Duodecim; lääketieteellinen aikakauskirja
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The number of patients with allergic bronchopulmonary aspergillosis is estimated to be between 2500 and 5000 in Finland. Genetic factors and bronchial epithelial cells in those having asthma or cystic fibrosis may upon exposure to Aspergillus fungus lead to airway inflammation that can slowly damage the lung tissue. Treatment of the disease is primarily based on settling of the inflammation with an oral corticosteroid and currently often also with itraconazole medication directed to the inflammation and attempting to eradicate aspergillus. Long-term prognosis is quite good, provided that the disease is detected and treated at an early stage.
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Cardiogenic shock is the most common fatal complication of acute myocardial infarction. The conception of an extensive irreparable myocardial injury underlying the cardiogenic shock has changed especially with the results of the SHOCK study. ⋯ Mortality is high at the initial stage, whereas subsequent prognosis is equivalent to that seen in other infarction patients. Essential therapy consists in a prompt revascularization of the infarcted area and optimization of hemodynamics, if necessary by applying mechanical supportive therapies.
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During the last few years, uniform criteria have been created for the diagnosis of acute renal insufficiency and its degree of severity. The term acute kidney injury covers all forms of acute damage regardless of the pathogenic mechanism. ⋯ The detection of tubular injury enables an earlier diagnosis of acute kidney injury, because impairment of glomerular filtration often precedes the tubular injury. New markers are becoming available, which are more sensitive and more specific for kidney injury.
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A physician travelling frequently by air is likely to receive sooner or later a call for medical help during the flight. According to the Finnish law the physician has a duty to help any patient that needs urgent medical assistance and this duty applies even in the airplane. The extent of required assistance is mostly dependent on the actual skills of the physician. Temporary incapacity caused, e.g., by intoxication does not abolish the physician's duty to help but justifies the omission of procedures that are adversely influenced by the alcohol intake.
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Any complaints from a patient about their memory should be examined. Diagnosis is based on international criteria. The basic evaluation consists of the medical history, clinical evaluation, cognitive tests and brain imaging, especially using MRI. ⋯ An acetylcholinesterase inhibitor or memantine can be used. These drugs are ineffective in the case of frontotemporal degenerations. For severe behavioural disorders, other psychoactive medications can be applied.