Surgery has been the standard treatment in localized non-small cell lung cancer. Some of the early stage lung cancer patients are not suitable for surgery owing to associated diseases or refusing surgery. Ninety percent...Surgery has been the standard treatment in localized non-small cell lung cancer. Some of the early stage lung cancer patients are not suitable for surgery owing to associated diseases or refusing surgery. Ninety percent of untreated patients die within five years. Stereotactic ablative radiotherapy is a technique in which highly focused radiation treatment is given at a couple of high single doses to the tumor region. The treatment results in an average of 90% local control of the cancer, and the adverse effects are minor. Treatment outcome is equivalent to those of surgical therapy and is better than obtained with conventional external radiation therapy.
Lappi-Blanco E, Randell J, Jartti A
… +2 more, Ahvenjärvi L, Halme M
Duodecim
· 2016 · PMID 27132295
In the diagnosis of lung cancer, tissue and cytologic specimens are needed for confirmation of the diagnosis, elucidation of the histologic type of lung cancer, determination of the extent of the cancer, and increasingly...In the diagnosis of lung cancer, tissue and cytologic specimens are needed for confirmation of the diagnosis, elucidation of the histologic type of lung cancer, determination of the extent of the cancer, and increasingly also for the molecular biological investigations required for the planning of drug therapy. The site and method of specimen collection are chosen multidisciplinarily on the basis of imaging studies, taking the clinical picture and patient safety into consideration. High-quality and quantitatively representative specimens are required for molecular biological analyses, and assessment of the response to drug therapy or modifying the treatment may require a new sample, which can be a tissue or cytologic specimen or a liquid biopsy.
In addition to conventional cytotoxic agents, novel drug treatments have in the last few years been introduced for the treatment of non-small cell lung cancer. Whereas some of the novel treatments have brought significan...In addition to conventional cytotoxic agents, novel drug treatments have in the last few years been introduced for the treatment of non-small cell lung cancer. Whereas some of the novel treatments have brought significant improvement in treatment outcome, the benefit brought about by the treatment has in some cases been quite small in comparison with the costs and adverse effects. In the present review we explore the goals of drug treatments of disseminated lung cancer, assessment of therapeutic benefits as well as most significant research results of novel drug treatments of the lastfew years In addition, we evaluate the effect of the novel drug treatments on Finnish treatment practices.
Death from infections among previously healthy infants is rare in our country. Occasionally, warning of a severe disease may in the initial phase of the disease become manifest only from the parents' description of the c...Death from infections among previously healthy infants is rare in our country. Occasionally, warning of a severe disease may in the initial phase of the disease become manifest only from the parents' description of the condition of their child. We describe two infants under the age of 3 months with paroxysmal cough, whose whooping cough progressed to require intensive care. A suspicion of whooping cough was not roused neither among those making the emergency care assessment nor by the attending physicians before the patients had to be placed on a ventilator as the illness progressed. One of our patients succumbed to the illness despite of intensive care. Whooping cough should be suspected in all unimmunized infants having paroxysmal cough.
Symptoms of the psychotic type are relatively common in young persons, but seldom result in the development of an actual psychotic disorder. Psychotic-like symptoms in the young are, however, associated with more severe...Symptoms of the psychotic type are relatively common in young persons, but seldom result in the development of an actual psychotic disorder. Psychotic-like symptoms in the young are, however, associated with more severe psychiatric symptoms and a less favorable prognosis, whereby their identification is important in psychiatric treatment. A symptom-oriented approach is important in the treatment: instead of the possible risk of psychosis, focus will be on the actual situation, taking the total symptom picture and the person's life situation into consideration. Cognitive psychotherapy is the recommended first-line treatment for psychotic-like symptoms.
In Finland, growth monitoring is a fundamental part of preventive child health care, aiming at an early detection of childhood illnesses as well as weight gain or loss. However, evidence-based studies on growth monitorin...In Finland, growth monitoring is a fundamental part of preventive child health care, aiming at an early detection of childhood illnesses as well as weight gain or loss. However, evidence-based studies on growth monitoring are practically lacking. Updated growth curves must be representative of the monitored population. Screening of Turner syndrome and celiac disease with novel growth monitoring methods could facilitate early diagnosis. Electronic health records provide an alternative to develop an automated growth monitoring program, which was found to be distinctly better than the manually orientated one in primary care. Systematic growth monitoring seems to be beneficial, although true population- based evidence on effectiveness is scarce.
Rauramaa R, Kukkonen-Harjula K, Arokoski J
… +10 more, Hohtari H, Ketola E, Kettunen J, Komulainen P, Kujala U, Laukkanen J, Pylkkänen L, Savela S, Savonen K, Tikkanen H
Duodecim
· 2016 · PMID 27089621
The purpose of the guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity plays a key role in the management of several chronic noncommunicable diseases....The purpose of the guideline is to promote physical activity in the prevention, treatment and rehabilitation of diseases. Physical activity plays a key role in the management of several chronic noncommunicable diseases. In this guideline, the following diseases are discussed: endocrinological, cardiovascular, musculoskeletal and respiratory diseases, as well as depression and cancer. In addition, physical activity during pregnancy and in senior citizens is reviewed. Exercise counseling should be included as part of disease management and lifestyle guidance.
