Duodecim; lääketieteellinen aikakauskirja
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Stability of a fractured ankle is the most important factor when considering the choice between operative and non-operative treatment. Depending on the mechanism of injury, the most common type of ankle fracture, spiral fracture of the lateral malleolus (Weber B) may be stable or unstable. It can be treated conservatively, provided that the shape of the ankle joint has remained intact in both projections and there is neither significant injury of deep deltoid ligament nor another fracture within the ankle region. In cases of suspected unstable ankle fracture the patients should be referred to a clinic having experience of surgical therapy of ankle fractures.
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Surrogate alcohols, i.e., methanol, ethylene glycol and isopropanol, still cause some dozens of deaths in Finland every year. Assessment of the severity of the intoxication is often hampered by the presence of ethanol. ⋯ Ethanol is commonly utilized as an antidote in Finland, whereas the use of a specific antidote, fomepizole, is slowly increasing. Reversal of acidosis and hemodialysis are also essential measures in the treatment of methanol and ethylene glycol poisoning.
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Formation of postoperative adhesions is frequent in open surgery technique operations. By causing intestinal obstruction, infertility and very likely chronic abdominal pain and by complicating reoperations they place a significant burden on the health care system. ⋯ Their formation is also increased by intraoperative peritonitis and contamination. Factors that can be applied to prevent the formation of adhesions include the surgical technique and instruments and products decreasing the formation of adhesions.
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The production of cathelicidin, an antimicrobial peptide is strongly increased in rosacea. Cathelicidin activates innate immunity, inflammation and angiogenesis. Cutaneous proteases produce inflammatory fragments of cathelicidin. ⋯ Retinoids and doxycycline inhibit inflammation, proteases, angiogenesis and TLR2 expression. A multicenter study 2010 proved that isotretinoin with a dose of 0,3 mg/kg/d for 12 weeks and doxycycline with the dose of 100 mg/d for 14 days followed with 50 mg/d were equally effective. Doxycycline 40 mg/d is also effective in milder cases.
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Plantar fasciopathy is the most frequent reason for foot pain. It is characterized by degeneration of the insertion of the plantar fascia on the medial process of the calcaneal tuberosity. Palpation over plantar fascia insertion reproduces the pain and may reveal swelling. ⋯ Initial treatment consists of anti-inflammatory medication, stretching exercises, night splints and shoe inserts. If these fail, steroid injections, custom made orthotics, and extra corporeal shock wave therapy may be tried. If disabling pain persists for more than one year, surgery may be indicated.