#31
|
|||
|
|||
Èíòåðåñíî – ó ìåíÿ íåò ïîëíîãî òåêñòà äàííîé ñòàòüè.  òîé ññûëêå íà àáñòðàêò ñòàòüè, êîòîðóþ ÿ ïðèâåë ÿ âîîáùå íå âèæó öèôðû 62%. Òàì íàïèñàíî - The incidence of bilateral clinical CTS in our population was 87% - è ýòî îáùèé à íå ïðîìåæóòî÷íûé âûâîä, ïî ìîåìó äîñòàòî÷íî îäíîçíà÷íî òðàêòóåìûé.
Êðîìå òîãî, îáðàòèòå âíèìàíèå ÷òî òå èññëåäîâàíèÿ êîòîðûå Âû è ÿ ïðèâîäèì áûëè íàïðàâëåíû íà ðåøåíèå ïðèíöèïèàëüíî ðàçíûõ çàäà÷ (è êñòàòè ïðîâîäèëèñü îäíîé è òîé æå ãðóïïîé.- Italian CTS Study Group), òî èññë. êîòîðîå ÿ ïðèâåë ñòàâèëî çàäà÷ó âûÿâèòü % áèëàòåðàëüíîñòè ÑÇÊ â ò.÷. è àñèìïòîìíîãî – ðåçóëüòàò 87%. Âàøà ññûëêà The Italian CTS Study Group studied 740 patients (a total of 1,123 hands with CTS, 383 affected bilaterally)[50] in 20 centers distributed throughout Italy Äàííîå ìóëüòèöåíòðîâîå èññëåäîâàíèå ðåøàëî ñîâñåì äðóãóþ çàäà÷ó, à èìåííî ñðàâíåíèå íåéðîôèç. è êëèíè÷åñêèõ äàííûõ ó ìóæ÷èí è æåíùèí ñ èäèîïàòè÷åñêèì ÑÇÊ à íå % áèëàòåðàëüíûõ ÑÇÊ â ïîïóëÿöèè, ïîýòîìó ñðàâíèâàòü åãî ñ òåì, ÷òî ÿ ïðèâåë íå ñîâñåì êîððåêòíî. ×òî êàñàåòñÿ . Heidi Michelsen, Martin A. Posner.Medical history of carpal tunnel syndrome //Hand Clin 18 (2002) 257–268 – íå íàøåë íè êîëè÷åñòâà ïàöèåíòîâ èññëåäîâàííûõ, íè÷åãî (ìîæåò ó Âàñ åñòü èíôîðìàöèÿ) – ÿ òàê ïîíèìàþ, ÷òî ýòî ÷òî-òî âðîäå îáçîðà à íå îðèãèíàëüíîå èññëåäîâàíèå? |
#32
|
|||
|
|||
Ïî-ìîåìó, ñëèøêîì ìíîãî óæå ñêàçàíî ïðî ÑÇÊ. Ìîæåò ïîïðîáîâàòü îáñóäèòü äðóãèå âàðèàíòû, íàïðèìåð, ñèíäðîì Çóäåêà èëè åùå ÷òî-íèáóäü?
|
#33
|
|||
|
|||
Öèòàòà:
|
#34
|
|||
|
|||
Ïðèâîæó äàâíî íàïèñàííûé îòâåò ðåöåíçåíòó îäíîãî èç æóðíàëîâ, êîòîðûé òîæå âîçìóùàëñÿ ìîèì îòíîøåíèåì ê ýëåêòðîäèàãíîñòèêå. Åñëè íå óñòðîÿò ýòè ññûëêè, òî ïîèùó áîëåå íîâûå, ãäå-òî îíè ó ìåíÿ "ãóëÿþò". Èòàê.
