#31
|
||||
|
||||
Öèòàòà:
Ìíå êàæåòñÿ òîïèêñòàðòåðó íå ñòîèò ïðèíèìàòü ýòè ðåêîìåíäàöèè áëèçêî ê ñåðäöó. Öèòàòà:
Öèòàòà:
Íî èçâîëüòå: êîììåð÷åñêàÿ êëèíèêà ñ ïðèëè÷íîé îáðàùàåìîñòüþ. Åñòåñòâåííî, íà ïåðâè÷íûé ïðèåì ïðèõîäèò çíà÷èòåëüíîå êîëè÷åñòâî íåïðîôèëüíûõ ïàöèåíòîâ, èëè ïàöèåíòîâ, ó êîòîðûõ äóïëåêñíîå ñêàíèðîâàíèå íå ïîâëèÿåò íà òàêòèêó ëå÷åíèÿ. Íà ïåðâè÷íîì ïðèåìå ó äîêòîðà äåøåâûé àïïàðàò ñ äîïïëåðîì. Òå, êîìó èññëåäîâàíèå (íåäåøåâîå) äåéñòâèòåëüíî íóæíî, íàïðàâëÿþòñÿ âðà÷îì íà äóïëåêñ ïî ïîêàçàíèÿì è ñîâåðøåííî îïðåäåëåííûìè öåëÿìè. Ïîâòîðþñü, äàâàéòå îñòàâèì íåïðîäóêòèâíûå ðàññïðîñû.
__________________
Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#32
|
|||
|
|||
Öèòàòà:
Severity of chronic venous disorders and its relationship to the calf muscle pump. Panny M, Ammer K, Kundi M, Katzenschlager R, Hirschl M. Vasa. 2009 May;38(2):171-6. Severity of chronic venous disorders and its relationship to the calf muscle pump.Panny M, Ammer K, Kundi M, Katzenschlager R, Hirschl M. Hanusch Hospital, Vienna, Austria. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] BACKGROUND: To investigate the relationship between the calf muscle pump and the clinical severity of chronic venous disorders (CVD) and of venous function parameters. PATIENTS AND METHODS: 84 limbs in 44 patients underwent duplex scan and digital photoplethysmography (DPPG), the range of ankle movement was measured by digital goniometry and strength of calf muscles was determined by dynamometry. Limbs were allocated on the basis of clinical signs of CVD (according to the CEAP classification) into 4 groups: controls (no signs and symptoms of CVD): 34 limbs, C1/2: 24 limbs, C3/4: 16 limbs, C6: 10 limbs. RESULTS: A higher degree in clinical severity of CVD was related to shorter venous refilltime (VRT) and lower venous pump power (VPP) measured by DPPG. The strength of dorsiflexion was significantly reduced in group C6 compared to controls. There was a positive correlation between measurements of DPPG and the strength of dorsiflexion and also with total strength (p < 0.05). In limbs with pathological reflux (> 1 s) the strength of dorsiflexion, range of ankle plantarflexion movement and total range of ankle movement were significantly reduced compared to those without pathological reflux (p < 0,05). Strength of plantarflexion was significantly reduced in group C1/2 compared to control group (p < 0,05). CONCLUSIONS: Strength of dorsiflexion seems to be the main driving factor of normal venous flow and range of ankle movement is impaired in patients with pathological venous reflux. Further prospective studies should clarify if additional strengthening of ankle dorsiflexors should be included in well established venous training programs. |
#33
|
|||
|
|||
Òåïåðü ïî äðóãèì âîïðîñàì.
