Duodecim; lääketieteellinen aikakauskirja
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Acute respiratory failure is the most common organ failure leading to need of intensive care. The incidence of acute respiratory failure in adult population is 78-89/100000/year and mortality is 35-40 %. ⋯ However, the evidence of NIV's effect on mortality in more heterogenous group of hypoxemic patients is scarce. Key recommendations conserning invasive ventilation is to avoid tidal volumes over 7 ml/bodyweight and to use at least 5 cm H2O of PEEP.
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Modern methods of brain imaging have enabled objective measurements of functional and structural brain changes associated with chronic pain conditions. According to recent investigations, chronic pain is not only associated with abnormally strong or prolonged activity of regions processing acute pain, but also with activation of brain networks that are characteristic for each pain state, changes in cortical remodeling, as well as local reduction of grey matter in several regions of the brain. Brain changes associated with chronic pain facilitate the understanding of mechanisms of various chronic pain conditions.
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Cerebral artery bypass surgery makes it possible to improve or replace cerebral circulation by bringing blood flow from extracranial arteries into the cerebral arteries or by creating new flow routes between cerebral arteries. Cerebral artery bypass operations play an important role in the treatment of the rare moyamoya disease causing cerebral artery stenosis and disturbances of the cerebral circulation and in the treatment of cerebral aneurysms that are unamenable to treatment with traditional microsurgical or endovascular techniques. Compared with conservative therapy, bypass surgery does, however, not seem beneficial in the prevention of strokes and hemodynamic disturbances of the cerebral circulation associated with atherosclerotic occlusion of the carotid artery.
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The diagnosis of appendicitis is based on the typical symptom picture and clinical findings. Laboratory studies, in which leukocytosis and an increased neutrophil count are typical findings, can be used in support of the diagnosis. ⋯ In cases of uncertain clinical diagnosis, appendicitis can be found fairly reliably by using computed tomography scanning of the abdomen. Urgent appendectomy is the current care for appendicitis.
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Painful neuropathy is a common complication of diabetes and causes disability and impaired quality of life. Treatment of neuropathy aims at pain relief, improved function and quality of life and avoidance of foot ulcers. Progression of neuropathy is prevented with good glycemic control and treatment of the risk factors of atherosclerosis. ⋯ Comorbidities, concomitant medications and possible contraindications are taken into account in drug selection. Since treatment with a single agent does not provide sufficient pain relief, combination of two drugs with different mechanism of action is recommended. Most patients need long-term treatment.