Îòíîøåíèå ê ýëåêòðîäèàãíîñòè÷åñêèì èññëåäîâàíèÿì ïðè ÑÊÇ – î÷åíü íåîäíîçíà÷íîå èç-çà ôàëüø-ïîçèòèâíûõ è ôàëüø-íåãàòèâíûõ ðåçóëüòàòîâ. Ê ïðèìåðó, â ñòàòüå Braun RM, Jackson NJ. Electrical studies as a prognostic factor in the surgical treatment of carpal tunnel syndrome. J Hand Surg 1994; 19A: 895 ïðèâîäÿòñÿ äàííûå î ðåçóëüòàòàõ îïåðàöèé ïðè ÑÊÇ, ãäå ó 50 ïðîîïåðèðîâàííûõ ïàöèåíòîâ (33% îò âñåõ ïðîîïåðèðîâàííûõ áîëüíûõ) íå áûëî ïàòîëîãè÷åñêèõ ýëåêòðîäèàãíîñòè÷åñêèõ èçìåíåíèé. Òî åñòü ïî äàííûì ýëåêòðîäèàãíîñòèêè îíè áûëè çäîðîâû, õîòÿ èìåëè âûðàæåííûå êëèíè÷åñêèå ïðîÿâëåíèÿ ÑÊÇ ( ïî÷åìó è áûëè ïðîîïåðèðîâàíû). Åùå ññûëêè. 1. Brown FE Compression neuropathies of the upper extremity. In:Jupiter JB, ed. Flynn’s hand surgery. 4th ed. Baltimore:Williams&Wilkins, 1990: 522 –“Electrodiagnostic studies are particularly helpful in diagnosing questionable or borderline cases but are not required for every patient. … False-negative results are reported in up 20% of patients”. 2. R. Jordan, T. Carter and C. Cummins. A systematic review of the utility of electrodiagnostic testing in carpal tunnel syndrome// British Journal of General Practice, 2002, 52, 670-673 - «…..in cases of clear-cut clinical CTS, electrodiagnosis is not warranted either as a diagnostic test, where clinical symptoms are well defined, or as a predictive indicator of surgical outcome. It may still be useful in cases where the clinical diagnosis is not clear». 3. Finsen V. Russwurm H,. Neurophysiology not required before surgery for typical carpal tunnel syndrome. J Hand Surg. 2001; 26B: 61-64.-“We conclude that neurophysiological studies contribute little to the diagnosis in typical cases of carpal tunnel syndrome, and are more often confounding than of assistance”. Ïî ïîâîäó "ñäîõøèõ ìûøö" - ýòî íàñ÷åò äðóãîé ïàòîëîãèè è äðóãîé òåìû, ñ êîòîðîé ìíå ïðåäëîæèëà îçíàêîìèòüñÿ ìîÿ îïïîíåíòêà. |
#35
|
|||
|
|||
Íå çíàþ, íå ñ÷èòàë. Ïî ïîêàçàíèÿì áîëüíîìó íàçíà÷àþ ëèáî êîíñåðâàòèâíîå ëå÷åíèå ( ïðàâäà ñàì åãî íå ïðîâîæó, íî ñîâåòóþ), ëèáî îïåðàöèþ. À áîëüíîé óæå ñàì ðåøàåò, ÷òî äåëàòü. Íàñèëüíî æå íå çàñòàâèøü ëå÷èòüñÿ. Êòî ïðèäåò, òîãî è ëå÷èì.
|
#36
|
|||
|
|||
Ìîãó ïîäåëèòüñÿ, õîòÿ íè÷åãî îñîáî èíòåðåñíîãî òàì íåò.
