Duodecim; lääketieteellinen aikakauskirja
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Surrogate alcohols, i.e., methanol, ethylene glycol and isopropanol, still cause some dozens of deaths in Finland every year. Assessment of the severity of the intoxication is often hampered by the presence of ethanol. ⋯ Ethanol is commonly utilized as an antidote in Finland, whereas the use of a specific antidote, fomepizole, is slowly increasing. Reversal of acidosis and hemodialysis are also essential measures in the treatment of methanol and ethylene glycol poisoning.
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Dabigatran has been introduced into the prevention of stroke in patients with atrial fibrillation. Monitoring of the effect and reversing the action of dabigatran as well as management of an emergency operation and bleeding in a patient who is using the drug is demanding. ⋯ There is no antidote for dabigatran, but its effect can possibly be partly reversed with recombinant coagulation factor VIIa and dialysis. With increasing use of dabigatran, more frequent severe bleeding complications and problems in emergency operations are to be expected.
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Botulism is caused by botulinum neurotoxin produced by the bacterium Clostridium botulinum. It is a flaccid paralysis in which consciousness and nociception are preserved. ⋯ In the diagnosis and treatment of botulism early suspicion is essential. Several coinciding or local clusters without a typical connecting source, or an uncommon type of toxin may indicate an intentionally caused epidemic.
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Most fractures of the distal radius are treated with closed reduction and casting. Locking plates are the most common method of fixation. In young persons and in elderly persons with functional activity above that of their age level, a <10 degrees dorsal or <20 degrees volar angle of tilt, a radial shortening of <2 mm, a radial inclination of >15 degrees and an intra-articular step-off or gap of <1 to 2 mm are regarded as an acceptable limit of position of the radius. In persons over 65 years of age the functioning of the hand can usually be restored with casting.
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Stability of a fractured ankle is the most important factor when considering the choice between operative and non-operative treatment. Depending on the mechanism of injury, the most common type of ankle fracture, spiral fracture of the lateral malleolus (Weber B) may be stable or unstable. It can be treated conservatively, provided that the shape of the ankle joint has remained intact in both projections and there is neither significant injury of deep deltoid ligament nor another fracture within the ankle region. In cases of suspected unstable ankle fracture the patients should be referred to a clinic having experience of surgical therapy of ankle fractures.