Duodecim; lääketieteellinen aikakauskirja
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The incidence of severe sepsis and septic shock requiring intensive care in Finnish adult population has increased to 0.60 11000 /y. Despite improved prognosis, hospital mortality related to severe sepsis and septic shock is high 24.1%. ⋯ Norepinephrine is the first-choice vasopressor in septic shock. Hydrocortisone should be considered only if fluid and vasopressor treatment does not restore hemodynamics.
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IgG4-related disease is a newly recognized systemic condition characterized by high serum IgG4 levels and an inflammatory reaction rich in IgG4-positive plasma cells associated with fibrosis and obliterative phlebitis. It predominantly affects middle-aged or elderly males and was first described as autoimmune pancreatitis. ⋯ Histopathology and immunohistochemistry form the basis of the diagnosis. Glucocorticoids are usually effective but relapses occur commonly.
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A Finnish physician encounters problems caused by tropical marine animals either during her/his own travelling or while treating travelers who have returned home. Certain species of medusae and cone shells as well as the stings by some fish species are life-threateningly poisonous. ⋯ Foreign material remaining in tissues after stings by echinoderms and spiky fish may cause problems months after the actual injury. The injuries become easily infected, and antimicrobial drug therapy must thus cover gram-negative rod-shaped bacteria as well.
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Emergency Medicine (EM) was established as a speciality in Finland in the beginning of 2013. The training period of six years conforms to the principles of the European Curriculum for EM. We present here the first-year training in Kanta-Häme Central Hospital, located in Southern Finland. ⋯ Lunchtime lectures covering a wide variety of topics in EM are an essential part of our weekly education day. This day also offers to the residents small group sessions with abstracts, case reports, focused lectures and ultrasound training. A successful training program of EM is achievable by good collaboration with other specialities.
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Ebola virus has been transmitted from its reservoirs to a human at least about twenty times, established limited human-to-human transmission chains and caused severe generalized infections, often with symptoms involving hemorrhagic fever. Of the five viruses belonging to the genus Ebolavirus, four have been described to have caused human disease, three of them having caused epidemics (25 to 90% mortality). ⋯ By October 25, 2014, the epidemic has caused 4,912 deaths in the epidemic region. The report reviews the background information on the virus, disease and its current spread, as well as describes the ebola preparedness currently in Finland.