Duodecim; lääketieteellinen aikakauskirja
-
Metallic osteosynthesis materials, i.e. implants used in the treatment of fractures and correction of bone position in children have traditionally been subsequently removed in a further operation. The necessity for the removal of orthopedic implants left completely under the skin is arguable and research-based evidence is scarce. ⋯ We present our literature- and experience-based recommendation on the removal of implants or leaving them in position. The removal of an implant should, however, always be decided on an individual basis.
-
The incidence of severe sepsis and septic shock requiring intensive care in Finnish adult population has increased to 0.60 11000 /y. Despite improved prognosis, hospital mortality related to severe sepsis and septic shock is high 24.1%. ⋯ Norepinephrine is the first-choice vasopressor in septic shock. Hydrocortisone should be considered only if fluid and vasopressor treatment does not restore hemodynamics.
-
IgG4-related disease is a newly recognized systemic condition characterized by high serum IgG4 levels and an inflammatory reaction rich in IgG4-positive plasma cells associated with fibrosis and obliterative phlebitis. It predominantly affects middle-aged or elderly males and was first described as autoimmune pancreatitis. ⋯ Histopathology and immunohistochemistry form the basis of the diagnosis. Glucocorticoids are usually effective but relapses occur commonly.
-
A Finnish physician encounters problems caused by tropical marine animals either during her/his own travelling or while treating travelers who have returned home. Certain species of medusae and cone shells as well as the stings by some fish species are life-threateningly poisonous. ⋯ Foreign material remaining in tissues after stings by echinoderms and spiky fish may cause problems months after the actual injury. The injuries become easily infected, and antimicrobial drug therapy must thus cover gram-negative rod-shaped bacteria as well.
-
Tongue abscess is a rare and sometimes life-threatening condition, as swelling of the tongue may rapidly occlude the airways. In a patient described by us swelling of the tongue was found in MR imaging to be caused by an abscess of the anterior part of the tongue, extending to the floor of the mouth, beside the submandibular gland. It was only after recanalization of the compartmentalized abscess of the tongue and removal of the salivary gland that the patient recovered.