#16
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Êîðîòêî è áåçàïåëÿöèîííî
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#17
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Íàâåðíîå âû çíàåòå, ÷òî áûâàþò ñëó÷àè àïïåíäýêòîìèè ïðè êèøå÷íîì èåðñèíèîçå, êîãäà ïîðàæåí èëåîöåêàëüíûé óãîë è âñå ñèìïòîìû àïïåíäèöèòà, à ïðè ðàçðåçå îáíàðóæèâàëè íåèçìåíåííûé àïïåíäèêñ. Áûëà ÷üÿ-òî ìîíîãðàôèÿ ÷òî-ëè, ãäå îòðåçàííûå îòðîñòêè îòïðàâëÿëèñü â ëàáîðàòîðèþ ñýñ äëÿ èññëåäîâàíèÿ íà èåðñèíèîç è âûÿâèëñÿ íåõèëûé ïðîöåíò.
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#18
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À åùå ãîäó òàê â 89-90 áûëà â ìîäå òàêàÿ ôèãíÿ - òåïëîâèçîð... Ìû åù¸ áóäó÷è ñòóäåíòàìè ðàçâëåêàëèñü
À åñëè ñåðú¸çíî - ãäå äåëàåòñÿ áîëüøèíñòâî àïïåíäýêòîìèé è êîãäà?  ëþáîé áîëüíèöå è â ëþáîå âðåìÿ. Êàêîé Ñ-ðåàêòèâíûé? Êàêèå 100 ñèìïòîìîâ? À åñëè åù¸ è èíòåðíû â îòäåëåíèè åñòü!!! Óâåðåí, ïðè æåëàíèè Ùåòêèíà ïîëîæèòåëüíûé ìîæíî ó àáñîëþòíî çäîðîâîãî ÷åëîâåêà ïîëó÷èòü. Òàê ÷òî âîò ñìîòðèøü æèâîò, è ëåéêîöèòîâ íåò, è çàáîëåë ÷àñà äâà íàçàä, à âèäèøü - åñòü, íàäî áðàòü. À ó äðóãîãî âñå 98 ñèìïòîìîâ íàéäåøü, à ÷òî-òî íå òî, íå çíàþ êàê ýòó ôèãíþ îáîçâàòü. Ó ìåíÿ â êîìïå çàáèòû íåñêîëüêî ñ-ìîâ â øàáëîíå îñìîòðà, ÿ èõ âñåì è ïå÷àòàþ íå ãëÿäÿ. Ñ îäíèì ñîãëàñåí - ïî íî÷àì àïïåíäèöèòû îïåðèðîâàòü - èçâðàùåíèå, äî óòðà åùå íèêòî íå ïîìåð è íå ïåðôîðíóë ) |
#19
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×àñòàÿ ïðîáëåìà - ïðîïóùåííûå õèðóðãàìè ïåðôîðàòèâíûå è àòèïè÷íûå àïïåíäþêè. Óæå ìíîãî ïðèøëîñü ó ñåáÿ â ãèíåêîëîãèè ïðîîïåðèðîâàòü (õèðóðãà çâàë óæå íà ñåáÿ). Ñèìïòîì Êîõåðà ó æåíùèí èíîãäà íà÷èíàåòñÿ ñ ïîÿñíè÷íîé îáëàñòè. Êàê äëÿ ãèíåêîëîãà, áåçóñëîâíî âàæíû ñèìïòîìû ïðîìïòîâà è Æåíäðèíñêîãî. Ðîâçèíãà - äàëåêî íå âñåãäà ïîëîæèòåëåí. Ùåòêèí è óìåðåííîå íàïðÿæåíèå ìûøö åñòü â 99% ñëó÷àåâ, íî îíî íå ñïåöèôè÷íî.
