Duodecim; laaketieteellinen aikakauskirja最新文献

Dysmenorrhea affects quality of life, but is often inadequately treated in teenagers. The mainstay of treatment is NSAID, which must be started pre-emptively and in adequate dose. If NSAID provides insufficient pain relief, or when contraception is required, combined oral contraceptives can be prescribed concomitantly. Hormonal IUD can also be used in teenagers. If dysmenorrhea persists despite appropriate treatment, the patient must be referred to a gynecologist. Endometriosis, the most common cause of severe dysmenorrhea, can manifest already during adolescence.

A young woman fell off a horse, leaving her right flank contused by a hoof. This resulted in a severe liver trauma that seemed to require surgical treatment. After fluid resuscitation and five units of red blood cells the patient's status, however, stabilized upon entering the operating room. The operation was avoided, but intensive care follow-up was continued for six days. The patient made a complete recovery. Conservative treatment of liver trauma is successful in 90% of mild and almost 70% in severe traumas.

A significant part of the population do not follow dietary and exercise recommendations. In Current Care Guidelines, lifestyle counseling is considered as part of good medical care. Lifestyle diseases are, however, not decreasing. Does counseling fail to reach its goal, or is it being provided at all? In the narrative review article based on systematic surveys, we approach the change in lifestyle through both conscious and automatic psychosocial processes. Research evidence indicates that a change in behavior can be supported through both processes. While intervention studies have been so far conducted mainly by influencing conscious processes, evidence of benefits of using automated processes is growing stronger. We present practical measures to support the desire for change and skills and establishments of habits. The same methods may in part be utilized to change professionals in their own behavior so that provision of quick and simple lifestyle counseling becomes a matter actualized in everyday life.

National and international research evidence of the importance of early childhood and early childhood education to human well-being, resilience and attachment to the society justifies the investment in childhood and children. From the society, this requires national intent, management by knowledge, and strengthening of fundamental rights of children.

Mechanical compression devices enable transportation of patients with cardiac arrest to the catheterization laboratory. Coronary angiography and coronary interventions can be performed while the patients are being resuscitated with these devices. In this report, we describe three cases in whom resuscitation with mechanical compression devices and rapid transportation to the catheterization laboratory resulted in favorable cardiac and neurological outcome.

The scientific advances in the past few years have enabled individualized prevention and treatment of diseases on the basis of genome-wide information. For example, dozens of genomic regions affecting the risk for coronary artery disease have been identified. Both Finnish and international longitudinal studies show that the risk assessment of coronary artery disease can be significantly improved if the estimate is based both on the newly discovered hereditary risk factors and the long-recognized traditional risk factors, e.g. age, gender, smoking, blood pressure, and serum lipid levels. In this review, by using coronary artery disease as an example, we present recent research aiming at enhancing the use of genome information in combination with traditional risk factors for the assessment of the risk for common disease of public health importance. We introduce the KardioKompassi tool, developed by us, which comprehensively utilizes the genetic profile of an individual in combination with conventional health information to assess the risk for coronary artery disease. We also discuss the prospects and opportunities provided by the newly developed next-generation risk prediction tools to promote health."

Nucleic acid diagnostic technologies are partly replacing traditional microscopy and antigen detection methods in parasitological diagnostics. In particular, the diagnostics of parasitic diarrhea is undergoing a transformation due to the application of polymerase chain reaction (PCR) tests. Diagnostics of malaria is still based on microscopy, but rapid nucleic acid tests are emerging. Laboratories of clinical microbiology in Finland currently provide PCR tests e.g. for intestinal protozoa, Toxoplasma and Trichomonas. Nucleic acid diagnostic methods are superior in specificity and sensitivity, but may give false positive results after a treated infection.

Introduction: The tilt table test is used for determining the loss of consciousness, and in the case of reflex syncope, for gaining insight into the circulatory mechanism. In 2015, all tilt tests within the Hospital District of Helsinki and Uusimaa (HUS) were performed in the clinical physiology unit of the HUS Medical Imaging Center at Peijas Hospital.

Methods: The patients' medical history, circulation monitor printouts, and medical reports were recorded from all tilt tests carried out during 2015. Positive tilt tests were classified according to the VASIS classification and the elapsed time to loss of consciousness was observed.

Results: Among a total of 133 patients, abnormal upright tolerance was found in 30 per cent of the patients. The average time to loss of consciousness was 35.2 minutes. The most common mechanism of syncope was mixed reaction (60.0%), whereas vasovagal reaction (22.5%), cardioinhibitory reaction (10.0%), and lacking stroke volume response (7.5%) were less common.

Conclusions: Practices of referral for the tilt table test vary among the different units of HUS. In our material, the cardioinhibitory reaction was less common than in previous studies.

Passive or active drainage can be used after abdominal surgery. Drains aim at eradicating infected or inflammatory tissue fluids and to alarm of undesired events such as bile, pancreatic, or bowel leak. Drains may, however, occlude or be situated away from the postoperative dilemma. Furthermore, drains themselves are susceptible to cause or maintain infection by retrograde contamination, may irritate the peritoneum causing excess ascites formation, and cause pain. Recent scientific evidence suggests that drains are unnecessary after most abdominal operations. Thus, drains should be used only in certain specific operation types such as pancreatic and emergency surgery. In other operations drains can be omitted if no clear risk factors are present.

While the majority of kidney transplantations in Finland have been traditionally performed from deceased donors, the frequency of living donors should be increased. Kidney donation is a safe procedure for a carefully examined donor, and for the recipient living donation enables elective surgery and preemptive transplantation. Potential risks for the donor must be minimized, but according to current recommendations, mild hypertension or obesity are not absolute contraindications for donation. Guidelines for donor selection and examination have been updated to simplify the process for all parties. Legislation in Finland requires changes to optimize the use of all potential living donors.