Duodecim; lääketieteellinen aikakauskirja
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Endometrial ablation is a commonly used procedure in the treatment of heavy menstrual bleeding. The procedure is considered quite safe, but may also involve severe complications. We present a patient who developed life-threatening sepsis after the procedure.
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For more than a quarter century, the research of and drug development for Alzheimer's diseases have been governed by the amyloid plaque hypothesis, whereby deranged metabolism of the amyloid precursor protein leads to the formation of extracellular amyloid plaques, which in turn causes the activation of microglial cells, destruction of neurons and a progressive memory disease. The ending of three extensive clinical trials in disappointment has raised the question whether the amyloid plaque hypothesis is the correct starting point in the development of curative treatment for Alzheimer's disease at all. Two commencing new trials with patients that are still symptomless will be the final challenge for the hypothesis.
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The recommendation to discharge low-risk pulmonary embolism patients from or after a brief monitoring in the emergency department has not been widely adopted in Finland. ⋯ A significant proportion of patients with pulmonary embolism can be treated on the outpatient basis.
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Acute respiratory failure is the most common organ failure leading to need of intensive care. The incidence of acute respiratory failure in adult population is 78-89/100000/year and mortality is 35-40 %. ⋯ However, the evidence of NIV's effect on mortality in more heterogenous group of hypoxemic patients is scarce. Key recommendations conserning invasive ventilation is to avoid tidal volumes over 7 ml/bodyweight and to use at least 5 cm H2O of PEEP.
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Modern methods of brain imaging have enabled objective measurements of functional and structural brain changes associated with chronic pain conditions. According to recent investigations, chronic pain is not only associated with abnormally strong or prolonged activity of regions processing acute pain, but also with activation of brain networks that are characteristic for each pain state, changes in cortical remodeling, as well as local reduction of grey matter in several regions of the brain. Brain changes associated with chronic pain facilitate the understanding of mechanisms of various chronic pain conditions.