#46
|
|||
|
|||
Ìíîãèå( â îòëè÷èå îò ìåíÿ ëè÷íî) íà ýòîì Ôîðóìå è êíèãè íå ïðèçíàþò, îñîáåííî îòå÷åñòâåííûå: íåò òàì ÐÊÈ.
Öèòàòà:
Íå î÷åíü ãóñòî. |
#47
|
||||
|
||||
Öèòàòà:
Biundo JJ, Jr Mipro RC, Djuric V Peripheral nerve enterpment occupation-related syndromes sports injures bursitis and soft tissue problems of the shoulder. Curr Opin Rheumatol 7 :151, 1995 Áîëåå òîãî ìîãó óòâåðæäàòü, ÷òî ïîäòâåðæäåíèå òóííåëüíîé íåðîïàòèè ñðåäèííîãî íåðâà íà óðîâíå çàïÿñòüÿ ÿâëÿåòñÿ "êëàññèêîé" ýëåêòðîäèàãíîñòèêè. È ìîãó òàêæå óòâåðæäàòü, ÷òî åñëè äàæå Âû è ñ ïîìîùüþ òåñòîâ ïîñòàâèòå ñèíäðîì êàðïàëüíîãî êàíàëà, íà íà ÝÍÌà áóäóò àáñîëþòíî íîðìàëüíûå äèñòàëüíûå ëàòåíòíîñòè, òî ñèíäðîìà êàðïàëüíîãî òóííåëÿ ñðåäèííîãî íåðâà Âàñ íèêòî íå ïîäòâåðäèò, âåäü ýòî â ïåðâóþ î÷åðåäü íåâðîëîãè÷åñêîå çàáîëåâàíèå ÏÍÑ. ß íå äóìàþ, ÷òî ÿ ãëóïåå Âàñ â ýòîì âîïðîñå óâàæàåìûé äîêòîð è åñëè ÿ áûë áû ñèëüíî íå ïðàâ, òî ìíåíèå êîëëåã ïî ýòîìó âîïðîñó áûëî áû íåçàìåäëèòåëüíûì è áåñïîùàäíûì, óæ ÿ ýòî òî÷íî çíàþ, êàê áûâàåòñÿ íà ýòîì ñåðâåðå. È ìîå ñëîâî ïðîòèâ Âàøåãî òàêîå æå âåñîìîå è Âû íå ìîé ó÷èòåëü, òåì áîëåå êàê ðàç ÿ ïîäòâåðæäàþ åãî äîêàçàòåëüíî. |
#48
|
|||||
|
|||||
Öèòàòà:
Õîòÿ Âû òàê è íå îòâåòèëè, ÷èòàëè ëè Âû ïîëíîñòüþ òå ñòàòüè, íà êîòîðûå äàåòå ññûëêè, èëè îçíàêîìèëèñü òîëüêî ñ ðåçþìå, íî ÿ ðèñêíó ïîêàçàòü, êàê Âû "ïîäêðåïëÿåòå" ñâîè óòâåðæäåíèÿ ññûëêàìè íà ëèòåðàòóðó. Èòàê. Âàø ïîñò ¹23 "Ñèíäðîìû, ñâÿçàííûå ñ ïîñòîÿííûìè îäíîîáðàçíûìè äâèæåíèÿìè, â ÷àñòíîñòè ñèíäðîì êàðïàëüíîãî êàíàëà, ëåæèò â îñíîâå 50% ïðîôåññèîíàëüíûõ çàáîëåâàíèé ÑØÀ*". Rempel DM, Harrison RJ: Work-related cumulative trauma disorders of the upper extremity, JAMA 267:838 1992. Òàê âîò öèòèðóþ â îðèãèíàëå èç ðåçþìå ýòîé ñòàòüè ( ëåãêî íàõîäèòñÿ ïî ÏàáÌåäó):"Cumulative trauma disorders due to performance of repetitive tasks account for more than 50% of all occupational illnesses in the United States today". Ãäå â îðèãèíàëå íàïèñàíî äîñëîâíî õîòü îäíî ñëîâî ïðî "â ÷àñòíîñòè ñèíäðîì êàðïàëüíîãî êàíàëà"? Cumulative trauma disorders è ñèíäðîì êàíàëà çàïÿñòüÿ íå ÿâëÿþòñÿ ñèíîíèìàìè. Èëè ÿ íåïðàâèëüíî ïåðåâåë ñ àíãëèéñêîãî ýòî ñëîâîñî÷åòàíèå? Âû ëó÷øå ïî÷èòàéòå, ÷òî òàêîå êóìóëÿòèâíàÿ òðàâìà, îâåðþç ñèíäðîì è ò.