Îñîáàÿ ïðîáëåìà - àïïåíäèöèòî âî âðåìÿ áåðåìåííîñòè. Êëèíèêè ïî÷òè íåò.  òàêèå ìèíóòû ÷àñòèî ìå÷òàþ î ñâîåì ìàëåíüêîì êàðìàííîì (íàäóâíîì?) ÌÐÒ :-) |
#20
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Öèòàòà:
Ìîæíî, êîíå÷íî, è íå äåëàòü, òîãäà îäíî èç äâóõ -ðàçâèòèå èíôèëüòðàòà ñ åñòåñòâåííûì âîâëå÷åíèåì â ïðîöåññ ïðèëåãàþùèõ òêàíåé, è íå ìíå Âàì ðàññêàçûâàòü î òðóäíîñòÿõ âûäåëåíèÿ îòðîñòêà ïðè äàëüíåéøåì âìåøàòåëüñòâå. -ìîæåò âåäü è ïåðôîðèðîâàòü ñî âñåìè âûòåêàþùèìè.. Íó è, ãîñïîäà êîëëåãè, ó÷èòûâàòü íóæíî åùå íåñêîëüêî ôàêòîðîâ -ïðîôåññèÿ ïàöèåíòà.Åñëè ìîðÿê, ëåò÷èê, øàõòåð è ò.ï.òî ÷àøà âåñîâ ñêëîíÿåòñÿ â ñòîðîíó îïåðàöèè/òàê íàñ ó÷èëè âî ÂÌÎËÀ /. Íåëüçÿ ðèñêîâàòü âûïóñêàÿ â ïîëåò èëè îòïðàâëÿÿ â ïëàâàíèå ÷åëîâåêà, êîòîðîìó ðåøèëè "îòëîæèòü îïåðàöèþ äî ñëåäóþùåãî ðàçà". -ìåñòî ïðîæèâàíèÿ ïàöèåíòà, ñ òî÷êè çðåíèÿ óäàëåííîñòè îò ñòàöèîíàðà. Íó ïîíÿòíî æå, ÷òî ãîðîäñêîé æèòåëü õîòü åæåäíåâíî ìîæåò ïîïàñòü â ïðèåìíûé ïîêîé áîëüíèöû, â îòëè÷èè îò ñ òðóäîì äîáðàâøåãîñÿ äî íåå.
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doctor Ðolonsky israel Ñíèìêè ñìîòðþ òîëüêî â ïðÿìîì ïîêàçå.,áåç íåîáõîäèìîñòè ñêà÷èâàíèÿ. Ïðîñüáà ïîêàçûâàòü ñíèìêè â ïðàâèëüíîì ïîëîæåíèè. |
#21
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Íó ìû òîæå ãèíåêîëîãèþ ÷àñòåíüêî íàõîäèì íà àïïåíäýêòîìèè. Âñ¸ çàâèñèò îò ïðèíöèïîâ êîíêðåòíîé áîëüíèöû - ó íàñ íàïðèìåð ãèíåêîëîãè â ñîìíèòåëüíûõ ñëó÷àÿõ âñåãäà õèðóðãàì áîëüíûõ îòäàþò. À ìû ÷òî - áîëèò, ëåéêîöèòû ðàñòóò, âîëåé-íåâîëåé â æèâîò ëåçåøü. À ãèíåêîëîãè ïîòîì ãîâîðÿò - äà íå íàäî áûëî òðîãàòü. (íå ñî÷òèòå çà ñêëî÷íèêà, äîñòàëî ýòî óæå, ïîâòîðÿþ - â êîíêðåòíîé îòäåëüíî âçÿòîé áîëüíèöå). Ìû òóò â îòðûâå îò öèâèëèçàöèè î FDA íå ñëûõàëè, õîòÿ ÊÒ íî÷üþ ìîæåì ñåáå ïîçâîëèòü. Ïðîñòî áîëüíèöà ó íàñ îäíà, áëèæàéøàÿ îáëàñòíàÿ - ïîëòîðà ÷àñà åçäû íà Òó-154. Ïîñåìó è ïîäõîä ê ëå÷åíèþ íåñêîëüêî ïðîùå - êîãäà äðåíàæ ëèøíèé ïîñòàâèøü, "íà âñÿêèé ñëó÷àé", êîãäà â æèâîò âëåçåøü íå ïî äåëó... È êîíñåðâàòèâíîå ëå÷åíèå àïïåíäèöèòà â íàøèõ óñëîâèÿõ ìåíÿ êàê-òî íå ïðèâëåêàåò. Õîòÿ ñ äðóãîé