#46
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Öèòàòà:
Íå çíàë, ÷òî Çèíîâèé Ñîëîìîíîâè÷ óìåð, î÷åíü æàëü... Ïîëàãàþ, ÷òî êà÷åñòâî êîíñóëüòàöèé è ïîìîùè íàñåëåíèþ âñå æå íå ñíèçÿòñÿ ïîñëå åãî ñìåðòè, õîòÿ çàÿâëåíèÿ ñïåöèàëèñòà èç åãî ëàáîðàòîðèè íå âíóøàþò îïòèìèçì...
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#47
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Öèòàòà:
Recommendations 4.1. For women with recurrent pregnancy loss (three or more miscarriages) and women with prior severe or recurrent preeclampsia, abruptions, or otherwise unexplained intrauterine death, we suggest screening for congenital thrombophilia and APLAs (Grade 2C). 4.2. For pregnant patients with APLAs and a history of multiple (two or more) early pregnancy losses or one or more late pregnancy losses, preeclampsia, IUGR, or abruption, we suggest administration of antepartum aspirin plus minidose or moderate-dose UFH or prophylactic LMWH (Grade 2B). 4.3. For women who are homozygous for thermolabile variant (C677T) of MTHFR, we suggest folic acid supplements prior to conception or, if already pregnant, as soon as possible, and throughout pregnancy (Grade 2C). 4.4. For women with a congenital thrombophilic deficit and recurrent miscarriages, a second-trimester or later loss, severe or recurrent preeclampsia, or abruption, we suggest low-dose aspirin therapy plus either minidose heparin or prophylactic LMWH therapy (Grade 2C). We also suggest that postpartum anticoagulants be administered to these women (Grade 2C). 4.5. Patients with APLAs and a history of venous thrombosis are usually receiving long-term oral anticoagulation therapy because of the high risk of recurrence. During pregnancy, we recommend adjusted-dose LMWH or UFH therapy plus low-dose aspirin and resumption of long-term oral anticoagulation therapy postpartum (Grade 1C). 4.6. Patients with APLAs and no prior VTE or pregnancy loss should be considered to have an increased risk for the development of venous thrombosis and, perhaps, pregnancy loss. We suggest one of the following approaches for these women: surveillance, minidose heparin, prophylactic LMWH, and/or low-dose aspirin, 75 to 162 mg/d (all Grade 2C). [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#48
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Èçâèíèòå, íå çíàëà, ÷òî îí óìåð...
Êàæåòñÿ, ó íèõ ñåé÷àñ ãëàâíûé - Ìîìîò (íå çíàþ èíèöèàëîâ). ß êîíå÷íî æå ñðàçó ñ ïåðâûõ äíåé áåðåìåííîñòè òóäà. Æàëü, ÷òî ðàíüøå íèêòî íå ïîäñêàçàë. LE-êëåòêè ÿ ñäàâàëà - îòðèö., îñòàëüíîå ó íàñ êàæåòñÿ íå äåëàþò (ó ìåíÿ ïðàéñû ïî÷òè âñåõ ëàáîðàòîðèé â ãîðîäå), õîòÿ ìîãó è îøèáàòüñÿ - ýòî (àíòèíóêëåàðíûé ôàêòîð è àíòèíóêëåàðíûå àíòèòåëà) ìîæåò êàê-òî ïî-äðóãîìó çâó÷àòü? Íàñ÷åò ðåêîìåíäàöèé, ïîêàçûâàòü ÿ èõ êîíå÷íî æå ïîáîþñü. À âîò çà èíôîðìàöèþ ñïàñèáî, îíà ìåíÿ ïðÿì êàê-òî íàñòðîèëà, áóäó êîíòðîëèðîâàòü âñå ñàìà, â ïåðâóþ î÷åðåäü. È ÍÐ â ìîåì ñëó÷àå, äóìàþ, äåéñòâèòåëüíî íóæíàÿ âåøü. Òåì áîëåå, ãåìîñòàçèîãðàìó ñäàâàòü - êàæäûå äâå íåäåëè, è îíà ïîêàæåò ëþáûå èçìåíåíèÿ, è â òó è â äðóãóþ ñòîðîíó, åñëè ÷òî. |
#49
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Ïðîñòèòå ìåíÿ çà ìîå íåâåæåñòâî, íî ÷òî òàêîå SLE, è 11 êðèòåðèåâ õàðàêòåðíûõ äëÿ çàáîëåâàíèÿ, à òàêæå 4 ,
LAC è ACA è Immunologic disorder? |
#50
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Öèòàòà:
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#51
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Öèòàòà:
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#52
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Ñïàñèáî óâàæàåìîìó êîëëåãå äîêòîðó Âàäó çà ðàçúÿñíåíèå òåðìèíîëîãèè,ê ñîæàëåíèþ ,íå óäàëîñü îäîáðèòü åãî èç çà ïîòðà÷åííîé îäîáðÿëêè
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#53
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Îôôôô âðà÷åáíûé:)
ß òàê ïîíÿëà- ýòî ìíå àäðåñîâàíî?
Öèòàòà:
Äëÿ ïîäòâåðæäåíèÿ òîãî, ÷òî íå âñåãäà òîëüêî â êðèòåðèÿõ äåëî-ïðèâåäó íåáîëüøîé ïðèìåð. Ìîëîäàÿ äåâóøêà(20 ëåò), ñâåòëîðûæåíüêàÿ, ñ 12 ëåò ñòðàäàåò òÿæåëîé ãèïåðòîíèåé.  18 ëåò-ñòðàííûå ïíåâìîíèè, íåñêîëüêî î÷àãîâ ïîñòïíåâìîíè÷åñêîãî ôèáðîçà â ëåãêèõ, ïëåâðèò ïî äàííûì ÊÒ.  àíàëèçàõ- òðîìáîöèòîïåíèÿ è àíåìèÿ. Âûðàæåííûå(45-80 òðîìáîöèòîâ, Íâ 9).  àíàëèçàõ ìî÷è- ýðèòðîöèòóðèÿ äî 4-8 â ïîëå çðåíèÿ, áåëêà íåò, êðåàòèíè 2,5 ìã/äë(Äàâíèé íåôðèò??????).Âñå âîë÷àíî÷íûå ìàðêåðû îòðèöàòåëüíûå, ÀÔÀ-êàê ÂÀ ïîëîæèòåëüíûé, òàê è ÀÊË â âûñîêîì òèòðå( îêîëî 90 GPL, 70 MPL). Âàøè ïðåäïîëîæåíèÿ? Ïî êðèòåðèÿì- ÑÊÂ. À åñëè ðàçîáðàòüñÿ: 1) àíåìèÿ ãåìîëèòè÷åñêàÿ-÷òî âïîëíå õàðàêòåðíî äëÿ ÀÔÑ. Òðîìáîöèòîïåíèÿ- ïðèðîäó, äóìàþ, ìîæíî íå îáúÿñíÿòü. 2) Ñåðîçèò- òðîìáîç ìåëêèõ âåòâåé ëåãî÷íîé àðòåðèè èí ñèòó, ñîïðîâîæäàþùèéñÿ ðåàêöèåé ïëåâðû 3) ïî÷êè- ýòî ÀÔÑ íåôðîïàòèÿ-ïðîÿâëåíèÿ òðîìáîòè÷åñêîé ìèêðîàíãèîïàòèè, à íå âîë÷àíî÷íûé íåôðèò, äëÿ êîòîðîãî äåéñòâèòåëüíî íå õàðàêòåðåí òàêîé ìî÷åâîé îñàäîê. Ïîëó÷àåòñÿ, äåâóøêà èìååò ÀÔÑ, à íå ÑÊÂ. |
#54
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À âû äðóãèå êðèòåðèè ïðîâåðèëè ?
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#55
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à êàê æå È ïðî äåáþò ÑÊÂ- î÷åíü..Î×ÅÍÜ ñîìíèòåëüíî- ñ 12 ëåòíåãî âîçðàñòà ãèïåðòîíèÿ, ñåé÷àñ êðåàòèíèí 2, 5.Âèäèìî, ìèêðîöèðêóëÿòîðíîå ðóñëî ïî÷åê áûëî ïîðàæåíî óæå òîãäà. Äèàãíîç-ÀÔÑ ñîìíåíèé íå âûçûâàåò.
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#56
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ýòî ñîñòîÿíèå ÷àñòî áûâàåò èçîëèðîâàííûì
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#57
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Öèòàòà:
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#58
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ÍÐ - ýòî êîíå÷íî ÍÌà (íåïðàâèëüíî íàïèñàëà). Ãåìîñòàçèîãðàììó ìíå ñêàçàëè ñäàâàòü êàæäûå 2-3 íåäåëè, ó íàñ òàê, äà è âî âñåé Ðîññèè, íàñêîëüêî ìíå èçâåñòíî òîæå (èç ôîðóìîâ). Ýòî ìîæåò áûòü äåéñòâèòåëüíî ìíîãîâàòî, îäíî ðàäóåò - ó ìåíÿ âåíû î÷åíü õîðîøèå.
ß âîò òóò ïðîñìàòðèâàëà ñâîè àíàëèçû è êîå-÷òî âñïîìíèëà, î ÷åì íå ïèñàëà ðàíüøå (ìîæåò ýòî âàæíî?) - ó ìåíÿ â ãåìîñòàçèîãðàììå íàïèñàíî - íàñëåäñòâåííàÿ òðîìáî(ýìåëèÿ? - íåðàçáîð÷èâî), ýòî çíà÷èò âðà÷ ó÷ëà òî, ÷òî ó ìåíÿ ïî îòöîâñêîé ëèíèè - íàëè÷èå ó ðîäñòâåííèêîâ ðàçëè÷íûõ òðîìáîçíûõ çàáîëåâàíèé (áàáóøêà - òðîìáîç íîã, â 50 ëåò óäàëèëè âåíó íà îäíîé íîãå, â 55 - íà äðóãîé; ïàïèí áðàò - èíñóëüò â 50, ó ïàïû íà ñåãîäíÿ - 50 ëåò - òàêæå ïðîáëåìû ñ íîãàìè, ãèïåðòîíèÿ è ÷òî-òî åùå, èç-çà ÷åãî îí ïîñòîÿííî êóðñàìè ïüåò êàðäèîìàãíèë). Íå îçíà÷àåò ëè ýòî, ÷òî ìíå íå íàäî ñäàâàòü ìóòàöèè ñèñòåìû ãåìîñòàçà - èòàê âñå ÿñíî? |
#59
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Êàê ðàç, åñëè ïðîñëåæèâàåòñÿ íàñëåäñòâåííîñòü ïî òðîìáîçó, òî ðàöèîíàëüíåå áûëî áû ñäåëàòü àíàëèçû íà âîçì. ãåíåòè÷. òðîìáîôèëè÷åñêèå ìóòàöèè (ôàêòîð V ëåéäåí, ìóòàöèè ïðîòðîìáèíà, ÌÒÃÔÐ), /ïðàâäà â Ðîññèè íå äåëàþò âñþ ïàíåëü ïîëíîñòüþ/, à òàêòèêà âñå ðàâíî îäíà - ÍÌÃ.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#60
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Ïîíÿëà, íî ðàç òàêòèêà îäíà, òî íàâåðíîå íå ïîåäó, óæ áîëüíî àíàëèçû äîðîãèå.
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