Duodecim; lääketieteellinen aikakauskirja
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The health-promoting effects of physical exercise are scientifically proven, but the health risks of sitting still remain rather poorly known. Technological development of the society will by no means cut down sitting. Should too much sitting be considered as one of the independent factors increasing the risk of metabolic diseases and its reduction as a health-promoting measure? Innovative solutions made possible by the new technology to cut down on sitting and to increase physical activity may prove to be important future tools for promoting health.
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Spinal claudication refers to symptoms caused by nerve compression in the spinal canal brought on during strain. The symptoms are felt as lower limb pain, numbness or fatigue, but back pain that becomes worse under stress is also common. ⋯ While the diagnosis is often clear, MRI imaging is worth conducting if the symptoms are atypical or cause a clear-cut disability or functional limitation. Most patients are treated conservatively.
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With the development and increasing use of imaging techniques, intraductal papillary mucinous neoplasm (IPMN) is being detected with increasing frequency. Two forms of the disease are distinguished, the rare main duct form and the common accessory pancreatic duct form. ⋯ In main duct IPMN, mucin production obstructs the pancreatic duct causing its dilatation and often symptoms typical of chronic pancreatitis. Main duct IPMN is always an indication for surgery, whereas monitoring is often sufficient for side duct IPMN.
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Acute basilar artery occlusion is a neurological emergency that almost invariably leads to death or severe disability if not recanalized. Therapeutic recanalization is attempted using thrombolytic therapy either intravenously alone or by bridging it to on-demand, endovascular procedures. ⋯ Different therapeutic approaches have not been compared in randomized controlled trials. The selection of recanalization therapies thus builds on empirical knowledge and availability of vascular interventional services in the local setting.
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Suspicion of epilepsy is an indication for an urgent referral to a pediatric or child neurology care unit. Diagnosis of epilepsy is based on medical history and clinical examination, supplemented with EEG, brain imaging and laboratory tests. Antiepileptic medication is usually initiated after the second epileptic seizure. ⋯ Some children with epilepsy may benefit from ketogenic diet. Surgical treatment options should be considered in children with drug-resistant epilepsy. Acute treatment for febrile seizures follows the same principles as treatment of epileptic seizures, but long-term preventive anticonvulsants are not recommended.