Duodecim; lääketieteellinen aikakauskirja
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Emergency Medicine (EM) was established as a speciality in Finland in the beginning of 2013. The training period of six years conforms to the principles of the European Curriculum for EM. We present here the first-year training in Kanta-Häme Central Hospital, located in Southern Finland. ⋯ Lunchtime lectures covering a wide variety of topics in EM are an essential part of our weekly education day. This day also offers to the residents small group sessions with abstracts, case reports, focused lectures and ultrasound training. A successful training program of EM is achievable by good collaboration with other specialities.
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Modern methods of brain imaging have enabled objective measurements of functional and structural brain changes associated with chronic pain conditions. According to recent investigations, chronic pain is not only associated with abnormally strong or prolonged activity of regions processing acute pain, but also with activation of brain networks that are characteristic for each pain state, changes in cortical remodeling, as well as local reduction of grey matter in several regions of the brain. Brain changes associated with chronic pain facilitate the understanding of mechanisms of various chronic pain conditions.
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Painful neuropathy is a common complication of diabetes and causes disability and impaired quality of life. Treatment of neuropathy aims at pain relief, improved function and quality of life and avoidance of foot ulcers. Progression of neuropathy is prevented with good glycemic control and treatment of the risk factors of atherosclerosis. ⋯ Comorbidities, concomitant medications and possible contraindications are taken into account in drug selection. Since treatment with a single agent does not provide sufficient pain relief, combination of two drugs with different mechanism of action is recommended. Most patients need long-term treatment.
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IgG4-related disease is a newly recognized systemic condition characterized by high serum IgG4 levels and an inflammatory reaction rich in IgG4-positive plasma cells associated with fibrosis and obliterative phlebitis. It predominantly affects middle-aged or elderly males and was first described as autoimmune pancreatitis. ⋯ Histopathology and immunohistochemistry form the basis of the diagnosis. Glucocorticoids are usually effective but relapses occur commonly.
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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.