Duodecim; lääketieteellinen aikakauskirja
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Comparative Study
[Anticoagulation for continuous renal replacement therapy in the intensive care unit: a comparison of dalteparin infusion with regional citrate anticoagulation].
Continuous renal replacement therapy (CRRT) is used to treat severe acute kidney injury in intensive care units. The aim of this study was to compare two anticoagulation techniques in CRRT, the infusion of dalteparin and regional citrate-calcium anticoagulation, in terms of efficacy and safety. ⋯ The primary endpoint was the life span of the CRRT circuit. The use of regional anticoagulation with citrate and calcium resulted in a significantly longer CRRT circuit life span as compared to that achieved with dalteparin infusion.
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The most common symptoms of cardiac sarcoidosis and giant cell myocarditis are atrioventricular block, ventricular tachycardia and cardiac insufficiency. Magnetic resonance imaging of the heart or positron emission tomography are utilized to evaluate the possibility of inflammatory heart disease. ⋯ The cause of cardiac sarcoidosis is not known, but granulomatous inflammation can be suppressed with corticosteroids. In giant cell myocarditis, more powerful immunosuppression is utilized than in sarcoidosis, but one third of the patients still require heart transplantation within one year from the diagnosis.
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Children's limb fractures are commonly seen in general practice and emergency departments. Diagnostics relies on relevant clinical examination and good quality radiographs and will be supplemented with CT scanning, when necessary. ⋯ With operative treatment, rigid fixation of the fracture is not necessary; K-wires and elastic intramedullary nails are widely used. Although the aim of the treatment is exact positioning of the fracture, growing bone has a great capacity of remodeling, which may correct malposition.
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Transgender people find their natal sex and the corresponding gender role unpleasant and alien, and wish to be able to live in the gender role and body of the other sex. Gender dysphoria is effectively alleviated by sex reassignment treatments. ⋯ Psychiatric symptoms at the initiation of the transition process, discrimination, negative attitudes, losses in relationships, and complications in somatic treatments may deteriorate the social integration and quality of life of the transgender people. Health-care professionals can ease the transition process by organizing support for transgender individuals according to the same principles as they do for other people.
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Powerful resuscitation may save the life of a person having cardiac arrest. Resuscitation measures may, however, cause injuries as well. We describe a patient, in whom a perforation of the gastric wall as a complication of resuscitation was detected, and upon imaging of the perforation, renal cell carcinoma was detected as an incidental finding. The resuscitation was successful, and the complication of resuscitation led to early diagnosis and treatment of the cancer.