ä. Òàê ÷òî óïîìèíàíèå î 50% èìåííî ÑÊÇ ó ïðîôåññèîíàëîâ ÿâíî, ìÿãêî âûðàæàÿñü, íåêîððåêòíîå. Ñëåäóþùåå Âàøå "ïîäòâåðæäåíèå". Âàøå ïèñüìî ¹29: "Ýòèîëîãèÿ: Èäèîïàòè÷åñêàÿ 43,2%, Íåèäèîïàòè÷åñêàÿ 56,8% íà 100 ñëó÷àåâ - Òðàâìà 13,4%, Êîëëàãåíîçû (ðåâìàòîèäíûé àðòðèò, ÑÊÂ) 6,5%, Ãîðìîíîçàâèñèìûå 6,4%, Ñàõàðíûé äèàáåò 6,1%, Ôèçè÷åñêàÿ ïåðåãðóçêà 5,9%, Àðòðèò ñóñòàâîâ êèñòè 5,3%, Áåðåìåííîñòü 4,6%, Òåíîñèíîâèò 3,1%, Ñìåøàííûå (îïóõîëü, àìèëîèäîç) 2,5%, Ìèêñåäåìà 1,4%, Äðóãèå (àêðîìåãàëèÿ, òóáåðêóëåç) 1,7%. Stevens, JS Beard CM, OFallen WM, et al.: Conditions associated with carpal tunnel syndrome. Mayo Clin Proc 67: 541 1992." Îòêðûâàåì ïåðâîèñòî÷íèê, à òàì â îðèãèíàëå íàïèñàíî: "In 43.2% of the 1,016 patients, no associated conditions were found on review of the medical records, whereas associated conditions were documented in 56.8%..... The standardized morbidity ratio was 3.6 for rheumatoid arthritis, 2.3 for diabetes mellitus, and 2.5 for pregnancy. The population attributable risk for pregnancy among women 15 to 44 years old was 7.0%". Òàê âîò ÿ è ñïðàøèâàþ: îòêóäà âçÿëèñü óïîìÿíóòûå Âàìè "ïîäòâåðæäàþùèå" öèôèðêè, åñëè â îðèãèíàëå ýòèõ ïðîöåíòîâ íå âèäàòü? Ìîæåò áûòü Âû ëè÷íî ÷èòàëè ñòàòüþ öåëèêîì, òîãäà ïðèâåäèòå öèòàòû â îðèãèíàëå, à ÿ ïðîâåðþ, ñîîòâåòñòâóåò ëè ýòî äåéñòâèòåëüíîñòè. À òàê ñêëàäûâàåòñÿ âïå÷àòëåíèå, ÷òî Âû äóðèòå íàðîä, à ýòî îé êàê íåõîðîøî. Öèòàòà:
Öèòàòà:
Öèòàòà:
Öèòàòà:
Äà è íå ñòðåìëþñü èì ñòàòü. Öåëè ó ìåíÿ â æèçíè äðóãèå. Óæ èçâèíèòå. |
#49
|
||||
|
||||
Óäà÷è Âàì. Íå áûë çäåñü ãîä, óæå íå ïîÿâëþñü âèäèìî íèêîãäà..íè÷åãî íå èçìåíèëîñü. "In 43.2% of the 1,016 patients, no associated conditions were found on review of the medical records, whereas associated conditions were documented in 56.8%..... The standardized morbidity ratio was 3.6 for rheumatoid arthritis, 2.3 for diabetes mellitus, and 2.5 for pregnancy. The population attributable risk for pregnancy among women 15 to 44 years old was 7.0% Âû çà÷åì ìíîãîòî÷èå òî ïîñòàâèëè ïîñëå ïðîöåíòîâ? ×òî âû õîòèòå äîêàçàòü, ÷òî òàì íå ïðîöåíòû? òàê ñëîæèòå âñå öèôðû è ó âàñ ïîëó÷èòñÿ 56,8%, à ÷òî òàì åùå äîëæíî áûòü 2,3 ÷åëîâåê ÷òîëü? È êñòàòè, ïðî òðàâìó ïî÷åìó íè ñëîâà?
