#16
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Åñòü -òî îíà åñò, íî íå âûðûâàåò ëè?
ß áû äóìàëà íå ñòîëüêî îá îíêîëîãèè, ñêîëüêî îá Ýëëåíáåðãå èëè íàðóøåíèè ïðèåìà ïèùè, íî ÷òî ïîäåëàåøü.. Êîíå÷íî, â ýÍÖ äèàáåòîëîãè åå íå âîçüìóò - ýòî êðåñò äëÿ ÌÌÀ, ðàç óæ ìû çíàêîìû ñ Âàìè. Ïåðåñûëàéòå âûïèñêó íà ôàêñ 248-64-77 ( íà ìîå èìÿ). Îõ è ïîìó÷àþñü..
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Ã.À. Ìåëüíè÷åíêî |
#17
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Ãàëèíà Àôàíàñüåâíà! Ñïàñèáî çà îòâåò. Äàæå åñëè ðå÷ü èäåò î íåâðîãåííîé àíîðåêñèè , òî êàëüöèôèöèðóþùèé ïàíêðåàòèò èëè òîòàëüíûé ïàíêðåàêàëüöèíîç â ñî÷åòàíèè ñ ìî÷åêàìåííîé áîëåçíüþ è îñòåîïîðîçîì ýòèì ôàêòîì íå îáúÿñíèòü. Â÷åðà ïîñìîòðåëè Ñ-ïåïòèä, îí ðàâåí 369 ïÌ ( íîðìà ïî íàøåé ëàáîðàòîðèè 160-1100), ÷òî òàêæå, íà ìîé âçãëÿä, óêàçûâàåò íà âòîðè÷íûé õàðàêòåð ÑÄ. Ñåãîäíÿ âçÿëè àíàëèç íà óðîâåíü Ñ-ïåïòèäà ÷åðåç 2 ÷àñà ïîñëå ïðèåìà ïèùè è HLA-òèïèðîâàíèå, ðåçóëüòàòû ïîêà â ðàáîòå. Ñåãîäíÿ ïðîâîäèëè êîíñèëèóì, êîëëåãèàëüíî ïîñòàâèëè ñëåäóþùèé äèàãíîç: Ïåðâè÷íûé ãèïåðïàðàòèðåîç áåç óñòàíîâëåíèÿ ëîêàëèçàöèè î÷àãà, ñìåøàííàÿ ôîðìà. ïàíêðåàêàëüöèíîç. Âòîðè÷íûé ñàõàðíûé äèàáåò, äåêîìïåíñàöèÿ. Ïîëèíåéðî-ìèîïàòèÿ ñìåøàííîãî ãåíåçà ( ãèïåðïàðàòèðåîèäíàÿ, äèàáåòè÷åñêàÿ). Ìî÷åêàìåííàÿ áîëåçíü. Âòîðè÷íûé õðîíè÷åñêèé ïèåëîíåôðèò âíå îáîñòðåíèÿ, ÕÏÍ 0. Âòîðè÷íûé îñòåîïîðîç ñìåøàííîãî ãåíåçà ( ãèïåðïàðàòèðåîç, ãèïîýñòðîãåíèÿ, ïðèåì àíòèêîíâóëüñàíòîâ). Äóîäåíèò. Äóîäåíîñòàç. Âòîðè÷íàÿ àìåíîðåÿ. Êàõåêñèÿ. Ïðèíÿòî ðåøåíèå î íàïðàâëåíèè áîëüíóþ íà êîíñóëüòàòèâíûé ïðèåì â Ìîñêâó, ïîêà íå ìîæåì îïðåäåëèòüñÿ êóäà èìåííî. Íà ñëåäóþùåé íåäåëå è.î. çàâåäóþùåé ýíäîêðèíîëîãè÷åñêîãî îòäåëåíèÿ êèðîâñêîé îáëàñòíîé êëèíè÷åñêîé áîëüíèöû Ðóáëåâà Íàòàëüÿ Þðüåâíà åäåò â Ìîñêâó íà Ñúåçä ýíäîêðèíîëîãîâ, âûïèñêó òàêæå áåðåò ñ ñîáîé. ß ïîñòàðàþñü îòïðàâèòü ôàêñ óæå çàâòðà è íàöåëþ Íàòàëüþ Þðüåâíó íàéòè Âàñ íà Ñúåçäå. Çàðàíåå áëàãîäàðíà, ñ óâàæåíèåì Óòåìîâà Åëåíà Äìèòðèåâíà.
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#18
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Ðàäè Áîãà - íî ôèáðîêàëüêóëåç ïîäæåëóäî÷íîé æåëåçû âõîäèë, ÿ óæå ïèñàëà, â äèàáåò íèùèõ. à ãèïåðïàðàòèðîç õàðàêòåðèçóåòñÿ óâåëè÷åíèåì óðîâíÿ ïàðàòãîðìîíà è êàëüöèÿ - ñ ýòèì íå ïîäåëàåøü íè÷åãî. Äàæå ïðè íîðìàëüíîì êàëüöèè - áóäüòå ëþáåçíû íàéòè ïàðàòãîðìîí.
