Duodecim; laaketieteellinen aikakauskirja最新文献

Deformation imaging (strain imaging) is an echocardiographic method for evaluating myocardial function that is also suitable for clinical use. There are two deformation imaging techniques: Tissue Doppler and 2D strain (speckle tracking). Deformation imaging allows the measurement of regional myocardial deformation in three dimensions. Longitudinal deformation (strain) measures longitudinal myocardial fiber contraction, and reflects subendocardial myocardial function, which is usually the first to deteriorate in patients with heart disease. Reduced longitudinal strain can reveal heart disease even when ejection fraction and cardiac contractility appear normal. Deformation imaging can be used for diagnosing ischemia, distinguishing between pathological and physiological hypertrophy, and early detection of heart disease in hypertension or diabetes. Global longitudinal strain (GLS) is an indicator of overall left ventricular systolic function, and correlates with the prognosis better than ejection fraction.

Social media has brought about a major change in communication. Besides ordinary people, the change applies to organizations and public authorities. In the social media, the public becomes an active player and content provider. With social media, communication will become increasingly media-centered. The change in communication scenery has challenged traditional expertise. On the other hand, social media also opens up many possibilities for the establishment of expertise and health communication. Within the social media, communities can become significant sites for the production of knowledge and expertise. They may generate useful activity as regards the combination of health information activities and everyday life, but sometimes they can also become a cradle of false information. In its various forms, social media provides a versatile forum for health communication, where people can be met interactively.

Neck pain is usually non-specific, but serious illness or specific reasons for neck pain need to be ruled out. Patients are encouraged to continue their daily activities. Acute neck pain often disappears without any special treatment. Patient information is important. If pain medication is needed, paracetamol is the primary choice. Multidisciplinary treatment is recommended if disabling pain does not improve during the first two months. Neck-specific exercises are recommended in the chronic phase.

Background: There is no comprehensive data in our country on the prevalence of life-supporting prolonged invasive ventilation support. The objective of the survey was to clarify in all hospital districts of continental Finland the prevalence of patients who were dependent on invasive ventilation support, and the disease leading to the treatment.

Patients and methods: The KOTIVEHNO 2015 survey was carried out as population-based cross-sectional study by sending a questionnaire to all doctors in charge of prolonged invasive ventilation support. The questionnaires were used to collect data on the patients within care on 1st January, 2017.

Results: The prevalence of life-supporting prolonged invasive ventilation support in Finland among the population aged over 16 years or more was 2/4 patients/100,000 habitants. Altogether 107 patients were within the care. There was variation in the prevalence among the hospital districts. Of the patients, 24% were affected with a motoneuron disease, in 18% the cause was spinal cord injury, 15% suffered from Duchenne's muscular dystrophy, and the rest had some other rare neurological disease.

Conclusions: Life-supporting prolonged invasive ventilation support is rare in Finland. The treatment is associated with neuromuscular diseases causing respiratory insufficiency, and with spinal cord injuries.

It is important to remember the possibility of nonspecific thoracic outlet syndrome (TOS) when treating patients with neck and upper extremity symptoms. There are no specific diagnostic criteria for the syndrome. Diagnosis is based on symptoms, clinical examination and the ruling out of other causes. The first-line option of clinical care is conservative treatment, which in most cases is sufficient for the patient to regain normal functioning. However, some of the most difficult TOS patients need surgical treatment, especially when persistent symptoms have already begun in adolescence, and if compression of neural or vascular structures is thought to result from anatomical structures. Conservative treatment options are essential also for surgically treated patients.

Moisture damages and dampness in buildings is a risk factor for respiratory symptoms and development of asthma. Diagnostics and care of the patients must be based on general guidelines, regardless of potential moisture damage in home or work place. No laboratory or other clinical tests exist that can be used to associate potential moisture damage to perceived symptoms of the patient. Buildings affected by moisture damages should be remediated, because it is likely to be beneficial to health of the occupants and other users and for the condition of the building.

Invasive treatment of pericardial effusion comes into question when the volume of liquid in the pericardium limits the pumping action, the cause of effusion is unclear, the response to conservative treatment has been poor, or administration of a drug into the pericardium is desired. A number of surgical means or puncture techniques are available for pericardial drainage. We present the indications and modes of treatment for invasive treatment of pericardial effusion. Thrombi, pus or air may also occasionally be present in the pericardium, limiting the heart's pumping action.

Background: The epidemiology of Achilles tendon ruptures and treatment strategies have undergone a major change in recent years. We investigated the incidence of acute Achilles tendon ruptures, the choice of treatment strategies and treatment implementation.

Materials and methods: The research material consisted of patients living in the catchment area of Central Finland Hospital District who had been diagnosed with an acute Achilles tendon rupture between 2010 and 2015.

Results: The final sample consisted of 266 patients. Conservative treatment was started for 207 patients, and the remaining 59 were referred for surgery. During the study period, the proportion of patients undergoing surgery fell from 41% to 10%. Three patients (1.4%) were referred for surgery during conservative treatment, and 10 patients (4.7%) developed deep vein thrombosis while wearing a cast or an orthosis. Twelve patients (5.8%) sustained a re-rupture after conservative treatment. Two surgically-treated patients (3.5%) sustained a re-rupture, and one patient (1.7%) developed deep vein thrombosis.

Conclusions: The strategies for treating acute Achilles tendon ruptures have clearly become more conservative in our hospital. Conservative treatment is safe and rarely fails. However, it is important to bear in mind that surgery still has a role in the treatment of acute Achilles tendon ruptures.

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?

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.