|
#50
|
||||
|
||||
Âàø ïîñò ¹23 "Ñèíäðîìû, ñâÿçàííûå ñ ïîñòîÿííûìè îäíîîáðàçíûìè äâèæåíèÿìè, â ÷àñòíîñòè ñèíäðîì êàðïàëüíîãî êàíàëà, ëåæèò â îñíîâå 50% ïðîôåññèîíàëüíûõ çàáîëåâàíèé ÑØÀ*". Rempel DM, Harrison RJ: Work-related cumulative trauma disorders of the upper extremity, JAMA 267:838 1992. Òàê âîò öèòèðóþ â îðèãèíàëå èç ðåçþìå ýòîé ñòàòüè ( ëåãêî íàõîäèòñÿ ïî ÏàáÌåäó):"Cumulative trauma disorders due to performance of repetitive tasks account for more than 50% of all occupational illnesses in the United States today"
Ýòî íå ìîÿ öèòàòà ïðî âêëþ÷åíèå ñèíäðîìà ÇÊ, à David G.Borenstein, ÌD Professor of Medicine Medical Director The Spine Center Associate Director of Edication and Research Division of Rheumatology The George Washington University Medical Center Washington, D.C. èç åãî êíèãè Áîëè â øåéíîì îòäåëå ñòð 619. Ìîæåò ïåðåâåëè íå âåðíî, íî ÿ ñîìíåâàþñü. Åñëè åñòü êíèãà Í.Ì. Æóëåâà "Íåâðîïàòèè", òî îòêðîéòå ñòð.330 è ïî÷èòàéòå îî÷åíü âíèìàòåëüíî, òàì âñå ãðàìîòíî íàïèñàíî. |
#51
|
||||
|
||||
Ó íàñ â Ïèòåðå óæå ïîÿâèëñÿ âðà÷ â îäíîì èç ñòàöèîíàðîâ..óæå îïåðèðóþùèé ñèíäðîì çàïÿñòíîãî êàíàëà ïî ñîáñòâåííîìó ðàçóìåíèþ áåç ÝÍÌÃ..Âèäèìî òîæå ãðàìîòíûé ñïåöèàëèñò.."òîæå ÷åé-òî ó÷èòåëü".
