Duodecim; laaketieteellinen aikakauskirja最新文献

The population of foreign origin in Finland is a heterogenic group, diverse for example with respect to reasons for and age at migration. While migration to Finland is a recent phenomenon, the size of the population of foreign origin has grown rapidly and will continue to increase. Changes in the population structure need to be taken into account in health promotion. For example lifestyle, health status, functional capacity, mental health, infectious diseases and reproductive health differ in foreign origin population compared with the general Finnish population. These differences may provide opportunities but also create challenges for service provision and health promotion planning.

Age-related macular degeneration is a condition affecting central vision, and is the leading cause of blindness and visual impairment in the western countries. For a long time, inflammation has been associated with the pathogenesis of the condition, and according to current knowledge, inflammation in the retinal pigment epithelial cells (RPE) results from an impairment of intracellular cleansing systems. In combination with the degeneration of RPE cells, this eventually leads to the destruction of light-sensing cells. By influencing the accumulation or elimination of waste material or the inflammatory reaction following its accumulation we may in the future possibly slow the progression of the disease or, in the best case, even cure it.

Background: The goal was to increase the knowledge of Full Outline of UnResponsiveness (FOUR) score in Finland, release its Finnish version and to evaluate its usefulness in Finnish ICU patients.

Materials and methods: The highest FOUR and Glasgow Coma Scale (GCS) scores of the adult ICU patients treated in Tampere University Hospital between 1st January and 31st October 2015 were analyzed retrospectively. In-hospital and 1-month mortality were the primary end-points.

Results: The Finnish version of FOUR performed comparably to previous studies. The ability of FOUR to predict mortality was equal to GCS.

Conclusions: FOUR is at least equal to GCS in predicting mortality of ICU patients.

A proximal humerus fracture typically occurs when an elderly woman falls directly onto her shoulder or on her outstretched arm. Local pain in the shoulder and immobility of the upper arm raise a suspicion of a significant injury. Other bone and tendon injuries in the shoulder region as well as dislocation of the shoulder should be considered on differential diagnosis. Diagnosis is achieved by plain X-ray. Most fractures can be treated conservatively. Consultation with an orthopedist is needed, if there are several fracture fragments with extensive dislocation.

Macrophages are an important type of white blood cells in the dialogue between inflammatory response and cancer. Macrophages can maintain a chronic inflammatory state that predisposes to the development of cancer. In the tumor, macrophages phagocytose and kill cancer cells directly and promote the generation of antitumoral cytotoxic lymphocyte response. Cancer cells, however, often modulate the functions of macrophages in several ways to promote tumor progression. Such protumoral macrophages increase neovascularization, produce molecules promoting the growth and dissemination of cancer cells, and suppress antitumoral immune responses. Hence, abundant macrophage infiltration correlates with poor prognosis in most types of cancer. Many cancer treatments also affect the antitumoral properties of macrophages. New drugs are developed to reduce the accumulation of macrophages into malignant tissue and to re-educate pro-tumoral macrophages to anti-tumoral macrophages and some of these drugs have already entered clinical trials.

Breast inflammation, i.e. mastitis is an entity with a variable etiology and severity, typically affecting women of fertile age. In most cases, anamnesis reveals the etiology of the disease, bacterial puerperal mastitis associated with breastfeeding being the most common. Periductal mastitis is a breast inflammation typically associated with smoking in women of 40 to 50 years of age, localized to the region of the areola. Granulomatous mastitis and other rare breast inflammations usually require specialized care. Regardless of etiology, treatment of acute inflammation depends on the clinical picture and, with the exception of puerperal mastitis, emergency ultrasound imaging is often necessary in order to detect an abscess and drain it. In all cases of mastitis, the possibility of underlying malignancy as well as inflammatory breast cancer should be kept in mind. If specialized care is required, breast inflammation is treated in a breast, general or plastic surgery unit.

Treatment of heart failure depends on etiology, left ventricular function and severity of symptoms. Appropriate diagnosis and treatment requires close collaboration between health care providers. In heart failure with reduced ejection fraction, pharmacological treatment and device therapies are based on solid scientific evidence. Less data exist on treatment of heart failure with preserved ejection fraction, where management of underlying diseases contributing to the syndrome is the primary goal. Patient education and self-care may reduce the need for hospitalizations and improve quality of life. Physical exercise reduces symptoms and improves exercise tolerance.

High-resolution computed tomography (HRCT) is a method of examination which is more precise than chest 2-rat in the diagnosis and monitoring of diseases of the lung tissue and the airways. Modern CT equipment enables a volume HRCT scan covering the whole lung tissue. HRCT slices can also be constructed from contrast-enhanced CT scans of the chest of the whole body. HRCT of the lungs can be applied to the diagnosis of both acute and more chronic diffuse diseases of the lung tissue and the airways. The best-known indications for HRCT include idiopathic interstitial pneumonias, such as idiopathic pulmonary fibrosis. High-resolution computed tomography has also become established in the diagnostics of pneumoconiosis, such as asbestosis. More acute indications for HRCT include various inflammations, drug reactions and diffuse alveolar injury. Medical history plays a central role in the interpretation of lung HRCT, because a finding in imaging examination is often unspecific. A good test requisition is therefore important.

Thrombolysis with tissue plasminogen activator is the mainstay in the treatment of acute stroke. Reducing the delay of thrombolysis treatment improves patient prognosis and reduces the incidence of complications. Variable telestroke regimens have improved the availability of stroke thrombolysis, especially in rural settings, where neurologists are not readily available. In the drip-and-ship strategy, stroke thrombolysis is initiated in a peripheral hospital and the patient is then transferred to a tertiary care unit. We report the first case of drip-and-ship stroke thrombolysis in a rural health care center in Northeastern Finland.

Antipsychotics play a key role in the pharmacological treatment of schizophrenia, and monotherapy is effective for most patients. Achieving an optimal treatment response is, however, often difficult. Combining an antidepressant drug to the antipsychotic regimen could potentially improve treatment outcomes, although the evidence supporting the use of such combinations is limited and contradictory. Positive evidence has mostly been obtained from the efficacy of antidepressants acting on monoamine receptors on the negative symptoms of schizophrenia. These receptor-active drugs may also improve cognition in schizophrenic patients. In the light of current knowledge, antidepressants do not appear to potentiate the psychotic symptoms of schizophrenic patients. However, there is no robust evidence of the efficacy of antidepressants in the treatment of schizophrenia-related depression, and thus monotherapy with an antipsychotic drug is recommended for treating it. If using antidepressants in addition to antipsychotics is deemed necessary, the risk of pharmacodynamic and pharmacokinetic interactions should be kept in mind.