Îòìå÷ó, ÷òî ýòî Âû ïåðâûé íà÷àëè äèñêóññèþ î òåðìèíîëîãèè, ïîïðàâèâ òîïèêñòàðòåðà, õîòÿ è òàê áûëî ïîíÿòíî, ÷òî îí èìåë â âèäó Ïðèìåð î òîì, ÷òî ñîâðåìåííîãî ìåòîäà íåò èëè íà íåãî æàëêî äåíåã, íåóäà÷åí.  òàéãå ïðè îòñóòñâèè èíñòðóìåíòîâ îòäåëüíûå óìåëüöû ïðè èíòðàêðàíèàëüíîé ãåìàòîìå óõèòðÿëèñü ñäåëàòü òðåïàíàöèþ òîïîðîì, ýòî æå íå çíà÷èò, ÷òî ýòî ñîâðåìåííûé ìåäèöèíñêèé ìåòîä. Ïðè íàëè÷èè ñîâðåìåííîãî îñíàùåíèÿ, ìåòîä ïðèâåäåííûé Âàìè íà êàðòèíêå íå ÿâëÿåòñÿ ìåòîäîì âûáîðà. Ýòî ïîäòâåðæäàåòñÿ è Âàøåé êëèíè÷åñêîé ïðàêòèêîé. Äëÿ ñêðèíèíãà äîñòàòî÷íî êàðìàííîãî äîïïëåðà, à íà âñåõ ñåðüåçíûõ ñîâåðìåííûõ ñòàöèîíàðíûõ àïïàðàòàõ åñòü äóïëåêñ. Ó÷èòûâàÿ, ÷òî êàðìàííûé äîïïëåð íå ïîäõîäèò ïîä îïðåäåëåíèå "-ãðàôèè", òî óëúòðàçâóêîâàÿ äîïïëåðîÃÐÀÔÈß â ñåãîäíÿøíåé ðåàëüíîñòè àâòîìàòè÷åñêè îçíà÷àåò äóïëåêñ (äîèñòîðè÷åñêèå ïðèáîðû â ðàññ÷åò íå áåðåì). Ññûëêà, êîòîðóþ ïðèâåë FRSM, ìîå ìíåíèå ïîäòâåðæäàåò. |
#34
|
||||||
|
||||||
Öèòàòà:
Öèòàòà:
Öèòàòà:
Ó ïàöèåíòà îñòðî ðàçâèâøèéñÿ îòåê êîíå÷íîñòè íèæå êîëåíà. Ïðè ÷åì òóò ìûøå÷íàÿ ïîìïà ãîëåíè è ãîëåíîñòîï? Ïðè ÷åì òóò õðîíè÷åñêàÿ âåíîçíàÿ íåäîñòàòî÷íîñòü? Öèòàòà:
Öèòàòà:
Öèòàòà:
Ó ìåíÿ äðóãîé ñëó÷àé. Êî ìíå èäóò óæå îòîáðàííûå ïàöèåíòû, íåïðîôèëüíûõ ìàëî. È ÷òî Âû òàê ê êàðòèíêå ïðèâÿçàëèñü - ñ÷èòàéòå, ÷òî ÿ ãîâîðèë ïðî êàðìàííûé äîïïëåð.
__________________
Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#35
|
||||
|
||||
Öèòàòà:
Ìîæíî ãîâîðèòü î òîì, ÷òî ýòî íåöåëåñîîáðàçíî, ïëîõî è íåñîâðåìåííî, íî ôàêò îñòàåòñÿ ôàêòîì - ÓÇÄà áåç B- ðåæèìà î÷åíü øèðîêî ïðèìåíÿåòñÿ â ðîññèéñêîé ïðàêòèêå, è íàçûâàåòñÿ ÓÇÄÃ. È àïïàðàòîâ ýòèõ ìíîãî, è ðàáîòàòü îíè åùå áóäóò äîëãî ïî âñåé ñòðàíå. Êðîìå òîãî, òàêèå àïïàðàòû ïðîèçâîäÿòñÿ îòå÷åñòâåííûìè ïðîèçâîäèòåëÿìè è çàêóïàþòñÿ â ðàìêàõ íàö ïðîåêòà, "âûðåçàíî öåíçóðîé". È áóäåò ó Âàñ òåðìèíîëîãè÷åñêîå íåïîíèìàíèå è íåäîâîëüñòâî. Âîïðîñ î òîì, ÷òî æå êîíêðåòíî ïðîâîäèëîñü (ÓÇÄà èëè äóïëåêñ) áûë çàäàí ñîâåðøåííî ñïðàâåäëèâî, ó÷èòûâàÿ íàøó ñòðàíó ïðîæèâàíèÿ.
__________________
Àííà, âðà÷-ýíäîêðèíîëîã Âîðîíåæ, êëèíèêà Íåïëàöåáî |
#36
|
||||
|
||||
Öèòàòà:
Ìàëîâåðîÿòíî, ÷òî ïðè ïîäîçðåíèè íà ÒÝËÀ êòî-òî áóäåò ïîëíîñòüþ îöåíèâàòü ïîâåðõíîñòíûå âåíû Öèòàòà:
Öèòàòà:
Öèòàòà:
|
#37
|
||||
|
||||
Íåáîëüøîå äîïîëíåíèå. Íà íàøåì îñòðîâå "÷èñòûì äîïïëåðîì" âîîðóæåíû è ñåìåéíûå âðà÷è, è ñîñóäèñòûå õèðóðãè. Ïîñëåäíèå åãî èñïîëüçóþò ïðè îñìîòðàõ áîëüíûõ â ïîëèêëèíè÷åñêèõ îòäåëåíèÿõ.
