Duodecim; lääketieteellinen aikakauskirja
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Ultrasonic examination performed for a hemodynamically unstable patient is a reliable means to find whether free fluid indicating bleeding is present in the abdominal cavity, pleura, or pericardium. Ultrasonic imaging is, however, less suitable for diagnosing visceral injuries, and if clinically possible, computed tomography, CT is the primary imaging technique for a trauma patient. In addition to visceral injuries, CT can be used for detecting active arterial bleeding, which has been found to predict the failure of conservative treatment. Embolization is a less invasive choice than surgery for treating bleeding.
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The spectrum of small vessel vasculitides includes Wegener's granulomatosis, microscopic polyangiitis, Churg-Strauss syndrome, Henoch-Schönlein purpura, cutaneous leukocytoclastic vasculitis and essential cryoglobulinemic vasculitis. The first three are characterized by the presence of circulating anti-neutrophil cytoplasmic antibodies (ANCA). The symptoms of vasculitis range from stable or slowly progressive to rapidly progressive glomerulonephritis or alveolar haemorrhage. ⋯ In severe cases the use of plasmapheresis treatment has been advocated. Medications suitable for remission maintenance include azathioprine, methotrexate, leflunomide and mycophenolate mofetil. Early experience with biologic drugs, particularly with rituximab, for refractory disease has been quite promising.
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Injuries of the larynx are rare, and generally approved and consistent clinical guidelines are lacking. Depending on the mechanism, such an injury is either blunt or penetrating. ⋯ Laryngoscopy with a mirror or a flexible laryngoscope forms the basis for clinical examination, often complemented with computed tomography of the neck. Minor injuries of the larynx are treated conservatively and dislocated fractures surgically.
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The number of patients with allergic bronchopulmonary aspergillosis is estimated to be between 2500 and 5000 in Finland. Genetic factors and bronchial epithelial cells in those having asthma or cystic fibrosis may upon exposure to Aspergillus fungus lead to airway inflammation that can slowly damage the lung tissue. Treatment of the disease is primarily based on settling of the inflammation with an oral corticosteroid and currently often also with itraconazole medication directed to the inflammation and attempting to eradicate aspergillus. Long-term prognosis is quite good, provided that the disease is detected and treated at an early stage.
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Mitotane has been used for 50 years as the first-line drug in the treatment of disseminated adrenocortical carcinoma. It reduces local recurrence of the disease and development of metastases even after a seemingly total surgical removal of the tumor. ⋯ Determination of plasma levels of mitotane will help in carrying out the treatment. The dosage can be optimized and the drug's adverse effects avoided by monitoring the plasma level.