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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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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Metallic osteosynthesis materials, i.e. implants used in the treatment of fractures and correction of bone position in children have traditionally been subsequently removed in a further operation. The necessity for the removal of orthopedic implants left completely under the skin is arguable and research-based evidence is scarce. ⋯ We present our literature- and experience-based recommendation on the removal of implants or leaving them in position. The removal of an implant should, however, always be decided on an individual basis.
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Tongue abscess is a rare and sometimes life-threatening condition, as swelling of the tongue may rapidly occlude the airways. In a patient described by us swelling of the tongue was found in MR imaging to be caused by an abscess of the anterior part of the tongue, extending to the floor of the mouth, beside the submandibular gland. It was only after recanalization of the compartmentalized abscess of the tongue and removal of the salivary gland that the patient recovered.