#241
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Ñëîæíî. Ññûëêè íà àìåðèêàíñêèé ÍÁ, êîòîðûé âðîäå áû îòëè÷åí îò åâðîïåéñêîãî.
À âîò ïîñëåäíåå åâðîïåéñêîå ìíåíèå. Â ïðèíöèïå, îáçîð ÌÐÒ ïðè ÍÁ ïðîõîäèò â Ñêàíäèíàâèè â íàñòîÿøåå âðååìÿ. : Acta Radiol. 2007 Sep;48(7):755-62. Links Brain magnetic resonance imaging does not contribute to the diagnosis of chronic neuroborreliosis.Aalto A, Sjöwall J, Davidsson L, Forsberg P, Smedby O. Division of Radiology, Department of Medicine and Care, Faculty of Health Sciences, Linköping University, Linköping, Sweden. [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] BACKGROUND: Borrelia infections, especially chronic neuroborreliosis (NB), may cause considerable diagnostic problems. This diagnosis is based on symptoms and findings in the cerebrospinal fluid but is not always conclusive. PURPOSE: To evaluate brain magnetic resonance imaging (MRI) in chronic NB, to compare the findings with healthy controls, and to correlate MRI findings with disease duration. MATERIAL AND METHODS: Sixteen well-characterized patients with chronic NB and 16 matched controls were examined in a 1.5T scanner with a standard head coil. T1- (with and without gadolinium), T2-, and diffusion-weighted imaging plus fluid-attenuated inversion recovery (FLAIR) imaging were used. RESULTS: White matter lesions and lesions in the basal ganglia were seen in 12 patients and 10 controls (no significant difference). Subependymal lesions were detected in patients down to the age of 25 and in the controls down to the age of 43. The number of lesions was correlated to age both in patients (rho = 0.83, P<0.01) and in controls (rho = 0.61, P<0.05), but not to the duration of disease. Most lesions were detected with FLAIR, but many also with T2-weighted imaging. CONCLUSION: A number of MRI findings were detected in patients with chronic NB, although the findings were unspecific when compared with matched controls and did not correlate with disease duration. However, subependymal lesions may constitute a potential finding in chronic NB. |
#242
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Óâàæàåìàÿ SVA,
íå ñîâñåì ïîíÿë, ïî÷åìó âîçíèêëî ïîäîçðåíèå íà ëàéì-áîððåëèîç, íî î÷íîìó ñïåöèàëèñòó ìîæåò áûòü âèäíåå... Ñåðîëîãè÷åñêàÿ äèàãíîñòèêà áîððåëèîçà âêëþ÷àåò 2 ýòàïà - 1) Èññëåäîâàíèå àíòèòåë ìåòîäîì ÈÔÀ 2) Ïðè ïîëîæèòåëüíîì ðåçóëüòàòå - ïîäòâåðæäàþùåå èññëåäîâàíèå ìåòîäîì èììóíîáëîòèíãà. Ñêîðåå âñåãî, âîçìîæíîñòè âûïîëíèòü èììóíîáëîòèíã â Âîðîíåæå íåò. Îöåíèâàÿ âîçìîæíûå ðèñêè è ïîçèòèâíûå ñòîðîíû ðàçíûõ ïîäõîäîâ, íàâåðíîå, ìîæíî ñîãëàñèòüñÿ ñ òåì, ÷òîáû ëå÷åíèå àíòèáèîòèêàìè áûëî ïðîâåäåíî ïðè ïîëîæèòåëüíîì ðåçóëüòàòå ÈÔÀ. Åñëè ýòî äåéñòâèòåëüíî íåéðîáîððåëèîç - òî ëå÷åíèå äîëæíî äàòü ýôôåêò. Íî, íàâåðíîå, íàäî ñðàçó ñêàçàòü, ÷òî åñëè óëó÷øåíèÿ íå áóäåò - òî ïîâòîðíûå êóðñû àíòèáèîòèêîâ è/èëè äëèòåëüíîå ëå÷åíèå àíòèáèîòèêàìè ñìûñëà íå èìååò - íàäî èñêàòü äðóãèå ïðè÷èíû, à íå íåéðîáîððåëèîç. |
#243
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Óñåðäíî ïûòàëñÿ îñìûñëèòü òåìó ñ ñàìîãî íà÷àëà. Ñîâñåì íå ïîíÿë îòêóäà âîçíèêëî ïîäîçðåíèå íà íåéðîáîððåëèîç...