|
#52
|
||||
|
||||
Physical Exam, Tests, Laboratory Studies,
and Imaging After establishing the history of the patients presenting symptoms, the next approach is the physical exam. The primary and most widely used provocative clinical tests to examine for median nerve compression at the wrist are Phalen’s maneuver and Hoffman- Tinel’s sign. Phalen’s maneuver or sign is performed by having the patient flexed their wrist at 90 degrees and maintained at this position for up to one minute or until pain and paresthesia are reproduced. Hoffman-Tinel’s sign, on the other hand, is performed by tapping over the carpal tunnel, where a positive sign is present when clinical symptoms are reproduced. However, the sensitivity and specificity of these tests are relatively low, ranging from 60-75% to 47-67%. In addition to these tests, Katz hand symptom diagram can also assist in diagnosing CTS, where the patient identifies areas of pain, numbness, tingling, and decreased sensation on the hand diagram with sensitivity of 96% and specificity of 76%. Also, patients frequently report nocturnal symptoms, in which is associated with shaking or flicking their hand (flick sign) to relieve the symptoms. Conflicting results have shown the “flick” sign sensitivity ranging from of 47% to 93% and specificity of 62% to 96%.15 Sensory testing can also access for CTS by using two-point discrimination,monofilament test, and vibration, but these are generally late physical findings and may lack diagnostic value. For instance, distribution or abductor pollicis brevis atrophy has a high specificity (>90%) but low sensitivity (<25%).17 Furthermore, electrodiagnostic testing, such as nerve conduction and electromyographic studies, helps to confirm the diagnosis of CTS and to localize the nerve entrapment, in which these studies has an 85% sensitivity and specificity greater than 95%, but NCS has a small false negative rate.18,19 Electrodiagnostic studies are usually performed if there is diagnostic doubt and before surgery. The findings from electrodiagnostic studies reveal prolongation of the distal motor and/or sensory latencies across the traverse carpal ligament (sensory latency of greater than 3.5 milliseconds or a motor latency of greater than 4.5 milliseconds), showing signs of demyelination. The consensus committees from the American Academy of Neurology, American Association of Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation recognize nerve conduction studies as the diagnostic standard for carpal tunnel syndrome.20,21 Even though these tests are not highly sensitive or specific for CTS, the physician can complete these tests and gain useful information in a short time. Âîò ïðåäìåò íàøåãî ñïîðà. Äåéñòâèòåëüíî óìåíüøèë öèôðû (ïèñàë ïðî Òèíåëÿ - òàì âñå âåðíî ïðèìåðíî), ÷óâñòâèòåëüíîñòü êîìïðåññèîííîãî òåñòà çíà÷èìî âûøå (âçÿë íà âîîðóæåíèå). Íî ñàìûé ÷óâñòâèòåëüíûé âñå-òàêè ýëåêòðîäèàãíîñòèêà ÷óâñòâèòåëüíîñòü 85% è áîëåå 95% ñïåöèôè÷íîñòü. The consensus committees from the American Academy of Neurology, American Association of Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation recognize nerve conduction studies as the diagnostic standard for carpal tunnel syndrome "Ýòî î êàêîì äèàãíîçå èäåò ðå÷ü? Åñëè î ñèíäðîìå êàíàëà çàïÿñòüÿ, òî ïðîâîäèòü ÝÍÌà ñîâñåì íåîáÿçàòåëüíî". Ýòî Âàø ïîñò ¹18 â ýòîé òåìå.. |
|
#53
|
||||
|
||||
Õîòåëîñü áû ïîíÿòü, ïî÷åìó Âû ñ÷èòàåòå, ÷òî ÝÍÌà íå ÿâëÿåòñÿ ñòàíäàðòîì â äèàãíîñòèêå ÑÇÊ, ïî÷åìó òðàâìà íå ìîæåò áûòü íà ïåðâîì ìåñòå ïðè íåèäèîïàòè÷åñêèõ ïðè÷èíàõ âîçíèêíîâåíèÿ ÑÇÊ, ïî÷åìó áåðåìåííîñòü íå ìîæåò âûçûâàòü ÑÇÊ, ïî÷åìó ÇÊÑ íå ìîæåò áûòü ÷àñòüþ ñèíäðîìîâ, ñâÿçàííûõ ñ îäíîîáðàçíûìè äâèæåíèÿìè è áûòü âêëþ÷åííûì â ðååñòð ïðîô. çàáîëåâàíèé? Ïî÷åìó 1% ñòðàäàþùèõ ÑÇÊ ýòî íå ãóñòî, 50000 äëÿ Ïèòåðà, ê ïðèìåðó, ñîâñåì íå ìàëî.
