#1
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Èøåìèÿ ÇÍ è áåðåìåííîñòü.
Õîòåë óçíàòü ìíåíèå ïî ïîâîäó òàêîé ñèòóàöèè: âî âðåìÿ áåðåìåííîñòè ïðè âîçíèêíîâåíèè íàðóøåíèé êðîâîîáðàùåíèÿ â ñîñóäàõ çðèòåëüíîãî íåðâà èëè öåíòð.ñîñóäîâ ñåò÷àòêè - ÷òî ìîæíî íàçíà÷èòü èç ìåäèêàìåíòîâ ïàöèåíòêå ñ ó÷åòîì äîñòîâåðíîãî ýôôåêòà è îòñóòñòâèÿ âðåäà (ÐÊÈ). Ëàçåðíûå âîçäåéñòâèÿ â îñòðûõ ñëó÷àÿõ - âîçìîæíû?
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#3
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Öèòàòà:
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#4
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Åñëè ïðåäïîëîæèòü òîëüêî íàðóøåíèÿ êðîâîîáðàùåíèÿ:
Îòäåëüíî âîïðîñ ïî ïàöèåíòêå ïîñëå ðîäîâñïîìîæåíèÿ ñ íàðêîçîì (è â áóäóþùåì ÷òîáû çíàòü) - âñå æå íàðóøåíèå èìåííî ñîñóäîâ â çðèòåëüíîì íåðâå (çðåíèå äî 0,2-0,3) ñåêòîðàëüíîå ñíèæåíèå ñåòîâîñïðèÿòèÿ ñ àáñîëþòíûìè ñêîòîìàìè ïàðàöåíòðàëüíî, ðàñøèðåíèå çîíû ñëåïîãî ïÿòíà, íå÷åòêîñòü êîíòóðîâ è áëåäíîâàòîñòü ÇÍ, îòåê â öåíòðàëüíîì îòäåëå - óìåíüøàþùèåñÿ ãåìîððàãèè è èøåìè÷íûå ó÷àñòêè. Êàðòèíà êîìáèíèðîâàííàÿ, íî íàðóøåíèé ëîêàëüíûõ öåíòðàëüíûõ ñîñóäîâ ñåò÷àòêè (ÖÀÑ, ÖÂÑ)íå âûÿâëåíî. - æåíùèíà æåëàåò ñîõðàíèòü åñò.âñêàðìëèâàíèå è äëèòåëüíîñòü ñîñòîÿíèÿ îêîëî 3-4íåäåëü. Ñîñòîÿíèå, êàê íåâðèò - ìåíåå âåðîÿòíî, äàííûå íåóáåäèòåëüíûå. 2) âîïðîñ - åñëè òàêàÿ ñèòóàöèÿ áóäåò ó áåðåìåííîé, ÷òî Âû íàçíà÷èòå? 3) ÷åëîâåê ñðåäíåãî âîçðàñòà - òðè ðàçíûõ ñèòóàöèè: Èøåì.Îïòèêîíåéðîïàòèÿ, íàðóøåíèÿ â ÖÀÑ, ÖÂÑ. Êàê â ýòèõ ñëó÷àÿõ âîçìîæíî äîïîëíèòü ãèïîòåíçèâíîé òåðàïèåé (ÂÃÄ) - äëÿ óëó÷øåíèÿ ïåðôóçèîííîãî êîìïîíåíòà, à êîãäà áóäåò "íå ïîêàçàíî". Åñëè åñòü èñòî÷íèêè - ïîäñêàæèòå. Ñïàñèáî. |
#5
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Î ðàçðîæä¸ííîé ñ íàðêîçîì âîïðîñ, - ýòî áûë ïîçäíèé òîêñèêîç, ïðå- èëè ýêëàìïñèÿ, ÷òî è ïðèâåëî ê ðîäîâñïîìîæåíèþ ñ íàðêîçîì? . Åñëè òàê, òî íè÷åãî áû íå íàçíà÷èë. Ó áåðåìåííîé àíàëîãè÷íî. Ïóñòü àêóøåðû òîêñèêîç ëå÷àò.