Öèòàòà:
Öèòàòà:
syndrome. Hand Clin 1996;12:643–55. |
#37
|
|||
|
|||
|
|
#38
|
|||
|
|||
Öèòàòà:
|
#39
|
|||
|
|||
Öèòàòà:
À â ýòîé ñòàòüå ïîä íîìåðîì 3 â Âàøåì ñïèñêå -. Sixty-three of the 68 patients responded well to surgery, three had equivocal outcomes and two did not improve, and thus were considered not to have carpal tunnel syndrome. (à ÷òî æå áûëî ó ýòèõ 2-õ ïàöèåíòîâ è çà÷åì èõ ïðîîïåðèðîâàëè?). ó ìåíÿ íåò ïîëíûõ òåêñòîâ ýòèõ ñòàòåé – ðàçíûå ÝÔÈ òåñòû èìåþò ðàçíóþ ÷óâñòâ. ïðè ÑÇÊ – êàêèå òàì ïðîâîäèëèñü?. |
#40
|
|||
|
|||
Öèòàòà:
Shiu Man Wong et al. Carpal Tunnel Syndrome: Diagnostic Usefulness of Sonography // Radiology , 2004, Volume 232, Number 1, p.93-99. – “Of the final 120 patients who entered the analysis, 98 were women and 22 were men, with a mean age of 49 years (range, 19–83 years). Seventy-five patients had bilateral symptoms, 23 patients had right-hand symptoms, and 22 patients had left-hand symptoms, which yielded a total of 195 hands with CTS”. Y. M. El Miedany, S. A. Aty and S. Ashour. Ultrasonography versus nerve conduction study in patients with carpal tunnel syndrome: substantive or complementary tests?// Rheumatology 2004;43:887–895. - “This was a cross-sectional, age-group-matched case–control study. Seventy-eight patients were included in this study. Eighteen patients had bilateral symptoms”. Isam Atroshi, Christina Gummesson, Ragnar Johnsson and Ewald Ornstein.Diagnostic properties of nerve conduction tests in population-based carpal tunnel syndrome//BMC Musculoskeletal Disorders 2003, 4:9. – “Of the remaining 262 symptomatic persons, 94 (67% women) were diagnosed by the examining surgeon as having clinically certain CTS. The mean age of these persons was 52 (SD, 13) years. Symptoms were bilateral in 59 persons (63%) and right-sided in 27 persons. The 168 persons (65% women) who were diagnosed with clinically uncertain CTS had a mean age of 53 (SD, 13) years. Symptoms were bilateral in 104 persons (62%) and right-sided in 51 persons”. DTB | Vol 47 | No 8 | August 2009. Management of carpal tunnel syndrome. - “About 55–65% of patients first present with bilateral carpal tunnel syndrome(Bland JDP. Carpal tunnel syndrome. BMJ 2007; 335: 343–6.)”. |
#41
|
||||
|
||||
 ñòàòüå îá ýòîì ñîîáùàåòñÿ ñëåäóþùåå, â òàáëèöå 2: “Group 3 ( 151 patients) - …. Symptoms moderate to severe and impair productivity”. Ýòî îñíîâíàÿ ãðóïïà, êîòîðàÿ è èññëåäîâààñü.
Áîëüíûå ñ àòðîôèåé òåíàðà â ýòó ãðóïïó èç 151 ÷åëîâåêà âêëþ÷åíû íå áûëè. Öèòàòà:
Î ïîêàçàíèÿõ ê îïåðàöèè â ñòàòüå íå ïèøåòñÿ. Íå áûëî, âèäèìî, öåëè îáñóæäàòü ýòîò âîïðîñ. Êàê îáñëåäîâàëè áîëüíûõ – íàïèñàíî. À ïî÷åìó áû è íåò? ×òî, êñòàòè, áîëüøå âñåãî áåñïîêîèò ïàöèåíòêó, ñ êîòîðîé íà÷àëàñü äàííàÿ òåìà? À î ïîêàçàíèÿõ ê îïåðàöèè Âû óæå ÷èòàëè.  äðóãîé òåìå. Öèòàòà:
Öèòàòà:
Öèòàòà:
Âäîãîíêó åùå íåñêîëüêî ñòàòåé. ANTHONY J. VIERA. Management of Carpal Tunnel Syndrome// Am Fam Physician 2003:68:265-72,279-80.- “Whether carpal tunnel syndrome is a clinical or electrophysiologic diagnosis remains somewhat controversial. In one study of 2,466 persons in a general population(2), 354 (14.4 percent) reported pain, numbness, or tingling in the distribution of the median nerve. Nerve conduction studies confirmed the presence of median nerve neuropathy in approximately 45 percent of these symptomatic patients. Interestingly, nerve conduction studies were negative in almost one third of “clinically certain” patients but positive in nearly one third of “clinically uncertain” patients. Of the 125 asymptomatic patients who were