Îòâåòüòå ïîæ-òà èìåííî âîò â ýòîì ðàêóðñå, íå ðàñêëàäûâàÿ ìîè ïîñòû ïî ÷àñòÿì, à ÷òî-òî ñàìè ñèíòåçèðóéòå. Èíòåðåñíî áûëî áû ñîçäàòü îïðîñíèê èëè íîâóþ òåìó, ãäå êàæäûé ñìîã áû "ïðîãîëîñîâàòü" ïî âñåì ïóíêòàì íàøåãî ñïîðà áåç îäîáðåíèÿ èëè íåîäîáðåíèÿ.. |
#54
|
|||
|
|||
Öèòàòà:
Òàê âîò ÿ åùå ðàç ïðèâåäó Âàøó "öèòàòó","ïîäòâåðæäàþùóþ" Âàøå ìíåíèå. Âàøå ïèñüìî ¹29: "Ýòèîëîãèÿ: Èäèîïàòè÷åñêàÿ 43,2%, Íåèäèîïàòè÷åñêàÿ 56,8% íà 100 ñëó÷àåâ - Òðàâìà 13,4%, Êîëëàãåíîçû (ðåâìàòîèäíûé àðòðèò, ÑÊÂ) 6,5%, Ãîðìîíîçàâèñèìûå 6,4%, Ñàõàðíûé äèàáåò 6,1%, Ôèçè÷åñêàÿ ïåðåãðóçêà 5,9%, Àðòðèò ñóñòàâîâ êèñòè 5,3%, Áåðåìåííîñòü 4,6%, Òåíîñèíîâèò 3,1%, Ñìåøàííûå (îïóõîëü, àìèëîèäîç) 2,5%, Ìèêñåäåìà 1,4%, Äðóãèå (àêðîìåãàëèÿ, òóáåðêóëåç) 1,7%. Stevens, JS Beard CM, OFallen WM, et al.: Conditions associated with carpal tunnel syndrome. Mayo Clin Proc 67: 541 1992." À òåïåðü ïðî÷èòàéòå âíèìàòåëüíî ðåçþìå ýòîé ñòàòüè. «Abstract With use of a comprehensive medical records-linkage system, we identified the comorbid conditions and risk factors in the residents of Rochester, Minnesota, who had a diagnosis of carpal tunnel syndrome during 1961 through 1980. In 43.2% of the 1,016 patients, no associated conditions were found on review of the medical records, whereas associated conditions were documented in 56.8%. The most frequent of these conditions were Colles' fracture, rheumatoid arthritis, hormonal agents or oophorectomy (or both), diabetes mellitus, and, among men, occupations that involved excessive use of the hands. Rheumatoid arthritis, diabetes mellitus, and pregnancy were significantly more frequent among the study patients with carpal tunnel syndrome than in the general population of Rochester, Minnesota. The standardized morbidity ratio was 3.6 for rheumatoid arthritis, 2.3 for diabetes mellitus, and 2.5 for pregnancy. The population attributable risk for pregnancy among women 15 to 44 years old was 7.0%. The standardized