Duodecim; lääketieteellinen aikakauskirja
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During the last few years, uniform criteria have been created for the diagnosis of acute renal insufficiency and its degree of severity. The term acute kidney injury covers all forms of acute damage regardless of the pathogenic mechanism. ⋯ The detection of tubular injury enables an earlier diagnosis of acute kidney injury, because impairment of glomerular filtration often precedes the tubular injury. New markers are becoming available, which are more sensitive and more specific for kidney injury.
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Cardiogenic shock is the most common fatal complication of acute myocardial infarction. The conception of an extensive irreparable myocardial injury underlying the cardiogenic shock has changed especially with the results of the SHOCK study. ⋯ Mortality is high at the initial stage, whereas subsequent prognosis is equivalent to that seen in other infarction patients. Essential therapy consists in a prompt revascularization of the infarcted area and optimization of hemodynamics, if necessary by applying mechanical supportive therapies.
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Any complaints from a patient about their memory should be examined. Diagnosis is based on international criteria. The basic evaluation consists of the medical history, clinical evaluation, cognitive tests and brain imaging, especially using MRI. ⋯ An acetylcholinesterase inhibitor or memantine can be used. These drugs are ineffective in the case of frontotemporal degenerations. For severe behavioural disorders, other psychoactive medications can be applied.
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A physician travelling frequently by air is likely to receive sooner or later a call for medical help during the flight. According to the Finnish law the physician has a duty to help any patient that needs urgent medical assistance and this duty applies even in the airplane. The extent of required assistance is mostly dependent on the actual skills of the physician. Temporary incapacity caused, e.g., by intoxication does not abolish the physician's duty to help but justifies the omission of procedures that are adversely influenced by the alcohol intake.
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Children's pneumonias should be treated with antibiotics. Since the symptoms and findings vary, a chest radiograph is required for a definite diagnosis. ⋯ Treatment of infants is readily initiated intravenously with benzyl penicillin, but hospital treatment can usually be restricted to 12 to 48 hours. If recovery does not start within 48 hours after initiation of antibiotic medication, the patient must be re-examined.