ñòîðîíû, ÿ ðàäè èíòåðåñà ïðîøìîíàë ñâîþ ÁÄ çà 8 ëåò (äî ýòîãî êîìïîâ ó íàñ íå áûëî) è âûÿâèë òàêóþ çàêîíîìåðíîñòü - â êîíöå 90-õ, êîãäà ðàáîòàëà ó íàñ ìîëîä¸æü (ÿ â òîì ÷èñëå), àïïåíäýêòîìèé áûëî ìíîãî è ïîëîâèíà - êàòàðàëüíûõ. Ñåé÷àñ æå êàòàðàëüíûõ - åäèíèöû, çàòî ïîëîâèíà íàðîäó âûïèñûâàåòñÿ ñî ñíÿòûì äèàãíîçîì. ß äóìàþ ýòî âðÿä ëè ìîæíî íàçâàòü êîíñåðâàòèâíûì ëå÷åíèåì àïïåíäèöèòà. Íî ìû, ïîëüçóÿñü òåì, ÷òî íà÷àëüñòâî â áîëüøèíñòâå - òåðàïåâòû, óòîïèëè èäåþ î äâóõ÷àñîâîì ëèìèòå è æäåì äî ñóòîê, à òî è áîëüøå. Ñêàæó ÷åñòíî - äî èíôèëüòðàòîâ è ïåðôîðàöèé íèêîãî íå äîâåëè òàêîé òàêòèêîé, íî äóìàþ "ñïàñëè" îò ëàïàðîòîìèé ìíîãèõ. Òàê ÷òî ýòî - êîíñåðâàòèâíàÿ òåðàïèÿ èëè âñåãî ëèøü îêîí÷àòåëüíàÿ äèàãíîñòèêà? Êñòàòè, äâå íåäåëè íàçàä ïàöèåíò, ó êîòîðîãî ïîä äèàôðàãìîé ïîëîñà ñàíòèìåòðà äâà âîçäóõà êàê íàðèñîâàííàÿ áûëà â îòâåò íà ïðåäëîæåííóþ îïåðàöèþ ìåíÿ ïîñëàë è äîìîé óøåë. Ïîâòîðÿþ - áîëüíèöà ó íàñ îäíà, à îí äî ñèõ ïîð ãäå-òî õîäèò. Íåóæòî òàê óäà÷íî ïðèêðûëîñü?
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#22
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Íàäî ïîèñêàòü èíôó ïî ÷àñòîòå ëîæíîïîëîæèòåëüíîãî ñèìïòîìà Ñïèæàðíîãî, à òî âåäü è ñïàòü áóäåò ïëîõî :-)
Ãèíåêîëîãè áûâàþò ðàçíûå êàê è õèðóðãè.  èäåàëå êîãäà â îäíîé áîëüíèöå åñòü îáà ýòè îòäåëåíèÿ. Îøèáîê íå áûâàåò òîëüêî ó òåõ êòî íå ðàáîòàåò. ß íàïèñàë òîëüêî î ñâîåì ïîñëåäíåì îïûòå (çà ìåñÿö 3 àïïåíäþêà è åùå ïàðó îòïðàâèë íàçàä). ó íàñ áûë àïïåíäèêóëÿðíûé àáñöåññ, êîòîðûé ïðîëåæàë â îòäåëåíèè äíÿ 3-4 (èíòèìíî çàïàÿí ñ ïðèäàòêàìè), áûë ÏÅÐÔÎÐÀÒÈÂÍÛÉ! àïïåíäèöèò â ïàëàòå!!! (íà îïåðàöèè áûë î÷åíü "óäà÷íî çàâåðíóò â ñàëüíèê"). Òàê ÷òî õâàòàåò âñÿêîãî Ã... åñëè ïîèñêàòü :-) |
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#23
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ëàäíî, íå áóäó áîëüøå
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#24
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Âíèìàíèå! Êàê ìîäåðàòîð ðàçäåëà ãîâîðþ. Òåìà íå î àïïåíäþêå â ãèíåêîëîãèè. À îá îñòðîì àïïåíäèöèòå íà ñîâðåìåííîì ýòàïå.
