#16
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Цитата:
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#17
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Цитата:
1- нет 2-да 3-Нисколько! За неё заплатит Орден Свидетелей Иеговы. 4-Идея не новая, из моей конторы вышел case-report очень похожего случая, но сделали используя циркуляторный арест, т.к. опухоль была уже в правом предсердии. Кого Вам я напомнил? Неужели Стива Констада? |
#18
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А кто у Вас занимается сразу 2-мя селл-сейверами, сам или есть специально обученные?
Судя по динамике, ждите следующего Саncer в районе диафрагмы. |
#19
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В целом, по андрогенам не совсем уж однозначная ситуация как адекватный адьювант для эритрипоэтина, уж лучше тогда карнитин
Epoetin and appropriate iron therapy are the mainstays of treatment for anemia in hemodialysis patients. Epoetin hyporesponsiveness despite adequate iron stores is a common clinical problem without a satisfactory solution. None of the pharmacologic agents discussed have been proven to be regularly effective and safe in this patient population. Only androgens, vitamin C, and l-carnitine have been studied in a sufficient number of reports to get any sense of their possible efficacy as an adjuvant to epoetin treatment; pentoxifylline, statins, vitamin E, and other vitamins and/or nutritional supplements have not been sufficiently studied or the studies that have been performed do not support their use. Androgens may potentiate the effect of low-dose epoetin, but side effects preclude their use in most circumstances. Vitamin C seems to have a reasonable physiologic premise for a putative role in anemia management in hyperferritinemic hemodialysis patients and may have a clinically beneficial effect in certain patients. The proper role for IV vitamin C, the appropriate dosing strategy, and the long-term benefits and risks of this therapy are not sufficiently defined to allow recommendation of its routine use. In carefully selected patients with functional iron deficiency who are unable to reach target Hb levels despite adequate epoetin doses, however, treatment for a limited duration with careful monitoring for response and toxicity may be reasonable. l-Carnitine carries with it provision for CMS-authorized reimbursement and recommendation for its use by the IV route from AAKP and NKF consensus conferences, but not by NKF-K/DOQI or European practice guidelines. The evidence supporting the use of l-carnitine is mixed, particularly among the randomized, placebo-controlled, double-blind trials, and most of the other reported studies were not of sufficient scientific quality to allow a confident recommendation about use. Nonetheless, in carefully selected patients who are unable to maintain target Hb levels or require very high epoetin doses to do so, a limited course of IV l-carnitine may be worth considering. It should also be noted that it is not known whether the higher Hb levels achieved in patients who respond to treatment with vitamin C or l-carnitine are associated with clinical outcomes (quality of life, exercise capacity, cardiovascular measures, etc.) that are better than untreated patients or that are the same as in patients that do not require these agents to achieve and maintain target Hb levels. Clearly, further studies are needed before any of the agents discussed in this review can be generally recommended in hemodialysis patients. Hemodial Int. 2005 Jan;9(1):7-22. Pharmacologic adjuvants to epoetin in the treatment of anemia in patients on hemodialysis. Berns JS, Mosenkis A.
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Искренне, Вадим Валерьевич. |
#20
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Нет информации о типе анемии, железодефицитная vs. из-за ХПН vs. анемия "of chronic disease" vs. гемоглобинопатии. Может иметь смысл поднять гемоглобин до high-нормы за 1-2 месяца до операции используя ВВ железо (Venofer, Ferrlecit) + Эритропоетин, будет проще переносить кровопотерю. Для использования карнитина нужно иметь низкий уровень карнитина в крови, иначе неэффективно (и страховка не заплатит).
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#21
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Anemia of chronic disease плюс "mild iron deficiency" (C).До первой операции была на мегадозах эритропоэтина плюс витамины плюс железо без большого прогресса в течении трёх недель. Гематологи порешили, что пока миосаркому не уберут - эритропоэтин работать не будет.К тому же у неё к тому моменту развился симптом Энижней полой вены".С этого момента начался мой стресс тест!
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#22
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Заключение!!
В пятницу всей интенсивкой ели пиццу, по поводу перевода нашей красавицы в реабилитационное учреждение.
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