Duodecim; lääketieteellinen aikakauskirja
-
Insomnia symptoms must be differentiated from insomnia disorder. The correct aiagnosis or insomnia aisoraer is important, as insomnia may also be a symptom of many other diseases. Cognitive behavioral methods are recommended as first-line treatment options. ⋯ In elderly persons adverse effects of hypnotics may exceed their beneficial effects in long-term use. Antidepressive medications acting on the histamine-1 system may be used in very small doses. The new guideline includes e.g. insomnia in pregnant and menopausal women and in cancer patients, and driving issues.
-
Review Case Reports
[Luxatio erecta: two case reports and review of the literature].
Luxatio erecta, inferior dislocation of the glenohumeral joint, is a rare type of injury (1% of shoulder dislocations). In most cases the injury is caused by falling while the upper extremity is hyperabducted. ⋯ According to the literature, the most frequently used method for the reduction of inferior shoulder dislocation is tractioncountertraction under sedation. If the patient has no other reason to be under general anesthesia or sedation, we recommend, however, administration of local anesthetics and using a less traumatic two-step manoeuvre to reduce inferior shoulder dislocation--luxatio erecta.
-
Currently a large proportion of patients with severe burn injuries survive. This gives increasing challenges also for psychological recovery after the trauma. ⋯ Only a small proportion of burn patients receive appropriate psychiatric care although psychosocial interventions specifically planned for burn victims exist. More frequent screening of symtoms of mental disorders and psychiatric consultation, also after acute care in hospital, could lead to better management of post-burn psychiatric care as well as better management of the burn treatment and rehabilitation itself.
-
Traditionally, acute evacuations of traumatic intracranial hematomas are performed by neurosurgeons in university hospitals. However, most patients with traumatic brain injury are initially transported to regional hospitals that lack neurosurgical expertise. ⋯ Twelve patients were operated for acute traumatic subdural hematoma (ASDH): three patients made good recovery, two were left with severe disability, and seven died. Two patients operated with acute epidural hematoma (EDH) recovered well.
-
Case Reports
[Thoracic lavage and open cardiac massage as treatment of hypothermic cardiac arrest--case report].
Cardiopulmonary bypass is the treatment of choice for a severely hypothermic patient with cardiac arrest. However, the treatment is not always available. We describe a successful three-and-a-half hour resuscitation of a hypothermic cardiac arrest patient with manual chest compressions followed by open cardiac massage and rewarming with thoracic lavage.