Diagostic approach to aneurysmal subarachnoid hemorrhage (aSAH) is based on computer tomography (CT) imaging, although a lumbar puncture and subsequent cerebrospinal fluid analysis is sometimes necessary. Identification...Diagostic approach to aneurysmal subarachnoid hemorrhage (aSAH) is based on computer tomography (CT) imaging, although a lumbar puncture and subsequent cerebrospinal fluid analysis is sometimes necessary. Identification of the ruptured aneurysm is done using angiography. Despite of modern imaging techniques, diagnostic definition of aSAH is still occasionally challenging. We describe three cases in which the diagnosis of aSAH has been delayed, in spite of positive imaging or lumbar puncture findings.
An efficient therapy for cough usually requires identification and treatment of the underlying disease, like asthma. However an underlying disease in cough is not found in all cases and conventional treatment of the unde...An efficient therapy for cough usually requires identification and treatment of the underlying disease, like asthma. However an underlying disease in cough is not found in all cases and conventional treatment of the underlying disease is ineffective against cough. Drug therapy options are available also for these situations. Honey or menthol can be tried for cough associated with respitatory infections, antihistamines for cough associated with allergic rhinitis, blockers of the leukotriene receptor or muscarinic receptor for asthma-associated cough and morphine for cough associated with a malignant disease. Menthol, blockers of the muscarinic receptor, or dextrometorphan can be tried for prolonged idiopathic cough. Codeine is not necessary in the treatment of cough. Refraining from drug treatment should always be considered.
Novel insulins have entered the market during recent years. The ultra-long acting insulins, insulin degludek and insulin glargine, the latter having a strength of 300 U/ml, exhibit a steady and predictable action curve....Novel insulins have entered the market during recent years. The ultra-long acting insulins, insulin degludek and insulin glargine, the latter having a strength of 300 U/ml, exhibit a steady and predictable action curve. Studies have indicated that significantly fewer hypoglycemiae occur when using degludek in patients with either type 1 or type 2 diabetes, whereas similar evidence about glargine (300 U/mI) has been obtained in the treatment of type 2 diabetes. The long duration of action of both insulins brings long-needed flexibility to.their dosing.
Helanterä I, Sadeghi M, Lautenschlager I
… +2 more, Hedman K, Auvinen E
Duodecim
· 2016 · PMID 27089617
The number of polyomaviruses causing infections in humans is as high as thirteen. The BK and JC polyomaviruses and the diseases caused by them are best known. For the present, the Merkel cell polyomavirus is the only hum...The number of polyomaviruses causing infections in humans is as high as thirteen. The BK and JC polyomaviruses and the diseases caused by them are best known. For the present, the Merkel cell polyomavirus is the only human polyomavirus considered to be a causative agent of cancer. Other disease associations of polyomaviruses are also subject to active research. All polyomavirus infections are usually harmless respiratory or intestinal infections of childhood. Polyomaviruses, remain in the body for the rest of life, i.e. they persist as part of the body microbiome. Upon weakening of cell-mediated immunity they can also become reactivated and cause clinical problems.
Currently a large proportion of patients with severe burn injuries survive. This gives increasing challenges also for psychological recovery after the trauma. More than half of burn patients have mental disorders already...Currently a large proportion of patients with severe burn injuries survive. This gives increasing challenges also for psychological recovery after the trauma. More than half of burn patients have mental disorders already before the burn injury but also patients who previously had no mental disorders may suffer from them. Some of the hospitalize burn patients have injuries due to suicidal attempts. Only a small proportion of burn patients receive appropriate psychiatric care although psychosocial interventions specifically planned for burn victims exist. More frequent screening of symtoms of mental disorders and psychiatric consultation, also after acute care in hospital, could lead to better management of post-burn psychiatric care as well as better management of the burn treatment and rehabilitation itself.
Tienari P, Kiviharju A, Valori M
… +2 more, Lindholm D, Laaksovirta H
Duodecim
· 2016 · PMID 27089615
The mechanisms of neurodegenerative diseases have begun to become unraveled, thanks to the progress in stem cell research. The repeat expansion in the C90RF72 gene was identified in 2011 as the most common genetic cause...The mechanisms of neurodegenerative diseases have begun to become unraveled, thanks to the progress in stem cell research. The repeat expansion in the C90RF72 gene was identified in 2011 as the most common genetic cause of both ALS and frontal lobe dementia. Only over a couple of years the disease mechanisms of this mutation have been revealed and treatment trials have already been conducted in nerve cell cultures differentiated from patients' stem cells. We discuss the role of the repeat expansion in the C90RF72 gene in the epidemiology of the diseases and the resulting disturbances in nerve cell function.
