#1
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Ïîâûøåíà ìî÷åâèíà ó ðåáåíêà
Çäðàâñòâóéòå! Ìàëü÷èê 3,7 ëåò, ñðåäíåñòâîëîâàÿ ãèïîñïàäèÿ, íà êîï÷èêå íåáîëüøàÿ ÿìî÷êà, ÌÐÒ íå äåëàëè.
Íà ïðîòÿæåíèè ãîäà ïîâûøåíà ìî÷åâèíà 6,7 ïðè íîðìå 1,1-4,3. Êðåàòèíèí 33 (16,9-50,9). Ðàíåå íå ñäàâàëè. Ïðåäñòîèò îïåðàöèÿ ïîä îáùèì íàðêîçîì ïî ïîâîäó ãèïîñïàäèè. Íàäî ëè äîïîëíèòåëüíî îáñëåäîâàòü ïåðåä îïåðàöèåé? È ìîæíî ëè äåëàòü ïðèâèâêè? |
#2
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ñàìîå ãëàâíîå â àíàëèçàõ - çà÷åì îíè äåëàþòñÿ, âòîðîå - íîðìàòèâû, èç-òîãî ÷òî ïîäðóêîé äëÿ äåòåé íîðìà òàêàÿ
Urea >16 years 2.5 – 7.8 mmol/l 0-12 months 0.8 – 5.5 mmol/l 1 – 16 years 2.5 – 6.5 mmol/l
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#3
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ïåðåä îïåðàöèåé íèêàêèå àíàëèçû íå íóæíû, îíè íóæíû õèðóðãàì âêëåèòü â êàðòî÷êó, ïðèâèâêè äåëàþòñÿ çäîð. ðåáåíêó, íå ãëÿäÿ è íå äåëàÿ àíàëèçîâ, ñîãë. íàö.êàë.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#4
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îàê âûïîëíåí ñ îøèáêàìè íà íåîòêàë. îáîð. - òàêîãî íèêîãäà íå áûâàåò
Ñðåäíÿÿ êîíöåíòðàöèÿ ãåìîãëîáèíà â ýðèòðîöèòå (MCHC) 468.0 https://forums.rusmedserv.com/showthread.php?t=289839
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#5
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Ñïàñèáî! Ïîñìîòðåëà ïðåäûäóùèå àíàëèçû - ýòîò ïîêàçàòåëü è â äðóãèõ ëàáîðàòîðèÿõ áûë ïîâûøåí (350-360). Ýòî íå ìîæåò ãîâîðèòü î äåôèöèòå B12? Åñòü ïðåäðàñïîëîæåííîñòü - ó ìàìû è ó äåäóøêè ðåá¸íêà B12 íå óñâàèâàåòñÿ, äåëàåì èíúåêöèè. Åù¸ ðåá¸íîê ïî íàçíà÷åíèþ íåâðîëîãà ïðèíèìàåò ãëèöèí, äëèòåëüíî.
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#6
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350 - ïðèåìëåìî, ÍÎ, åñëè äåëàòü àíàëèçû êðîâè â ïîëóêëèíèêàõ íà êîëåíêå, òî åòî êàê ïðîñðî÷åííóþ åäó ñîáèðàòü íà ìóñîðêå è íåñòè â äîì - êà÷åñòâî íå óãàäàòü; àòðîôè÷åñêèé ãàñòðèò ó ìàìû è äåäóøêè - åòî âîçðàñòíîå, êàê âîëîñû íà ëîáêå, ìîæíî ëè ãîâîðèòü, ÷òî ó ðåáåíêà ïðîáëåìû ñ ðîñòîì âîëîñ â òîì ìåñòå? Ãëèöèí äëÿ ðåáåíêà ïî ñîâåòó íåâðîëîãà = ðåçèíîâûé ôàëëîñ äëÿ çà÷àòèÿ ïî ñîâåòó ãèíåêîëîãà
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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Ãàñòðèòîâ ïî ÔÃÄÑ íåò, äåôèöèòû âûÿâëåíû â ìîëîäîì âîçðàñòå. Åñòü ìóòàöèè ãåíîâ ôîëàòíîãî öèêëà. À ó ðåá¸íêà ïî ÎÀÊ ìîæíî ïðåäïîëîæèòü íåäîñòàòîê Â12?
