Duodecim; lääketieteellinen aikakauskirja
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A physician travelling frequently by air is likely to receive sooner or later a call for medical help during the flight. According to the Finnish law the physician has a duty to help any patient that needs urgent medical assistance and this duty applies even in the airplane. The extent of required assistance is mostly dependent on the actual skills of the physician. Temporary incapacity caused, e.g., by intoxication does not abolish the physician's duty to help but justifies the omission of procedures that are adversely influenced by the alcohol intake.
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Any complaints from a patient about their memory should be examined. Diagnosis is based on international criteria. The basic evaluation consists of the medical history, clinical evaluation, cognitive tests and brain imaging, especially using MRI. ⋯ An acetylcholinesterase inhibitor or memantine can be used. These drugs are ineffective in the case of frontotemporal degenerations. For severe behavioural disorders, other psychoactive medications can be applied.
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Children's pneumonias should be treated with antibiotics. Since the symptoms and findings vary, a chest radiograph is required for a definite diagnosis. ⋯ Treatment of infants is readily initiated intravenously with benzyl penicillin, but hospital treatment can usually be restricted to 12 to 48 hours. If recovery does not start within 48 hours after initiation of antibiotic medication, the patient must be re-examined.
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The determination of troponin from a blood sample is the most sensitive means to prove a recent myocardial injury. An elevating troponin level associated with acute coronary syndrome indicates an increased risk of death and reinfarction, serving as an indication for an invasive investigation of coronary anatomy. ⋯ The use of troponin should be focused on situations involving a suspicion of myocardial ischemia on clinical grounds. We analyzed the causes of an elevated troponin level from the emergency discharge diagnoses of 301 patients referred to internal medicine emergency.
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A sensation of a lump in the throat will often cause fear of tumor. Underlying the symptom is only seldom a tumor, which is, however, malignant in about 97 to 99% of cases of hypopharyngeal occurrence. Excessive alcohol consumption and smoking constitute the their greatest risk factors. We present a patient case relating to a rare benign tumor of the hypopharynx (giant fibrovascular polyp, GFP).