Duodecim; lääketieteellinen aikakauskirja
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A physician travelling frequently by air is likely to receive sooner or later a call for medical help during the flight. According to the Finnish law the physician has a duty to help any patient that needs urgent medical assistance and this duty applies even in the airplane. The extent of required assistance is mostly dependent on the actual skills of the physician. Temporary incapacity caused, e.g., by intoxication does not abolish the physician's duty to help but justifies the omission of procedures that are adversely influenced by the alcohol intake.
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Children's pneumonias should be treated with antibiotics. Since the symptoms and findings vary, a chest radiograph is required for a definite diagnosis. ⋯ Treatment of infants is readily initiated intravenously with benzyl penicillin, but hospital treatment can usually be restricted to 12 to 48 hours. If recovery does not start within 48 hours after initiation of antibiotic medication, the patient must be re-examined.
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Balanitis, phimosis and foreskin adhesions are common indications for foreskin surgery during childhood. In phimosis, the foreskin cannot be drawn behind the glans penis because of the narrow external opening of the former. It is important to be able to distinguish between physiologic and pathologic phimosis, since their treatment is different. In adulthood, the need for surgery can be caused by phimosis, a difficult sequel of paraphimosis, recurrent inflammations of the glans penis and foreskin, diseases and cancers of the skin as well as difficulties at intercourse due to the shortness of the frenulum of the prepuce of the penis.
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The determination of troponin from a blood sample is the most sensitive means to prove a recent myocardial injury. An elevating troponin level associated with acute coronary syndrome indicates an increased risk of death and reinfarction, serving as an indication for an invasive investigation of coronary anatomy. ⋯ The use of troponin should be focused on situations involving a suspicion of myocardial ischemia on clinical grounds. We analyzed the causes of an elevated troponin level from the emergency discharge diagnoses of 301 patients referred to internal medicine emergency.
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Treatment of advanced or metastatic non-small cell lung cancer with current cytotoxic agents is at its best able to only slow down the progression of the disease, while no curative treatment is known. Novel antiangiogenetic agents such as Bevacizumab have been expected to bring about a change in the treatment and prognosis of this disease. Two randomized studies have been conducted with Bevacizumab, whereby it was observed to make the therapeutic results more effective when combined with a cytotoxic platinum agent in a selected patient group. In our opinion the current scientific evidence does not yet support the use of Bevacizumab as the standard therapy for lung cancer.