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#8
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ãàñòðèòîâ íå áûâàåò/íå âèäíî ïî ôãäñ, èõ äèàãíîñòèðóþò ïî-äðóãîìó, ìóòàöèè ôîëàòíûõ öèêëîâ åñòü ó êàæäîãî âòîðîãî æèòåëÿ ïëàíåòû Çåìëÿ; åøå ðàçî÷åê - ïî äåôåêòîèäíîìó àíàëèçó êðîâè íè÷åãî íåëüçÿ óâèäåòü, êàê â äâåðíîé ãëàçîê, åñëè êòî-òî çàëåïèë åãî æóâà÷êîé ñíàðóæè, íî åòî íå îçíà÷àåò, ÷òî çà äâåðüþ íèêîãî íåò. Äåôèöèò â12 ó äåòåé 1-5 ëåò - òîëüêî â ñåìüå âåãàíîâ, ñòàâèòñÿ ïóò¸ì îïðåäåëåíèÿ åãî êîíöåíòðàöèè â êðîâè, â ÎÀÊ èçìåíåíèé ìîæåò è íå áûòü, à íåâðîëîãè÷åñêàÿ èëè ïñèõèàòðè÷åñêàÿ ñèìïòîìàòèêà óæå áûòü; åñëè Âàì íå ÷óæä èíîñòðàííûé
The prevalence of cobalamin deficiency is unknown for children aged <4 years. No clinical practice guidelines exist for diagnosing cobalamin deficiency in young children. Methylmalonic acid is a sensitive and specific indicator of cobalamin deficiency; holotranscobalamin II, total homocysteine, and serum B12 also are useful indicators (2,4,6). Macrocytic anemia and other hematologic indices are not appropriate screening tools (4). //Neurologic Impairment in Children Associated with Maternal Dietary Deficiency of Cobalamin --- Georgia, 2001
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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Âàì îòâåòèë â äðóãîé òåìå ïðî âàæíîñòü äèàãíîñòèêè ìèîïàòèè ó ðåáåíêà, åñëè îíà åñòü - ðåáåíîê ðèñêóåò ÍÅ ïåðåæèòü îïåðàöèè (ñ ãèïîñïàäèåé æèâóò äî ñòàðîñòè è çàâîäÿò äåòåé) - ÂÑÅ ñâîè ñèëû è ýíåðãèþ íàïðàâèòü íà ÅÒÎ ÑÅÉ×ÀÑ â ðåàëüíîì ìèðå, èíòåðíåò òîëüêî èñïîëüçîâàòü òîëüêî äëÿ ëîêàëèçàöèèè äåòñêèõ ñïåöèàëèñòîâ, ÷òîáû ê íèì íàïðÿìóþ îáðàòèòüñÿ ñ äèàãí. öåëüþ
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#10
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Ñïàñèáî! À êàê è ãäå ìîæíî äèàãíîñòèðîâàòü íàñëåäñòâåííóþ ìèîïàòèþ â Ìîñêâå? Ìû ñòîëüêèõ âðà÷åé - íåâðîëîãîâ è ïåäèàòðîâ îáîøëè, îá ýòîì íè ñëîâà íå áûëî. È ìîæíî ëè äî äèàãíîñòèêè äåëàòü âàêöèíàöèþ V3 îò ãåïàòèòà? Îïåðàöèÿ íàçíà÷åíà íà ñåðåäèíó èþíÿ, õîòåëà ïðèâèòü îò ãåïàòèòà ïîëíîñòüþ. Ãèïîñïàäèÿ ñðåäíåñòâîëîâàÿ, âèçóàëüíî âèäíî, îïåðèðîâàòü ïðèä¸òñÿ.
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#11
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íå çíàþ êàê - åñòü îïðåäåëåííûå ðåêîìåíäàöèè çà ðóáåæîì - ñîáëþäàþò ëè èõ â ÐÔ? ïåðåâåäèòå íà íåõèòðûé ðóññêèé ñòàòüþ, ÷òî òàì Âàì îñòàâèë - è èøèòå òåõ, êòî òàê äåéñòâóåò
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#12
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åøå ðàçîê - Âàø ñûí ñèëüíî ðèñêóåò íå ïåðåæèòü àíåñòåçèþ, åñëè áóäóò íàðêîç ïðîâîäèòü òàêèå æå äèëåòàíòû, êîòîðûå äåëàëè ðåáåíêó ÎÀÊ "ñïóñòÿ â ðóêàâà"
In the absence of a precise diagnosis, children presenting with an undiagnosed neuromuscular disease should not have elective surgery or anaesthesia other than as part of the diagnostic process. All these children should have their functional status assessed before operation and consideration given to transfer to specialist centres with intensive care facilities. Anaesthesia for children with neuromuscular disease [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#13
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íåêîòîðûå âèäû ìèîïàòèé àññîöèèðîâàíû ñ ãèïîñïàäèÿìè
Centronuclear (myotubular) myopathy [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#14
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À êàê Âû ñ÷èòàåòå - çà ãðàíèöåé, â ÷àñòíîñòè, â Ñåðáèè, áåçîïàñíåå â ýòîì ïëàíå? Òàì ýòè ðåêîìåíäàöèè è ïðîòîêîëû ñîáëþäàþòñÿ? ß óæå 2 ðàçà ïåðåíîñèëà îïåðàöèþ èìåííî èç-çà ðèñêîâ àíåñòåçèè ïî îáðûâî÷íûì ñâåäåíèÿì èç èíòåðíåòà; âðà÷è ìàøóò ðóêîé è ãîâîðÿò: «èäèòå îïåðèðóéòåñü è íè÷åãî íå áîéòåñü».
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#15
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íå èìåþ íèêàêîãî ïðåäñòàâëåíèÿ, íî ìîæíî ïîçâîíèòü-íàïèñàòü è îáñóäèòü êàê ó íèõ òàì
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |