Duodecim; lääketieteellinen aikakauskirja
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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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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.
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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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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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Hepatopulmonary syndrome (HPS) is characterized by the triad of liver disease, intrapulmonary vascular dilatation and arterial deoxygenation. Mediating factors are tumor necrosis factor a, endothelin 1 and nitric oxide. Typical symptom is an increase in dyspnea while in standing position, orthodeoxia. ⋯ The blood flow distribution to the lungs is changed as the pulmonary vascular tone is altered. Diagnosis is based on the evidence of liver disease, hypoxemia and pulmonary vascular shunt detected by the so-called bubble test. Liver transplantation is currently the only efficient therapeutic option.