Àìåíîðåå âåëåíî áûòü ïðè ÈÌÒ 15 êã/ì2, îñòåîïîðçó òîæå áûòü òàì,âûïàäàåò èç ðÿäà òîëüêî íåôðîëèòèàç - à òàê êàõåêòè÷åñêàÿ íåéðîïàòèÿ ( ÿ áû åùå ïîñìîòðåëà â êðîâè 1,25 îêñèäåâèò è Â1) Âû äóìàåòå î ãèïåðïàðàòèðîçå ïðè íîðìàëüíîì êàëüöèè è ïàðàòãîðìîíå- êàê ïðèêàæåòå èñêàòü ? Ñöèíòèãàðôèÿ ñ òåõíåòðèëîì- áëàãîâîëèòå ñäåëàòü ñàìè..Êîñòè òðóá÷àòûå è êèñòè ñíÿòü ìîæåòå è Âû...
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Ã.À. Ìåëüíè÷åíêî |
#19
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Diabetic neuropathic cachexia: report of a recurrent case.
Jackson CE, Barohn RJ. Department of Medicine/Neurology, The University of Texas Health Science Center at San Antonio, 78284-7883, USA. Diabetic neuropathic cachexia is an uncommon peripheral neuropathy associated with diabetes mellitus and characterised by profound weight loss and painful dysaesthesias over the limbs and trunk. The pathophysiological basis of this disorder remains unknown and there have been no published cases of recurrent episodes. A hispanic man who experienced two episodes of diabetic neuropathic cachexia over a seven year period is described.
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Ã.À. Ìåëüíè÷åíêî |
#20
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Coincident diabetes mellitus and primary hyperparathyroidism.
Taylor WH, Khaleeli AA. Halton General Hospital, Runcorn, Cheshire WA7 2DA, UK. The prevalence of diabetes mellitus in primary hyperparathyroidism is approximately 8% and that of primary hyperparathyroidism in diabetic patients is approximately 1%. Both values are about three-fold higher than the respective expected prevalences in general populations. Patients with both disorders are over 40 years of age and 80% are female; 22% have type 1 and 78% type 2 diabetes. Primary hyperparathyroidism presents first in approximately 20% of patients, and diabetes mellitus in 40%; both disorders present together, or within 1 year, in 40%. Approximately 40% of patients with primary hyperparathyroidism have impaired glucose tolerance. Insulin resistance is present in hyperparathyroidism and probably arises from a raised intracellular free calcium concentration which, by decreasing normal insulin-stimulated glucose transport, increases the requirement for insulin: if this insulin resistance progresses, impaired glucose tolerance and diabetes mellitus would result. Parathyroidectomy has been followed by regression of diabetes and of impaired glucose tolerance in some but not all patients. Early diagnosis of the second disorder is clinically desirable when one disorder is present. Hyperparathyroid patients should therefore be screened for impaired glucose tolerance and diabetes annually, and pre-operatively. Diabetic patients should be checked for hypercalcaemia at appropriate intervals; although only 1% of them may have hyperparathyroidism, this disorder if untreated is associated with hypertension, to which diabetic patients are already prone. Copyright 2001 John Wiley & Sons, Ltd. ×òî êàñàåòñÿ èíñóëèíîðåçèñòåíòíîñòè è äèàáåòà ïðè ãèïåðïàðàòèðîçå- òî ýòà èñòîðèÿ ìàëî ïîõîæà íà Âàøó
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Ã.À. Ìåëüíè÷åíêî |
#21
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Âñÿ ïðîáëåìà â òîì, ÷òî ñöèíòèãðàôèþ ìû ñäåëàòü íå ìîæåì, â îáëàñòíîì îíêîäèñïàíñåðå óæå 7 ëåò íå ðàáîòàåò ãàììà-êàìåðà è âîîñòàíàâëèâàòü å¸ íèêòî íå ñîáèðàåòñÿ.
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#22
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Áîþñü, ÷òî ïðîáëåìà â äðóãîì- ãèïåðïàðàòèðîç âûçûâàåò èíñóëèíîðåçèñòåíòíîñòü , íî ñèòóàöèÿ - ïàðàòèðîìà ñ ìèíèìàëüíîé àêòèâíîñòüþ è íîðìàëüíûì êàëüöèåì - óäåë ïîæèëûõ, è äîëæíî áûòü õîòü ÷òî-òî çà ñîáñòâåííî ãèïåðïàðàòèðîç- ïóñòü îñòåîïîðîç äèôôóçíûé áåç êèñò ( ìàëî ëè ÷òî áûâàåò), íî ïóñòü íîðìàëüíûé êàëüöèé- íî õîòü ïàðàòãîðìîí-òî äîëæåí áûòü?