Âîïðîñ ¹ 3 èíòåðåñíûé, íè÷åãî íå ìîãó ñêàçàòü, òåìà äëÿ êàíäèäàòñêîé, íàâåðíîå, õîðîøàÿ. |
#6
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 òîì òî è äåëî, ÷òî ýòî íå íàó÷íûé ïîèñê èñòèíû, ýòî ðåàëüíûå ïðèìåðû - íàïðèìåð ó ðîæàâøåé íàçíà÷èëè "ðåêîìáèíàíò.ïðîóðîêèíàçó" (áåç ðåêëàìû) è ñòåðîèäû ìåñòíî. ×åñòíî ãîâîðÿ ðåçóëüòàò èç òåõ "à âîò íå äåëàëè áû - áûëî áû õóæå". Âîò è âîçíèê âîïðîñ. À ïðî ãèïîòåíçèâíûå â ýòèõ ñèòóàöèÿõ - âðîäå êàê ê êíèãàõ íàïèñàíî (è äàæå âàðèàíòû: âîò ýòîò ëó÷øå âîò òîãî), íî òîëüêî òóò æå ñïèñîê ëåêàðñòâ, êîòîðûé äàæå â ïå÷àòíîì âèäå íå ïîäíÿòü?) Õîòåëîñü áû ÷åòêîãî àëëãîðèòìà..
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#7
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Ñïàñèáî AmuRRR çà ññûëêó [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
Occlusive vascular disorders It is well appreciated that pregnancy represents a hypercoagulable state, through various changes that occur with platelets, clotting factors, and arteriovenous flow dynamics. Such changes may be related to the development of retinal artery and vein occlusion, disseminated intravascular coagulopathy (DIC), thrombotic thrombocytopenic purpura (TTP), amniotic fluid embolism, and cerebral venous thrombosis. Both branch and central retinal artery occlusions have been reported to occur in pregnancy. Although a hypercoagulable workup may detect an abnormality, routine hematological workup may be unremarkable. A case report exists of bilateral central retinal artery occlusion from amniotic fluid embolism, which in and of itself is a potentially fatal condition. Retinal vein occlusions are less common than arterial occlusions. DIC is characterized by widespread small vessel thrombosis often associated with hemorrhage and tissue necrosis. It may occur with complications in pregnancy, such as abruptio placentae, severe preeclampsia, complicated abortion, and intrauterine death. The choroid is the most common location in the eye for DIC to manifest. Patients often complain of visual loss from choroidal infarction or hemorrhage, retinal pigment epithelial, or serous detachments usually located in the posterior pole. Visual recovery usually occurs once the DIC resolves; however, mild pigmentary changes may persist. TTP is a rare disorder characterized by small vessel thrombosis, thrombocytopenia, microangiopathic hemolytic anemia, neurologic and renal dysfunction, and fever. Visual symptoms may occur due to serous retinal detachment, retinal artery narrowing, retinal hemorrhage, and optic nerve head edema. The central nervous system may be involved, and the most common visual complaint is a homonymous hemianopia. Antiphospholipid antibody syndrome is another condition that warrants consideration. In this syndrome, patients are in a thrombophilic state and are prone to recurrent arterial and/or venous thrombosis. Diagnostic criteria include clinical evidence of recurrent pregnancy loss or thrombosis in any organ or tissue as well as laboratory evidence of circulating antiphospholipid antibodies or lupus anticoagulant. Ophthalmic manifestations may present in the form of vascular thrombosis of the retina, the choroid, the optic nerve and visual pathway, and ocular motor nerves. Òàì æå ëå÷åíèå (åãî ïðàêòè÷åñêè íåò). Ñïàñèáî. Ñëó÷àè ðåäêèå - ïîýòîìó äîñòîâåðíî ãîâîðèòü î ýôôåêòèâíîñòè ðàçíûõ ñõåì òðóäíî. |
#8
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Ïðèìåð òîãî êàê â ÞíÑòÀìåðèêà èíîãäà ïðèìåíÿþò ÅÂÌ: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] Åñòü áèáëèîãðàôèÿ, åñòü ññûëêè íà êëèíè÷åñêèå èññëåäîâàíèÿ, íî îïðåäåëåííîñòåé ìàëî. Ïðîñêàëüçûâàåò, ÷òî ïðèìåíåíèå "òîãî-èë-òîãî" - ïðèíÿòî, íî ìàëîýôôåêòèâíî èëè íàîáîðîò è ò.ï. À â êîíå÷íîì èòîãå: "ìû äåëàåì ýòî ëó÷øå, ÷åì äðóãèå, ïîýòîìó âñå ê íàì..."
Ïðî ïèëîêàðïèí - åñòü â ðàçíûõ èñòî÷íèêàõ, ÷òî îí ìîæåò äîïîëíèòåëüíî óëó÷øàòü ñîñòîÿíèå â òàêèõ ñèòóàöèÿõ (åñòü æå äàæå ôðàçû ïðî ëå÷åíèå ïðè äèñòðîôè÷åñêèõ ïðîöåññàõ). [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |