Duodecim; lääketieteellinen aikakauskirja
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Injuries of the larynx are rare, and generally approved and consistent clinical guidelines are lacking. Depending on the mechanism, such an injury is either blunt or penetrating. ⋯ Laryngoscopy with a mirror or a flexible laryngoscope forms the basis for clinical examination, often complemented with computed tomography of the neck. Minor injuries of the larynx are treated conservatively and dislocated fractures surgically.
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The spectrum of small vessel vasculitides includes Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome, Henoch-Schönlein purpura, cutaneous leukocytoclastic vasculitis and essential cryoglobulinemic vasculitis. The first three are characterized by the presence of circulating anti-neutrophil cytoplasmic antibodies (ANCA). The symptoms of vasculitis range from stable or slowly progressive to rapidly progressive glomerulonephritis or alveolar haemorrhage. ⋯ In severe cases the use of plasmapheresis treatment has been advocated. Medications suitable for remission maintenance include azathioprine, methotrexate, leflunomide and mycophenolate mofetil. Early experience with biologic drugs, particularly with rituximab, for refractory disease has been quite promising.
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The number of patients with allergic bronchopulmonary aspergillosis is estimated to be between 2500 and 5000 in Finland. Genetic factors and bronchial epithelial cells in those having asthma or cystic fibrosis may upon exposure to Aspergillus fungus lead to airway inflammation that can slowly damage the lung tissue. Treatment of the disease is primarily based on settling of the inflammation with an oral corticosteroid and currently often also with itraconazole medication directed to the inflammation and attempting to eradicate aspergillus. Long-term prognosis is quite good, provided that the disease is detected and treated at an early stage.
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Cardiogenic shock is the most common fatal complication of acute myocardial infarction. The conception of an extensive irreparable myocardial injury underlying the cardiogenic shock has changed especially with the results of the SHOCK study. ⋯ Mortality is high at the initial stage, whereas subsequent prognosis is equivalent to that seen in other infarction patients. Essential therapy consists in a prompt revascularization of the infarcted area and optimization of hemodynamics, if necessary by applying mechanical supportive therapies.
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During the last few years, uniform criteria have been created for the diagnosis of acute renal insufficiency and its degree of severity. The term acute kidney injury covers all forms of acute damage regardless of the pathogenic mechanism. ⋯ The detection of tubular injury enables an earlier diagnosis of acute kidney injury, because impairment of glomerular filtration often precedes the tubular injury. New markers are becoming available, which are more sensitive and more specific for kidney injury.