Ñàõàðíûé äèàáåò 1 òèïà, ðàçâèâàþùèéñÿ íà ôîíå äèåòè÷åñêèõ îãðàíè÷åíèé äî çàáîëåâàíèÿ è óæ òåì áîëåå âî âðåìÿ îíîãî ÷ðåâàò è àìåíîðååé, è äèôôóçíûì îñòåîïîðîçîì, è ôèáðîêàëüêóëåçîì ( åùå ðàç - äèàáåò íèùèõ); åìó íå ïîìåõà è äèàáåòè÷åñêàÿ íåéðîïàòè÷åñêàÿ êàõåêñèÿ( êñòàòè, îïèñàíà äàæå áåðè-áåðè) è â ïðèíöèïå âñå ïðîõîäèò, åñëè âûÿñíèòü ïðè÷èíó;ðàñøèðèâ óãëåâîäû, ðåàëüíî äîáàâèâ âèòàìèíû è ïð. Ìåøàåò, êîíå÷íî, íåôðîëèòèàç, Ñ- ïåïòèä íå ìåøàåò, ïîñîêoëüêó ìîæíî èìåòü Ñ- ïåïòèä ïîçèòèâíîñòü äîëãî.. Ñëîâîì, âåðñèÿ î ãèïåðïàðàòèðîçå ïðè íîðìàëüíîì ïàðàòãîðìîíå ( õîòü ÿ íå ñïîðþ î òðóäíîñòÿõ ëàáîðàòîðíîé äèàãíîñòèêè) ñîìíèòåëüíà, íî ìû ïîñìîòðèì õîðîì - Ë. Ðîæèíñêàÿ, Ã. Ãàëñòÿí è ÿ - ïîäóìàåì.
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Ã.À. Ìåëüíè÷åíêî |
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#23
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Kidney stones in anorexia nervosa: a case report and review of the literature.
Jonat LM, Birmingham CL. Eating Disorders Program, University of British Columbia, St. Paul's Hospital, Vancouver, British Columbia, Canada. Nephrolithiasis (kidney stones) is a recognized complication of anorexia nervosa (AN). We present the case of a 41-year-old woman with a 25-year history of AN. Between 1978 and 1986, she had two episodes of calcium oxalate kidney stones. Proper management of kidney stones in AN requires collection of the stone, laboratory analysis of the stone to determine its composition, and laboratory evaluation of the urine and blood to determine what treatment is necessary to prevent recurrent kidney stone formation.
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Ã.À. Ìåëüíè÷åíêî |
#24
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Óâàæàåìàÿ Ãàëèíà Àôàíàñüåâíà! Ïîëó÷èëè ëè Âû íàø ôàêñ?
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#25
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Çàâòðà áóäó â ÌÌÀ, íà ñúåçäå íå ïîäõîäèëè, â ÝÍÖ íåò- íàâåðíî, â ÌÌÀ
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Ã.À. Ìåëüíè÷åíêî |
#26
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Ãàëèíà Àôàíàñüåâíà! Íà ñúåçäå ê ïðåçèäèóìó áûëî "íå ïðîòîëêíóòüñÿ". Ïîäõîäèëè ê Ðîæèíñêîé ïîñëå äîêëàäà ïî ãèïåðïàðàòèðåîçó, ïîêàçûâàëè âûïèñêó. Âñå áûëî î÷åíü áûñòðî, áóêâàëüíî íà õîäó. Ñêàçàëà, ÷òî íóæíî èññëåäîâàòü ïàðàòãîðìîí-ïîäîáíûé ïåïòèä. Íå çíàåì êóäà ïèñàòü îôèöèàëüíîå íàïðàâëåíèå. Èç ñòàöèîíàðà âûïèñàëè ( êîéêî-äåíü!). Î÷åíü âîëíóþñü. Ãëàâíûé ýíäîêðèíîëîã îáëàñòè îáåùàëà ïîñìîòðåòü áîëüíóþ è äàòü çàêëþ÷åíèå î íåîáõîäèìîñòè êîíñóëüòàöèè íå ðàíåå 13 íîÿáðÿ.
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#27
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Çàâòðà ïîñìîòðþ ôàêñ
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Ã.À. Ìåëüíè÷åíêî |
#28
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Èíòåðåñíî ÷åì çàêîí÷èëàñü ýòà èñòîðèÿ?
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#29
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Ôàêñà íå áûëî
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Ã.À. Ìåëüíè÷åíêî |
#30
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Àääèñîíîâàÿ áîëåçíü
Óâàæàåìàÿ Ãàëèíà Àôàíàñüåâíà! Ïîìîãèòå ïîæàëóéñòà!  òå÷åíèè 20 ëåò ïðèíèìàëà êîðòèçîíà àöåòàò. Ñ 2006 ãîäà åãî íå ñòàëî. Çàìåíèëè êîðòåôîì. Òåïåðü íåò êîðòåôà, íåò åãî ó ïîñòàâùèêîâ. ×åì ìîæíî åãî çàìåíèòü ïðè àääèñîíîé áîëåçíè!?
Çàðàíåå áîëüøîå ñïàñèáî! |