morbidity ratio for polymyalgia rheumatica was not significantly increased». Ãäå çäåñü íàïèñàíî ïðî óïîìÿíóòûé ( âìåñòå ñ ïðîöåíòàìè) àìèëîèäîç, òåíîñèíîâèò, àêðîìåãàëèþ, îïóõîëè, òóáåðêóëåç? È ãäå çäåñü âñå ýòè ïðîöåíòû, î êîòîðûõ Âû ñîîáùàåòå? ß ÷ðåçâû÷àéíî ñëàá â àðèôìåòèêå, ïîýòîìó òàê è íå ïîíÿë, ÷òî ñ ÷åì íàäî ñêëàäûâàòü è îòíèìàòü, ÷òîáû ïîëó÷èòü óïîìÿíóòûå Âàìè ïðîöåíòû.  ðåçþìå îá ýòîì íè ñëîâà íå óïîìèíàåòñÿ. Âîò îíî-ðåçþìå, ïðÿìî ïåðåä ãëàçàìè. Öèòèðîâàòü íàäî ÊÎÐÐÅÊÒÍÎ, òîãäà è âîïðîñîâ áóäåò ìåíüøå. |
#55
|
|||
|
|||
Öèòàòà:
Íå çíàþ, íå ÷èòàë, íåèíòåðåñíî îïÿòü òðàòèòü ñâîå âðåìÿ íà åðóíäó, î êîòîðîé ìû çäåñü ñïîðèì. Ðåçóëüòàò ìîæåò áûòü îïÿòü òåì æå ñàìûì. Ìîæåò áûòü è õîðîøàÿ, è ãðàìîòíàÿ, íî ó ìåíÿ ýòîé êíèãè âðîäå áû íåò, íî åñòü äðóãèå, äóìàþ, ÷òî åùå áîëåå ãðàìîòíûå. Êàæäîìó - ñâîå. |
#56
|
|||
|
|||
Âðà÷åé, îïåðèðóþùèõ ÑÊÇ, â Ïèòåðå äîëæíî áûòü "íàâàëîì", â ýòîì ÿ óâåðåí íà 200%. À âîò îïåðèðîâàòü ñ ÝÍÌà èëè áåç íåå - ðåøàåò îïåðèðóþùèé õèðóðã. Èìåííî îí, êñòàòè, è îòâå÷àåò çà èñõîä ëå÷åíèÿ, à íå ñïåöèàëèñò, âûïîëíèâøèé ÝÍÌÃ.
|
#57
|
|||
|
|||
Öèòàòà:
Öèòàòà:
Âû èëè íå ÷èòàåòå òîãî, ÷òî èçëàãàåòå, èëè êîå-÷åãî íå ïîíèìàåòå.  ïðèâåäåííîé Âàìè öèòàòå èç íåâåäîìîãî ëèòåðàòóðíîãî èñòî÷íèêà ÷åòêî è îäíîçíà÷íî íàïèñàíî: "Furthermore, electrodiagnostic testing, such as nerve conduction and electromyographic studies, helps to confirm the diagnosis of CTS and to localize the nerve entrapment,....Electrodiagnostic studies are usually performed if there is diagnostic doubt and before surgery." Ýòî ÷òî, èäåò âðàçðåç ñ ìîèìè âûñêàçûâàíèÿìè? À ïî ïîâîäó òîãî, ÷òî ýëåêòðîäèàãíîñòèêà ïðîâîäèòñÿ ïîñëå îïåðàöèè, òàê ýòî èìååò âïîëíå ïîíÿòíîå è ðàñïðîñòðàíåííîå íà Çàïàäå îáúÿñíåíèå: äëÿ ñòðàõîâûõ êîìïàíèé. Äëÿ òîãî, ÷òîáû íå ïðèäèðàëèñü è ìîæíî áûëî "îáúåêòèâíî" äîêàçàòü íåîáõîäèìîñòü è ýôôåêòèâíîñòü îïåðàöèè. |
#58
|
||||
|
||||
Öèòàòà:
À ãäå Âû âèäåëè ìîè âîçðàæåíèÿ? Ýòî äàâíî èçâåñòíî è îïèñàíî íå òîëüêî ó àìåðèêàíöåâ â êíèæêàõ è æóðíàëàõ. Öèòàòà:
