Duodecim; lääketieteellinen aikakauskirja
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A previously quite healthy 65-year-old woman sought emergency hospital care due to fatigue, weight loss and sensation of thirst appearing over a couple of months. Further analysis revealed a process affecting the neurohypophysis and extensive lytic sclerotic bone lesions. Eventually a rare generalized underlying disease was unraveled: the diagnosis included both Langerhans cell histiocytosis and Erdheim-Chester disease.
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According to the update of the Finnish guidelines for management of patients with atrial fibrillation (AF) dronedarone should be used only in patients with non-permanent AF as a second line medication. It is recommended to monitor the patients regularly and stop dronedarone if permanent AF, heart failure or other adverse events are detected. Dabigatran and rivaroxaban can be used as an alternative to warfarin in patients requiring oral anticoagulation therapy. The selection between warfarin and the new anticoagulants should be based on careful evaluation of the benefits and disadvantages of the drugs in a given patient.
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Both mechanical and pharmacological methods are used for induction of labour. ⋯ Labour induction with Foley catheter is as safe and effective as induction with misoprostol.
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Trampolines for home use have become common in Finland during the past ten years, being especially favored by children. Trampoline jumping is beneficial and constructive physical exercise, but poses a significant risk for injuries. The most common injuries include sprains and strains. ⋯ Fractures are by far the most common trampoline injuries requiring hospital care. Injuries can be prevented by using safety nets. Only one child at a time is allowed to jump on the trampoline.
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The pathophysiology of delirium is poorly known and scientific evidence of effective forms of treatment is scarce. Detection of triggering factors and their appropriate treatment still constitute the cornerstone of the treatment. ⋯ The use of restraint systems should be avoided. The delirium experience is often gravely traumatizing for the patient, and the psychological aftercare of delirium must therefore not be ignored.