Ðàäèîëîãè ïîëüçóþòñÿ ìåòîäîì ïåðåä ñîñóäèñòîé êàòåòåðèçàöèåé.  ïàëàòàõ ïåðåä óñòàíîâêîé öåíòðàëüíûõ ëèíèé àïïàðàòàìè ïîëüçóþòñÿ âñå. Êëèíè÷åñêèõ ïðèìåðîâ - ìàññà. |
|
#38
|
|||
|
|||
Áîëüíîé â ðåàíèìàöèè àíòèêîàãóëÿíòû íå ïîëó÷àë.
Ñåé÷àñ èçìåíåíèå óæå óøëè ìèíèìóì íà ïîëîâèíó: ïîñâåòëåëè è ò.ï. - ò.å. áûñòðàÿ ïîëîæèòåëüíàÿ äèíàìèêà. Îãðàíè÷åíèÿ ïîäâèæíîñòè â ãîëåíîñòîïíîì ñóñòàâå íå áûëî è íåò. Ìîæåò äåéñòâèòåëüíî ðîæà... Âñåì ñïàñèáî çà ó÷àñòèå! |
#39
|
||||
|
||||
Ïðèõîäèòå åùå.
__________________
Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#40
|
|||
|
|||
[ìîäåðèðîâàíî]
íà ôîòî, êðîìå îòåêà - ïîõîæå, ïîäêîæíàÿ ãåìàòîìà, âåðîÿòíî, ñâÿçàíà ñ ïðèåìîì âàðôàðèíà. òàêèå èçìåíåíèÿ êîæè áûëè äî ïîÿâëåíèÿ æàëîá ñî ñòîðîíû ëåãêèõ? êîíòðîëèðîâàëè ëè ÌÍÎ, ïðîòðîìáèíîâûé èíäåêñ? õîòÿ ýòî íå îáúÿñíÿåò ïðè÷èíó îòåêà (îáøèðíóþ ãåìàòîìó áûëî áû âèäíî íà ÓÇÈ), íî âñå-æå êàê âåðñèÿ î êîæíûõ èçìåíåíèÿõ. èíòåðåñíî, åñëè òàêîå æå êðîâîèçëèÿíèå áûëî áû â ëåãî÷íóþ ïàðåíõèìó - îáÿçàòåëüíî ëè îíî ïðîÿâèëîñü êðîâîõàðêàíèåì? |
#41
|
||||
|
||||
Áóäüòå âíèìàòåëüíåå - ýòî äèñêóññèîííûé ðàçäåë, àâòîð òîïèêà - âðà÷.  ïåðâóþ î÷åðåäü îáñóæäàëèñü âîïðîñû, êîòîðûå èíòåðåñîâàëè åãî.
__________________
Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#42
|
|||
|
|||
à ÷òî âû äóìàåòå ïî ñóòè îá èçëîæåííîì ìíîþ?
|
#43
|
||||
|
||||
Öèòàòà:
__________________
Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#44
|
|||
|
|||
ïàöèåíòû ñ ìåðöàòåëüíîé àðèòìèåé êàê ïðàâèëî ïðèíèìàþò íåïðÿìûå àíòèêîàãóëÿíòû, ÷àñòî íå êîíòðîëèðóþò ÌÍÎ.
|
#45
|
|||
|
|||
íåìíîãî íå òî, íî âñå-æå:
Warfarin-Induced Eosinophilic Pleurisy Taishi KUWAHARA1), Mareomi HAMADA1), Yoshikazu INOUE1), Shuji AONO1) and Kunio HIWADA1) 1) the Second Department of Internal Medicine, Ehime University School of Medicine [Received: 1995/02/13] [Released: 2006/03/27] Abstract: A 51-year-old man was admitted to our hospital because of dry cough and low grade fever with right-sided pleural fluid and blood eosinophilia. Warfarin had been prescribed following coronary artery bypass grafting. After the discontinuation of warfarin the clinical and chest X-ray findings improved; readministration of the drug caused recurrent blood eosinophilia and pleural effusion in the other lung. Since no other specific etiologies for eosinophilia and pleural effusion were determined by extensive evaluation, warfarin seemed to be associated with his illness. This is the first report of warfarin-induced eosinophilic pleurisy. (Internal Medicine 34: 794-796, 1995) |