Duodecim; lääketieteellinen aikakauskirja
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Although anesthetic monitoring has rapidly developed over the past few years, accidental awareness during general anesthesia still remains a significant clinical problem. It occurs in one out of thousand surgical patients. In addition to conventional clinical signs, the adequacy of anesthesia can be assessed for instance by monitoring the changes occurring in the electroencephalogram (EEG). The EEG effects of different anesthetics are, however, highly varied, and attempts to develop an unequivocal neurophysiological measure or quantity for human consciousness or unconsciousness have so far been unsuccessful.
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Glycocalyx consisting of proteins and carbohydrates is lining the complete healthy vascular endothelium. Being in continuous interaction with plasma proteins and other plasma components, the glycocalyx forms an endothelial surface layer playing an important role as protective mechanism of the vascular wall, in blood coagulation and regulation of permeability. ⋯ The extent of tissue swelling is also connected with morbidity and mortality. The question about the volume effect of infusion solutions and, on the other hand, prevention of permeability disturbance still remains highly actual.
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Hoarding is a mental disorder having its onset at young age and often worsening with age, manifested as a need of storing up goods to an extent that significantly hampers everyday life. In the light of conducted studies, at least 1 to 2% of the adult population suffers from hoarding. ⋯ Hoarding differs from obsessive-compulsive disorder in its course and treatment response. Treatment of hoarding disorder is based on methods applied in cognitive behavior therapy.
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Central aspects in the prevention of pain from becoming chronic are good management of acute pain, early recognition of risk factors and a multidisciplinary working approach. Postherpetic neuralgia can probably be prevented with a vaccine and medication. In the prevention of prolonged postoperative pains there is some evidence of the effect of local anesthetics and ketamine, but their clinical significance is unclear. Multidisciplinary therapeutic and rehabilitative actions can be taken to prevent prolongation and recurrence of lower back pain especially in patients having an increased risk of chronic pain.
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Sexually offending behavior by adolescents may be directed towards children, age-mates and adults. Neurocognitive and psychiatric disorders and the associated inability to age-related interpersonal relationships and inability to control the sexual desires activated during adolescence may lead a young person to seek inappropriate sexual satisfaction from children. ⋯ Interventions should be focused on the distorted cognitions and attitudes maintaining the injurious sexual behavior, and on the risk of criminal behavior in general. Pharmacological therapy, mainly with SSRI drugs, has also been tested in adolescents.