, D-dimer testing and imaging studies, and individualized antithrombotic treatment. Outpatient management is encouraged for patients with favourable prognosis. Interventions such as thrombolysis, venous stenting and inferior vena cava filters are limited to specific subgroups of patients. The duration of anticoagulation is tailored by balancing the risks of VTE recurrence and bleeding. Without contraindications, the minimal duration of anticoagulation is 3 months. The selection between warfarin, direct oral anticoagulants (apixaban, dabigatran, rivaroxaban) and low molecular weight heparin is based on individual patient characteristics and suitability of each drug.
[Thoracic lavage and open cardiac massage as treatment of hypothermic cardiac arrest--case report].
Koponen T, Vänni V, Kettunen M … +2 more , Reinikainen M, Hakala T
Duodecim · 2016 · PMID 27188092
Cardiopulmonary bypass is the treatment of choice for a severely hypothermic patient with cardiac arrest. However, the treatment is not always available. We describe a successful three-and-a-half hour resuscitation of a...
Cardiopulmonary bypass is the treatment of choice for a severely hypothermic patient with cardiac arrest. However, the treatment is not always available. We describe a successful three-and-a-half hour resuscitation of a hypothermic cardiac arrest patient with manual chest compressions followed by open cardiac massage and rewarming with thoracic lavage.
[Sarcoidosis-lymphoma syndrome].
Partanen A, Pukkila S, Jantunen E
Duodecim · 2016 · PMID 27188091
Lymphoma risk is increased in middle-aged patients in association with chronic active sarcoidosis. The sarcoidosis- lymphoma syndrome poses a challenge for differential diagnosis particularly in the era of fluoro-deoxy-g...
Lymphoma risk is increased in middle-aged patients in association with chronic active sarcoidosis. The sarcoidosis- lymphoma syndrome poses a challenge for differential diagnosis particularly in the era of fluoro-deoxy-glucose positron emission tomography-computed tomography (FDG-PET-TT). Upon detection of enlargement of lymph nodes, the diagnosis should be confirmed with a histological sample.
[Recognize tuberculosis--prevent outbreak].
Soini H, Kotilainen H, Marttila H … +7 more , Marttila J, Pietikäinen R, Ruotsalainen E, Smit P, Valve K, Vasankari T, Lyytikäinen O
Duodecim · 2016 · PMID 27188090
INTRODUCTION: The number of tuberculosis cases in Finland has decreased. Cases among immigrants have, however, increased, and the disease may not be recognized early enough. METHODS: We describe four group exposures to t...
INTRODUCTION: The number of tuberculosis cases in Finland has decreased. Cases among immigrants have, however, increased, and the disease may not be recognized early enough. METHODS: We describe four group exposures to tuberculosis that occurred in Finland, the index patient coming from a country with a high incidence rate of tuberculosis. RESULTS: Over 900 persons were exposed to tuberculosis. Coordination of the surveys was hampered by the fact that several healthcare operators participated in the study. Three index patients had drug-resistant tuberculosis, one of which was multidrug resistant. CONCLUSIONS: Extensive operations of tracking and prevention could have been avoided, if the symptoms would have been recognized earlier.
[Rapid diagnosis of diarrhea viruses].
Loginov R, Mannonen L, Lappalainen M
Duodecim · 2016 · PMID 27188089
Viral diagnosis is required mainly in the analysis of outbreaks of diarrhea, cases of gastroenteritis in infants and in the exploration of the cause of diarrhea in severely ill patients. Antigens of rotaviruses and adeno...
Viral diagnosis is required mainly in the analysis of outbreaks of diarrhea, cases of gastroenteritis in infants and in the exploration of the cause of diarrhea in severely ill patients. Antigens of rotaviruses and adenoviruses can be detected in the feces of the patient, and the rapid tests applied have proven to possess sufficient sensitivity. Sensitivities of the tests intended for norovirus antigen detection have instead remained poor. In addition to antigen detection tests, a real-time PCR test based on the,detection of norovirus nucleic acids has come onto the market, being both easy to use and substantially more sensitive. In the future, multiplex PCR tests allowing simultaneous detection of several different diarrhea-causing microorganisms are expected to become more common.
[Drug therapy of advanced pancreatic neuroendocrine tumor].
Ristamäki R, Tarkkanen M
Duodecim · 2016 · PMID 27188088
Although several options of drug therapy exist for advanced neuroendocrine cancer of pancreatic origin, few data based on randomized studies are available. The results of the most recent randomized placebo-controlled stu...
Although several options of drug therapy exist for advanced neuroendocrine cancer of pancreatic origin, few data based on randomized studies are available. The results of the most recent randomized placebo-controlled studies are obscured by the assignment of patients from the placebo branch to the treatment branch. Application of the study results is further hampered by small patient groups, heterogeneity and retrospective set-up of study materials and, in older studies, inaccurate response assessment. We describe drug therapies that can be utilized to affect the clinical course of locally advanced or metastatic neuroendocrine cancer of pancreatic origin. Supportive therapy of hormonally active tumors has been restricted to somatostatin analogue treatment.
