Duodecim; lääketieteellinen aikakauskirja
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Amyotrophic lateral sclerosis (ALS) is a disease causing degeneration of motor neurons, without any curative treatment. The most common cause of death is respiratory arrest due to atrophy of the respiratory musculature. ALS-associated respiratory insufficiency differs in mechanism from the more common causes of dyspnea, such as diseases of pulmonary or cardiac origin. ⋯ It should be possible to predict the development of respiratory insufficiency in order to avoid leaving the treatment decisions concerning respiratory insufficiency to emergency services. Noninvasive ventilatory support can be used to alleviate the patient's dyspnea. It is actually recommended as the first-line treatment of ALS-associated respiratory insufficiency.
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Comparative Study
[Anticoagulation for continuous renal replacement therapy in the intensive care unit: a comparison of dalteparin infusion with regional citrate anticoagulation].
Continuous renal replacement therapy (CRRT) is used to treat severe acute kidney injury in intensive care units. The aim of this study was to compare two anticoagulation techniques in CRRT, the infusion of dalteparin and regional citrate-calcium anticoagulation, in terms of efficacy and safety. ⋯ The primary endpoint was the life span of the CRRT circuit. The use of regional anticoagulation with citrate and calcium resulted in a significantly longer CRRT circuit life span as compared to that achieved with dalteparin infusion.
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Central aspects in the prevention of pain from becoming chronic are good management of acute pain, early recognition of risk factors and a multidisciplinary working approach. Postherpetic neuralgia can probably be prevented with a vaccine and medication. In the prevention of prolonged postoperative pains there is some evidence of the effect of local anesthetics and ketamine, but their clinical significance is unclear. Multidisciplinary therapeutic and rehabilitative actions can be taken to prevent prolongation and recurrence of lower back pain especially in patients having an increased risk of chronic pain.
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Transgender people find their natal sex and the corresponding gender role unpleasant and alien, and wish to be able to live in the gender role and body of the other sex. Gender dysphoria is effectively alleviated by sex reassignment treatments. ⋯ Psychiatric symptoms at the initiation of the transition process, discrimination, negative attitudes, losses in relationships, and complications in somatic treatments may deteriorate the social integration and quality of life of the transgender people. Health-care professionals can ease the transition process by organizing support for transgender individuals according to the same principles as they do for other people.
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Gleason grading of tumor biopses is the only method to distinguish clinically significant prostate cancer. Local cancer is usually symptomless, and men would benefit from functional screening. ⋯ In blood test diagnostics, established use is made only of the levels of prostate-specific antigen (PSA) and free PSA. New methods for blood test diagnosis are "Prostate Health Index" and the four-kallikrein panel.