Duodecim; lääketieteellinen aikakauskirja
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Non-convulsive status epilepticus is an insidious condition and a challenging diagnosis for neurologists on call. The condition must, however, be recognized, since it constitutes a neurological emergency. Non-convulsive status epilepticus may also be associated as an additional complication with an acute neurologic disease, in which case an EEG recording is usually required. In addition, non-convulsive status epilepticus can be found in a significant proportion of patients with unconsciousness of unknown origin.
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Revisions of both psychiatric classifications, ICD and DSM are in progress. The ICD-11 is scheduled to be published at the earliest in 2011 and the DSM-V in 2013. The scientific basis for a criteria-based psychiatric classification was created in the 1950's when the concept of construct validity was outlined. ⋯ Presently, one of the main themes is incorporating dimensional assessment into diagnostics. However, mere dimensionality as grounds for classification, would lead to too much complexity. It is liable that category disorders will be used also in the future in psychiatric classifications.
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Balanitis, phimosis and foreskin adhesions are common indications for foreskin surgery during childhood. In phimosis, the foreskin cannot be drawn behind the glans penis because of the narrow external opening of the former. It is important to be able to distinguish between physiologic and pathologic phimosis, since their treatment is different. In adulthood, the need for surgery can be caused by phimosis, a difficult sequel of paraphimosis, recurrent inflammations of the glans penis and foreskin, diseases and cancers of the skin as well as difficulties at intercourse due to the shortness of the frenulum of the prepuce of the penis.
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Ultrasonic examination performed for a hemodynamically unstable patient is a reliable means to find whether free fluid indicating bleeding is present in the abdominal cavity, pleura, or pericardium. Ultrasonic imaging is, however, less suitable for diagnosing visceral injuries, and if clinically possible, computed tomography, CT is the primary imaging technique for a trauma patient. In addition to visceral injuries, CT can be used for detecting active arterial bleeding, which has been found to predict the failure of conservative treatment. Embolization is a less invasive choice than surgery for treating bleeding.
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Mitotane has been used for 50 years as the first-line drug in the treatment of disseminated adrenocortical carcinoma. It reduces local recurrence of the disease and development of metastases even after a seemingly total surgical removal of the tumor. ⋯ Determination of plasma levels of mitotane will help in carrying out the treatment. The dosage can be optimized and the drug's adverse effects avoided by monitoring the plasma level.