Íå óäåðæàëñÿ. Öèòèðóþ ïî ïîâîäó "îäíîîáðàçíûõ äâèæåíèé" è "ïðîô.âðåäíîñòåé". - "Äëèòåëüíîå âðåìÿïðåïðîâîæäåíèå ó êîìïüþòåðà èëè ìîíîòîííîå âûïîëíåíèå ñãèáàòåëüíî-ðàçãèáàòåëüíûõ äâèæåíèé êèñòè íåðåäêî ïðèâîäèò ê ðàçâèòèþ áîëè â çàïÿñòüå. Íî ó÷åíûå èç Óíèâåðñèòåòà Êîâåíòðè â Âåëèêîáðèòàíèè (Coventry University, UK) óòâåðæäàþò, ÷òî ÷àùå âñåãî áîëè â çàïÿñòüå âûçûâàþò... ÷ðåçìåðíûå çàíÿòèÿ ñåêñîì! Ãëàâà èññëåäîâàòåëüñêîé ãðóïïû, äîêòîð Äæîí Öåíèàí (Dr. John Zenian), îïóáëèêîâàë ðåçóëüòàòû ïðîâåäåííîãî èññëåäîâàíèÿ â æóðíàëå "Ìåäèöèíñêèå Ãèïîòåçû" (Medical Hypotheses). Òàì ñêàçàíî, ÷òî ÷ðåçìåðíîå äàâëåíèå íà çàïÿñòüÿ îáîèõ ðóê âî âðåìÿ èíòèìíîé áëèçîñòè ïàðòíåðîâ ïîâûøàåò ðèñê ðàçâèòèÿ ñèíäðîìà çàïÿñòíîãî êàíàëà.Íàïîìíèì, ÷òî ñèíäðîì çàïÿñòíîãî êàíàëà (åùå èçâåñòåí êàê êàðïàëüíûé òóííåëüíûé ñèíäðîì) - ýòî íåâðîïàòèÿ, ïðè êîòîðîé ïðîèñõîäèò ñäàâëèâàíèå ñðåäèííîãî íåðâà ìåæäó êîñòíûìè ñòåíêàìè çàïÿñòíîãî êàíàëà è ïîïåðå÷íîé ñâÿçêîé çàïÿñòüÿ. Äîêòîð Äæîí Öåíèàí ãîâîðèò: "×àñòîå äèàãíîñòèðîâàíèå ñèíäðîìà çàïÿñòíîãî êàíàëà â ïîñëåäíèå ãîäû ìîæíî îáúÿñíèòü ëèøü ÷ðåçìåðíûìè çàíÿòèÿìè ñåêñîì. Âåäü ýòî îäíî èç íàèáîëåå ðàñïðîñòðàíåííûõ çàíÿòèé, âî âðåìÿ êîòîðîãî òðåáóåòñÿ èñïîëüçîâàíèå îáåèõ ðóê. Áîëåå òîãî, âî âðåìÿ èíòèìíîé áëèçîñòè ïðîèñõîäèò íåèìîâåðíîå äàâëåíèå íà çàïÿñòüÿ, ÷òî âïîñëåäñòâèè ïðèâîäèò ê ðàçâèòèþ äàííîãî íåäóãà". Öèòèðóþ ñ îäíîãî ïîðòàëà. Ññûëêó íà ïîðòàë ìîãó ïðèâåñòè ïî ðàçðåøåíèþ-òðåáîâàíèþ ìîäåðàòîðà. Ïîïîëíèì ðååñòð ïðîôâðåäíîñòåé åùå îäíîé "âðåäíîñòüþ"? Öèòàòà:
Öèòàòà:
For what? Òàê, êàæåòñÿ, ýòî íàçûâàåòñÿ. |
#59
|
||||
|
||||
Öèòàòà:
|
#60
|
||||
|
||||
Öèòàòà:
Åùå ðàç ïîâòîðÿþ The consensus committees from the American Academy of Neurology, American Association of Electrodiagnostic Medicine, and American Academy of Physical Medicine and Rehabilitation recognize nerve conduction studies as the diagnostic standard for carpal tunnel syndrome Âàì ïåðåâåñòè? |