Duodecim; lääketieteellinen aikakauskirja
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Botulism is caused by botulinum neurotoxin produced by the bacterium Clostridium botulinum. It is a flaccid paralysis in which consciousness and nociception are preserved. ⋯ In the diagnosis and treatment of botulism early suspicion is essential. Several coinciding or local clusters without a typical connecting source, or an uncommon type of toxin may indicate an intentionally caused epidemic.
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Platelet inhibitors and anticoagulants are called antithrombotic drugs. New platelet inhibitors prasugrel and ticagrelor are more effective than the traditional clopidogrel, but their use is also accompanied by more frequent bleeding complications. ⋯ New anticoagulants are easier to use but clearly more expensive. The use of new anticoagulants is also accompanied by several potential problems that the clinician should be aware of.
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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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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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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.