Duodecim; lääketieteellinen aikakauskirja
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For a long time, the EEG examination has been used as a laboratory examination especially in the diagnostics of epilepsy, but both technical difficulties and problems in interpretation have limited its use in emergency medicine outside special neurological intensive care units. Development of monitoring technology and easier data transfer is making EEG monitoring possible also in the emergency area. The greatest need focuses on the diagnostics and treatment of status epilepticus underlying an unclear unconsciousness. In other indications the usually required information can be obtained by daytime measurements.
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Treatment of advanced or metastatic non-small cell lung cancer with current cytotoxic agents is at its best able to only slow down the progression of the disease, while no curative treatment is known. Novel antiangiogenetic agents such as Bevacizumab have been expected to bring about a change in the treatment and prognosis of this disease. Two randomized studies have been conducted with Bevacizumab, whereby it was observed to make the therapeutic results more effective when combined with a cytotoxic platinum agent in a selected patient group. In our opinion the current scientific evidence does not yet support the use of Bevacizumab as the standard therapy for lung cancer.
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Practice Guideline
[Update on current care guidelines. The treatment of status epilepticus].
Status epilepticus is a medical emergency. Most epileptic seizures last for 1-4 minutes and seizures lasting over five minutes, should be treated as status epilepticus. ⋯ Third-line treatment is suppressive general anaesthesia, monitored by continuous EEG. Antiepileptic medication of patients with epilepsy should be carefully re-evaluated after episode of status epilepticus.
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According to the Finnsepsis Study, the incidence in Finland of severe sepsis requiring intensive care was 0.38/1,000 inhabitants/year. ICU and hospital mortality was 15.5% and 28.3%, respectively. The Finnsepsis Study showed that compliance with protocols was rather poor and antimicrobial treatment was often delayed. ⋯ Low-dose hydrocortisone may be used to shorten the need for vasopressors. Activated protein C should be considered in selected patients. The blood glucose target recommendation is between 5 and 8 mmol/l.
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Every woman in labor shall have the right to receive effective analgesia if she so wishes. Management of labor pains should strive for individuality according to the mother's wishes, even if they are changing. ⋯ Anesthesia may be given when labor is clearly under way, and can be continued even at the expulsive stage. With contemporary drug mixtures it is possible to carry on with the anesthesia throughout the delivery without significantly affecting its course.