Duodecim; lääketieteellinen aikakauskirja
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Posterior dislocation of the sternoclavicular joint is a rare injury. It can be associated with life-threatening complications. Computed tomography is the imaging modality of choice with which possible associated injuries can be detected. ⋯ A fracture-dislocation is inherently more unstable than an isolated dislocation. Surgical treatment is advocated in cases of delayed diagnosis or failed closed reduction. With early diagnosis and treatment, the long-term outcome of this injury is good.
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Short lingual frenulum is a common structural abnormality with unknown mechanisms of origination. The frequency of occurrence among newborn infants can be as high as 4%. Short lingual frenulum may cause problems, if it restricts the movements of the tongue. Therapeutic indications for short lingual frenulum in newborn infants are mainly breastfeeding problems, whereas in children of preschool age and older the indication is defective pronunciation.
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Suspicion of epilepsy is an indication for an urgent referral to a pediatric or child neurology care unit. Diagnosis of epilepsy is based on medical history and clinical examination, supplemented with EEG, brain imaging and laboratory tests. Antiepileptic medication is usually initiated after the second epileptic seizure. ⋯ Some children with epilepsy may benefit from ketogenic diet. Surgical treatment options should be considered in children with drug-resistant epilepsy. Acute treatment for febrile seizures follows the same principles as treatment of epileptic seizures, but long-term preventive anticonvulsants are not recommended.
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Advanced Parkinson's disease, essential tremor and dystonia are the most common indications for deep brain stimulation (DBS). The patients having this disease should be referred to DBS assessment at a stage where a satisfactory response to motor symptoms is no longer obtained with conventional medication. DBS therapy is acceptable also in epilepsy, when standard epilepsy surgery is out of question. To date, about 500 patients have had a deep brain stimulator implanted in Finland.
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Respiratory symptoms cause much of suffering in palliative care. Opioids are the first-line drugs in symptomatic treatment, and a therapeutic intervention with benzodiazepines may also be justified. ⋯ Physical therapy and methods of respiratory management are profitable in the treatment of respiratory symptoms. Radiation therapy relieves cancer-induced hemoptysis, cough, chest pain and dyspnea.