examined (control group), 23 (18.4 percent) were found to have median nerve neuropathy on nerve conduction testing”. JASON T. KOO, AND ROBERT M. SZABO. COMPRESSION NEUROPATHIES OF THE MEDIAN NERVE//JOURNAL OF THE AMERICAN SOCIETY FOR SURGERY OF THE HAND, VOL. 4, NO. 3, AUGUST 2004, p.156-175.. – “Nerve conduction studies can provide objective evidence of impaired conduction, but standards vary widely.63 In general, distal motor latencies of more than 4.5 ms and distal sensory latencies of more than 3.5 ms are considered abnormal. Asymmetry of conduction between both hands of more than 1 ms for motor conduction or 0.5 ms for sensory conduction time also is considered abnormal. Nevertheless, a group of 12 medical researchers agreed by consensus that a positive electrodiagnostic test with absent symptoms cannot lead to a diagnosis of CTS (64). They were unable to agree on the diagnosis of patients with classic symptoms of CTS and negative electrodiagnostic findings(64)”. Robert M. Szabo, Robert R. Slater, Jr, Thomas B. Farver, Donna Breger Stanton, Wahida K. Sharman. The Value of Diagnostic Testing in Carpal Tunnel Syndrome//J Hand Surg 1999;24A:704–714.- “We found that the addition of electrodiagnostic tests did not increase the diagnostic power of the combination of 4 clinical tests”. Äîëãî è íóäíî ïàòîôèçèîëîãè ãíåâíî êëåéìèëè àâòîðîâ ýòîé ñòàòüè!!! Luc De Smet. Value of some clinical provocative tests in carpal tunnel syndrome: Do we need electrophysiology and can we predict the outcome?// Hand Clin 19 (2003) 387–391. – “Electrophysiology is required in the atypical cases; however, it has no prognostic value. There is no good correlation between electrophysiology and symptoms….Postoperatively the electrophysiologic parameters ameliorate symptoms, but this is not correlated to the patient’s satisfaction”. David D. Kilmer, Brian A. Davis. Electrodiagnosis in carpal tunnel syndrome//Hand Clin 18 (2002)243–255. –“Summary: There is currently no gold standard to definitively diagnose carpal tunnel syndrome. It remains a clinical diagnosis supported by characteristic electrodiagnostic abnormalities. Properly performed electrodiagnostic studies should provide the hand surgeon with information regarding severity, progression if a previous study was performed, and a reasonable assurance that concomitant peripheral nervous system abnormalities are not present. Hand surgeons do not need to discern nuances of an electrodiagnostic evaluation; however, the ability to identify state-of-the-art techniques coupled with a thoughtful interpretation by the electrodiagnostician will improve their confidence in using this important diagnostic tool to evaluate carpal tunnel syndrome”. Ïîäïèñûâàþñü ïîä êàæäûì ñëîâîì. |
#42
|
|||
|
|||
Öèòàòà:
|
#43
|
|||
|
|||
Ñèíäðîì Ðåéíî - ïñèõîñîìàòèêà? !!!
Çäðàâñòâóéòå êîëëåãè - ñìåæíèêè. Ïðîðàáàòûâàÿ äåòñêèå äðàìû ñ ðÿäîì ñâîèõ ïàöèåíòîâ ÿ çàìåòèë, ÷òî ó íåêîòîðûõ èç íèõ èñ÷åçàåò ñèíäðîì õîëîäíûõ (ïîòëèâûõ) êîíå÷íîñòåé . Íàáðàâ ñòàòèñòèêó ÿ îïðåäåëèë òèï ñòðåññà è ïðîâ¸ë íåñêîëüêî çàíÿòèé äëÿ äðóçåé, çíàêîìûõ è çíàêîìûõ-çíàêîìûõ è ïîëó÷èë ïîäòâåðæäåíèå ðàáîòû ìåòîäà íà 85-95% çà îäíî çàíÿòèå 2-4 ÷àñà. Ïðîæèâàþ â Ìèíñêå.
Èìåþ èíòåðåñ: ïðîâåðèòü âîçìîæíîñòüþ ïðèìåíåíèÿ ìîåãî ìåòîäà ê ñèíäðîìó Ðåéíî ïîä êîíòðîëåì ëå÷àùåãî âðà÷à. Åñëè ïîëó÷èòñÿ äîêàçàòü, ÷òî ÷åëîâåê íîñèò âíóòðè ñòðåññ è ýòî íå ïîâîä äëÿ õèðóðãè÷åñêîãî âìåøàòåëüñòâà, ãîòîâ äåëèòüñÿ ìåòîäèêîé ñ ïðàêòèêóþùèìè âðà÷àìè. Íå ïðèìåíÿåòñÿ íè ãèïíîç íè âíóøåíèå, òîëüêî êîíñòðóêòèâíîå âçàèìîäåéñòâèå. ãðóïïîâàÿ ðàáîòà. |