Duodecim; lääketieteellinen aikakauskirja
-
Glycocalyx consisting of proteins and carbohydrates is lining the complete healthy vascular endothelium. Being in continuous interaction with plasma proteins and other plasma components, the glycocalyx forms an endothelial surface layer playing an important role as protective mechanism of the vascular wall, in blood coagulation and regulation of permeability. ⋯ The extent of tissue swelling is also connected with morbidity and mortality. The question about the volume effect of infusion solutions and, on the other hand, prevention of permeability disturbance still remains highly actual.
-
Although anesthetic monitoring has rapidly developed over the past few years, accidental awareness during general anesthesia still remains a significant clinical problem. It occurs in one out of thousand surgical patients. In addition to conventional clinical signs, the adequacy of anesthesia can be assessed for instance by monitoring the changes occurring in the electroencephalogram (EEG). The EEG effects of different anesthetics are, however, highly varied, and attempts to develop an unequivocal neurophysiological measure or quantity for human consciousness or unconsciousness have so far been unsuccessful.
-
Sexually offending behavior by adolescents may be directed towards children, age-mates and adults. Neurocognitive and psychiatric disorders and the associated inability to age-related interpersonal relationships and inability to control the sexual desires activated during adolescence may lead a young person to seek inappropriate sexual satisfaction from children. ⋯ Interventions should be focused on the distorted cognitions and attitudes maintaining the injurious sexual behavior, and on the risk of criminal behavior in general. Pharmacological therapy, mainly with SSRI drugs, has also been tested in adolescents.
-
Powerful resuscitation may save the life of a person having cardiac arrest. Resuscitation measures may, however, cause injuries as well. We describe a patient, in whom a perforation of the gastric wall as a complication of resuscitation was detected, and upon imaging of the perforation, renal cell carcinoma was detected as an incidental finding. The resuscitation was successful, and the complication of resuscitation led to early diagnosis and treatment of the cancer.
-
We describe a prolonged and successful in-hospital resuscitation, during which the cause of cardiac arrest was treated by transluminal coronary angioplasty. A closed cardiac massage device was used in the resuscitation of the patient, and the treatment required close collaboration between the cardiologist and the resuscitation team. In spite of the difficult initial situation and several disturbances of vital functions the patient was discharged in good condition.