Áóäó óäàëàòü (ïåðåìåùàòü) íåòåìàòè÷åñêèå ïîñòû. |
#25
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Öèòàòà:
Öèòàòà:
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#26
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À íå ïðîùå ëè â ñîìíèòåëüíîì ñëó÷àå ëàïîðîñêîïèþ ïðîâåñòè?
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#27
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Ïðîùå ÷åì ÷òî?
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#28
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Öèòàòà:
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#29
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Ïðåäëàãàþ ðàçìåùàòü èíôîðìàöèþ è î ñîâðåìåííîì ëå÷åíèè îñòðîãî àïïåíäèöèòà ïðè áåðåìåííîñòè. Ýòî òîæå îòíîñèòñÿ ê ýòîé òåìå.
Ñòàòüÿ î íåîáõîäèìîñòè èíòåðâàëüíîé àïïåíäýêòîìèè ïîñëå "êîíñåðâàòèâíîãî" ëå÷åíèÿ àáñöåññà. J Pediatr Surg. 1996 Feb;31(2):291-4. Recurrent appendicitis after initial conservative management of appendiceal abscess. Price MR, Haase GM, Sartorelli KH, Meagher DP Jr. Department of Pediatric Surgery, The Children's Hospital, Denver, CO, USA. Therapy for children with appendiceal abscess remains controversial. The authors present two such cases initially treated conservatively, without interval appendectomy, that later had recurrent appendicitis. An 8-year-old boy presented with fever, abdominal pain, and a right-lower-quadrant abscess (noted by ultrasonography). During laparotomy, the abscess was drained and the appendix was not found. He was lost to follow-up but returned 2 1/2 years later with perforated appendicitis. An appendectomy was performed, and image-guided drainage of a postoperative abscess was required. A 10-year-old girl presented with fever and right-lower-quadrant pain. Computed tomography showed a multiloculated mass. During laparotomy, the cecum was found to be densely adherent to the pelvic organs and bowel, so the surrounding abscess was drained. Interval appendectomy was refused. The patient returned 8 months later with recurrent acute appendicitis and an appendiceal abscess requiring appendectomy and drainage. Although initial drainage alone of appendiceal abscess is efficacious, the authors strongly advocate interval appendectomy as a critical component of the complete management of this entity. |
#30
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×àñòîòà ðåöèäèâîâ ïîñëå êîíñåðâàòèâíîãî ëå÷åíèÿ àïïåíäèöèòà. Ìíå êàæåòñÿ ýòà ñòàòüÿ ÷åòêî îáúÿñíÿåò "ýôôåêòèâíîñòü" êîíñåðâàòèâíîãî ëå÷åíèÿ - 38% ðåöèäèâîâ, áîëüøèíñòâî - â ïåðâé ãîä. Çà ýòî ïàöèåíò âà ñïàñèáî íå ñêàæåò.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Spontaneously Resolving Appendicitis: Frequency and Natural History in 60 Patients PURPOSE: To establish the frequency and natural history of ultrasonographically (US) documented spontaneously resolving appendicitis following conservative treatment. MATERIALS AND METHODS: From July 1987 to July 1997, the authors encountered 106 patients with US-diagnosed spontaneously resolving appendicitis. We retrospectively studied clinical data and US findings obtained at admission and follow-up relating to 60 patients who were treated conservatively. Over the same 10 years, 1,280 appendectomies for acute appendicitis were performed in the authors' hospital. RESULTS: Of 60 patients, 23 (38%) had recurrent appendicitis after a median of 14 weeks (range, 2–254 weeks), with 16 (70%) having recurrence within 1 year of the first attack. US findings indicated that patients with an appendiceal diameter of at least 8 mm were more prone to recurrence than patients with an appendiceal diameter of less than 8 mm; the recurrence rates were 47% (21 of 45 patients) and 13% (two of 15 patients). The other parameters did not show a statistically significant difference. CONCLUSION: Spontaneously resolving appendicitis occurs in at least one in 13 cases of appendicitis and has an overall recurrence rate of 38%, with the majority of cases reccurring within 1 year. |