Pekkonen E, Atula S, Autere J
… +6 more, Eerola-Rautio J, Kaasinen V, Kauppinen M, Martikainen K, Ruottinen H, Viljamaa M
Duodecim
· 2016 · PMID 27044185
The treatment of Parkinson's disease may be initiated with dopamine agonist or MAO-B-inhibitor for people under 60-65 years of age. For older patients, the treatment may also be started with levodopa. If there are motor...The treatment of Parkinson's disease may be initiated with dopamine agonist or MAO-B-inhibitor for people under 60-65 years of age. For older patients, the treatment may also be started with levodopa. If there are motor complications, such as on-off-symptoms, apomorphin injections can be beneficial in addition to other medications. In the case of difficult on-off-symptoms and dyskinesias in spite of optimal treatment, deep brain stimulation, duodenal levodopa infusion and apomorphine infusion should be considered. Rehabilitation can improve gait speed and balance, decrease falls and improve speech. However, with advancing disease the results are not maintained if trainino is discontinued.
The most common cause of persistent postoperative pain after inguinal hernia repair is entrapment of a sensory nerve in the wound closure, The pain may be triggered by touching the skin, and the pain is relieved after a...The most common cause of persistent postoperative pain after inguinal hernia repair is entrapment of a sensory nerve in the wound closure, The pain may be triggered by touching the skin, and the pain is relieved after a nerve block. In two patient cases, division of the nerve immediately terminated the pain, and the relief seemed to be permanent. Pains are common in inguinal hernia scars, but also after an appendectomy operation and Pfannenstiel's incision.
Chest radiography is the most common radiological examination in children. The indications are severe or complicatec pneumonia, exclusion of other diseases when diagnosing asthma, and suspected foreign body aspiration if...Chest radiography is the most common radiological examination in children. The indications are severe or complicatec pneumonia, exclusion of other diseases when diagnosing asthma, and suspected foreign body aspiration if emergency bronchoscopy is not performed. Community-acquired pneumonia can be diagnosed on the basis of clinical symptoms anc findings alone, but if hospitalization is needed for pneumonia, the diagnosis needs to be confirmed with chest radiography Imaging is the only reliable method to assess the severity of pneumonia and to detect the complications.
Hahl T, Peromaa-Haavisto P, Tarkiainen P
… +2 more, Knutar O, Victorzon M
Duodecim
· 2016 · PMID 27044182
BACKGROUND: Relatively little is known about the use of fast track protocols in bariatric surgery. MATERIAL AND METHODS: We carried out an observational study of 422 consecutive patients who underwent bariatric surgery b...BACKGROUND: Relatively little is known about the use of fast track protocols in bariatric surgery. MATERIAL AND METHODS: We carried out an observational study of 422 consecutive patients who underwent bariatric surgery by a fast track protocol. RESULTS: Mean length of stay was 1.3 days, median 1 day. Of all patients, 83% were discharged on the first postoperative day. Three patients (0.7%) had life-threatening complications. The readmission rate was 4.7%, and 3.3% of the patients had to be reoperated. The body weight dropped 31% in a year. CONCLUSIONS: Early discharge does not seem to increase postoperative morbidity or readmissions.
According to the polyvagal theory, the autonomic nervous system can, in deviation from the conventional theory, be divided in three distinct parts that are in hierarchical relationship with each other. The most-primitive...According to the polyvagal theory, the autonomic nervous system can, in deviation from the conventional theory, be divided in three distinct parts that are in hierarchical relationship with each other. The most-primitive autonomic control results in depression of vital functions, the more evolved one in fighting or escape and the most evolved one in social involvement. Practical application of the polyvagal theory has resulted in positive results above all in the treatment of emotional trauma. in Finland, therapy of complex trauma is founded on the theory of structural dissociation of the personality, which together with the polyvagal theory forms a practical frame of reference for psychotherapeutic work.
Conventional anticancer drugs, cytotoxic agents, function by killing all rapidly dividing cells without distinguishing between cancer cells and normal cells of the body. Understanding of the regulatory mechanisms of the...Conventional anticancer drugs, cytotoxic agents, function by killing all rapidly dividing cells without distinguishing between cancer cells and normal cells of the body. Understanding of the regulatory mechanisms of the immune system has enabled the development of immunotherapeutic drugs and, through them, liberation of the immune response for the management of cancer. In Finland, interferons and antibody therapies represent the clinically applied immunotherapy of melanoma. While most antibody therapies are fairly harmless, the new drugs enhancing T cell defense are associated with a significant risk of autoimmune adverse effects. Immediate recognition and treatment of adverse effects are essential for the survival of the patients.
Salmela P, Metso S, Moilanen L
… +3 more, Niskanen L, Nuutila P, Schalin-Jäntti C
Duodecim
· 2016 · PMID 27044179
The diagnosis of hypothyroidism is based on the findings of an increased serum TSH (above the reference range) and decreased serum free T4 (below the reference range) concentration. Treatment of subclinical hypothyroidis...The diagnosis of hypothyroidism is based on the findings of an increased serum TSH (above the reference range) and decreased serum free T4 (below the reference range) concentration. Treatment of subclinical hypothyroidism is indicated if serum THS is above 10 mU/l. For less severe forms of subclinical hypothyroidism, the treatment should be individually tailored. The treatment of choice is synthetic human levothyroxine. The goals for treatment are amelioration of symptoms and normalization of TSH and free T4 concentrations.