Duodecim; lääketieteellinen aikakauskirja
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Currently a large proportion of patients with severe burn injuries survive. This gives increasing challenges also for psychological recovery after the trauma. ⋯ Only a small proportion of burn patients receive appropriate psychiatric care although psychosocial interventions specifically planned for burn victims exist. More frequent screening of symtoms of mental disorders and psychiatric consultation, also after acute care in hospital, could lead to better management of post-burn psychiatric care as well as better management of the burn treatment and rehabilitation itself.
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Review Case Reports
[Luxatio erecta: two case reports and review of the literature].
Luxatio erecta, inferior dislocation of the glenohumeral joint, is a rare type of injury (1% of shoulder dislocations). In most cases the injury is caused by falling while the upper extremity is hyperabducted. ⋯ According to the literature, the most frequently used method for the reduction of inferior shoulder dislocation is tractioncountertraction under sedation. If the patient has no other reason to be under general anesthesia or sedation, we recommend, however, administration of local anesthetics and using a less traumatic two-step manoeuvre to reduce inferior shoulder dislocation--luxatio erecta.
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The most common symptoms of cardiac sarcoidosis and giant cell myocarditis are atrioventricular block, ventricular tachycardia and cardiac insufficiency. Magnetic resonance imaging of the heart or positron emission tomography are utilized to evaluate the possibility of inflammatory heart disease. ⋯ The cause of cardiac sarcoidosis is not known, but granulomatous inflammation can be suppressed with corticosteroids. In giant cell myocarditis, more powerful immunosuppression is utilized than in sarcoidosis, but one third of the patients still require heart transplantation within one year from the diagnosis.
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Transgender people find their natal sex and the corresponding gender role unpleasant and alien, and wish to be able to live in the gender role and body of the other sex. Gender dysphoria is effectively alleviated by sex reassignment treatments. ⋯ Psychiatric symptoms at the initiation of the transition process, discrimination, negative attitudes, losses in relationships, and complications in somatic treatments may deteriorate the social integration and quality of life of the transgender people. Health-care professionals can ease the transition process by organizing support for transgender individuals according to the same principles as they do for other people.
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Amyotrophic lateral sclerosis (ALS) is a disease causing degeneration of motor neurons, without any curative treatment. The most common cause of death is respiratory arrest due to atrophy of the respiratory musculature. ALS-associated respiratory insufficiency differs in mechanism from the more common causes of dyspnea, such as diseases of pulmonary or cardiac origin. ⋯ It should be possible to predict the development of respiratory insufficiency in order to avoid leaving the treatment decisions concerning respiratory insufficiency to emergency services. Noninvasive ventilatory support can be used to alleviate the patient's dyspnea. It is actually recommended as the first-line treatment of ALS-associated respiratory insufficiency.