[New psychosocial therapies for schizophrenia].
Viertiö S, Mehtälä T, Sailas E
Duodecim · 2016 · PMID 27188087
Almost all schizophrenia patients suffer from various cognitive symptoms that cause difficulties in everyday living and lower the quality of life even when psychotic symptoms are in remission. Defects in social cognition...
Almost all schizophrenia patients suffer from various cognitive symptoms that cause difficulties in everyday living and lower the quality of life even when psychotic symptoms are in remission. Defects in social cognition constitute special problems that relate to recognizing facial expressions and understanding social situations, for example. There is no evidence that psychiatric medication improves these symptoms. On the other hand, there are several cognitive remediation programs that have been shown to be of use. New programs have also emerged to treat problems in social cognition. When neurocognitive rehabilitation is insufficient, a program that compensates for deficits in cognitive functioning is also available.
[Male breast cancer].
Mattson J, Vehmanen L
Duodecim · 2016 · PMID 27188086
Breast cancer is rare in men. Diagnosis of the illness may be delayed due to the fact that the doctor and the patient fail to suspect it. Male breast cancer is treated mainly on the same principles as female breast cance...
Breast cancer is rare in men. Diagnosis of the illness may be delayed due to the fact that the doctor and the patient fail to suspect it. Male breast cancer is treated mainly on the same principles as female breast cancer. A man affected with breast cancer should always be directed to genetic testing, as inherited mutations increasing the risk of developing cancer are more common than in female breast cancer. Most breast cancers in men are hormone receptor positive. Among hormone treatments, the antiestrogen tamoxifen exhibits the best efficacy both in early-state and advanced cases.
[Percutaneous treatment of coronary chronic total occlusions].
Kajander OA, Ilveskoski E, Jussila R
Duodecim · 2016 · PMID 27188085
Chronic total occlusions (CTOs) are frequently detected on diagnostic coronary angiograms. For the selection of patients for CTO percutaneous coronary intervention, factors such as the level of symptoms, level of myocard...
Chronic total occlusions (CTOs) are frequently detected on diagnostic coronary angiograms. For the selection of patients for CTO percutaneous coronary intervention, factors such as the level of symptoms, level of myocardial viability and extent of ischemia must be taken into account. Remarkable progress has been achieved in the success of complex CTO procedures during the past decade. In addition to antegrade wire escalation strategy, subintimal passage of the guidewire with or without dissection and re-entry techniques and retrograde techniques can be utilized. After successful wiring of the lesion, balloon angioplasty and stenting comparable to a non-CTO lesion are performed.
[Molecular pathologic diagnosis of lung cancer requires basic knowledge also from clinicians].
Lappi-Blanco E, Salmenkivi K, Kytölä S … +1 more , Kononen J
Duodecim · 2016 · PMID 27132299
Besides histological classification of lung cancers, molecular biological examination of tumors is part of modern diagnostics of lung cancers, and cancer therapies are based on molecular biological diagnosis. Current lab...
Besides histological classification of lung cancers, molecular biological examination of tumors is part of modern diagnostics of lung cancers, and cancer therapies are based on molecular biological diagnosis. Current laboratory technique enables the examination of many mutations as part of standard routine diagnosis, necessitating functional multidisciplinary collaboration, with the pathologist playing a central role in the handling of the specimens. In the future, especially pathologists, pulmonary specialists and oncologists are expected to need a good command of molecular biological data on lung cancer, but basic knowledge will be required also from other physicians working with lung cancer patients.
[Developing surgical options for lung cancer].
Sihvo E
Duodecim · 2016 · PMID 27132298
The selection of correct treatment for lung cancer is multidisciplinary collaboration and requires careful assessment of the extent of the tumor and the condition of the patient. In localized non-small cell lung cancer,...
The selection of correct treatment for lung cancer is multidisciplinary collaboration and requires careful assessment of the extent of the tumor and the condition of the patient. In localized non-small cell lung cancer, mere surgery or surgery in combination with adjuvant therapies are the best options for curing the disease. The trend in modern surgery is mini-invasiveness and preservation of lung tissue. Accordingly, any unit conducting lung cancer operations should have access to all modern techniques in order to provide each patient with optimal, patient-tailored surgical therapy.
[Novel drug therapies and their cost-effectiveness in the treatment of lung cancer].
Purmonen T, Törmälehto S, Jekunen A
Duodecim · 2016 · PMID 27132297
The treatments of lung cancer have progressed significantly during the past ten years through the enhanced understanding of the underlying biological processes. Treatment outcomes have become better in the era of targete...
The treatments of lung cancer have progressed significantly during the past ten years through the enhanced understanding of the underlying biological processes. Treatment outcomes have become better in the era of targeted treatments, but these new treatments are more expensive than their predecessors. Cost-effectiveness of the new treatments has been widely evaluated internationally. Nevertheless, the results from these analyses have been contradictory. Based on the published evaluations it is neither possible to rank the new treatments nor is it possible to unambiguously claim the cost-effectiveness of the new treatments compared with traditional treatments. National cost-effectiveness analyses of lung cancer treatments have not been published in Finland.
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