Läkartidningen
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Hypothenar hammer syndrome is a possibly underdiagnosed but treatable cause of Raynaud's phenomenon and hand ischemia elicited by thombosis or aneurysm secondary to acute or chronic blunt trauma to the ulnar artery at the level of Guyon's canal. This paper provides a summary of the condition with some emphasis on prophylactic and therapeutic aspects.
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The inner side of the endothelium is covered by a thin layer of glycosylated proteins called the glycocalyx, which binds plasma to its surface up to a total thickness of 1-3 µm. The glycocalyx governs the endothelial permeability for macromolecules and has a key role in the regulation of microvascular perfusion. ⋯ The glycocalyx is involved in the initiation of the inflammatory response and is easily broken down (shedded) in response to sepsis, trauma, surgery, and cardiovascular disease. A shedded glycocalyx layer seems to impair the prognosis of heart failure and kidney disease. Its role as a mediator of cardiovascular complications to chronic disease is currently an important research topic.
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For the most severely injured and unstable patients physician staffed second tier emergency medical service (EMS) units are used in many European areas. Physician staffed prehospital care is associated with a high rate of survival, advanced trauma care and beneficial cost-effectiveness. In the Nordic countries anaesthesiologists staff the rapid response cars and ambulance helicopters. This article reviews the current status of physician EMS in Sweden and the rapid development of new prehospital intensive care methods.
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Early repolarization defined as antero-lateral ST-segment elevation exists in 1-2 % of the general population and has been considered a benign ECG finding for decades. However, early repolarization, defined as infero-lateral J-waves, has in recent studies been associated with an increased - albeit low - risk of sudden and cardiovascular death. This ECG pattern is present in 3-13% of the general population. ⋯ In athletes, early repolarization, regardless of type, is considered benign. In asymptomatic non-athletes, the absolute risk is too low to use this ECG finding in clinical practice. In individuals with J-wave syndrome, on the other hand, ICD implantation should be strongly considered to prevent sudden cardiac death.
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A thorough investigation is warranted when a person presents to health care services with signs and symptoms of schizophrenia. Positive (hallucinations and delusions) as well as negative symptoms (blunted affect, avolition, and loss of speech content) should be assessed in order to confirm the diagnosis. Further, psychosocial functioning must be evaluated. ⋯ Case management in a multiprofessional »Assertive Community Treatment« (ACT) setting should be used as an organizational model for psychiatric teams caring for persons with first onset psychoses as well as those with long-term psychotic illness. Collaboration between psychiatric and social services is central and mandatory by law. Models for collaboration need to be examined further.