Íî, ÈÌÕÎ, ðèñêè íåëå÷åíèÿ åæåëè ýòî áîððåëèîç íàìíîãî âûøå, ÷åì íåíóæíîãî ëå÷åíèÿ àíòèáèîòèêàìè. À ñïîðèòü ñî ñïåöèàëèñòîì, êîòîðûé ñìîòðåë â ðåàëå... Ãëàâíîå - ÷òîáû íåéðîáîððåëèîç íå ñòàë åäèíñòâåííûì äèàãíîçîì â äèôôåðåíöèàëüíîì ñïåêòðå è íå ïûòàëèñü åãî "ëå÷èòü äî ïîáåäíîãî êîíöà". À âîîáùå, íàñêîëüêî ÿ ìîãó ñóäèòü - ìîãó îøèáàòüñÿ - íèêòî òîëêîì íå çíàåò, êàêèå èçìåíåíèÿ íà ÌÐÒ ñâÿçàíû ñ íåéðîáîððåëèîçîì, ïîñêîëüêó ñïåöèôè÷íûõ èñêëþ÷èòåëüíî äëÿ íåéðîáîððåëèîçà ïîðàæåíèé âðîäå íå îïèñàíî. |
#244
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Ïðè ïðî÷èõ ðàâíûõ óñëîâèÿõ - ïîäîçðåíèå íà ÍÁ äèêòóþò íåîáõîäèìîñòü èììóíîáëîòà, íî îòìåíÿåò ëè íåîáõîäèìîñòü áèîïñèè?
Íà ìîé íåïðîñâåùåííûé âçãëÿä îáà äèàãíîçà ïîêà âèñÿò â âîçäóõå è òðåáóþò ñêîðåå èñêëþ÷åíèÿ, íåæåëè ïîäòâåðæäåíèÿ.
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Ñ óâàæåíèåì, Þñèô Àëõàçîâ. |
#245
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Ìîæåò áûòü ñòîèò îïðåäåëèòüñÿ ñ êîíñåíñóñîì è äîâåñòè äî ìàìû êîíñîëèäèðîâàííîå ìíåíèå? À òî, âðîäå, å¸ áîððåëèîç îáíàä¸æèë êàê-òî...
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#246
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ÈÌÕÎ, íåëüçÿ äîëãî òÿíóòü ñ áèîïñèåé. Ìîæíî ëè óçíàòü êàê ïðîô. Ñ Êîçëîâ ïðèø¸ë ê äèàãíîçó?
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#247
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Ñåãîäíÿ óæå ïîçäíî, íåóäîáíî çâîíèòü. Íî ó íèõ íà êàôåäðå ñàìûé áîëüøîé â Ïèòåðå îïûò ïî áîððåëèîçó, îíè ïåðâûå íà÷àëè èì çàíèìàòüñÿ, ïî÷òè âñå Ëàéìèêè èäóò ÷åðåç íèõ è ïîòîì ó íèõ íàáëþäàþòñÿ. Âèäèìî, óâèäåë ñîîòâåòñòâóþùóþ êëèíèêó.
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Åëåíà Åâãåíüåâíà Êîðíàêîâà, ïàðàçèòîëîã. |
#248
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Íà âñÿêèé ñëó÷àé, åæåëè êîìó èíòåðåñíî, ïîñëåäíèé, ÈÌÕÎ, äîêóìåíò.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] |
#249
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Öèòàòà:
Óâàæàåìûå âðà÷è!!! Î×ÅÍÜ ïðîøó èíôåêöèîíèñòîâ ïîñìîòðåòü èñòîðèþ ìîåãî ðåáåíêà íà ïðåäìåò êàêèõ-òî èíôåêöèé. Ìîãó äîáàâèòü, ÷òî â 7, 10 ëåò ó ðåáåíêà áûë ñèëüíåéøèé îòèò. Äîêòîð Anton Verbine êàê-òî ïðîðîíèë ôðàçó: "Êàæåòñÿ, äîêòîð, äàâ àíòèáèîòèêè, ñïàñ âàøåãî ðåáåíêà, õîòÿ è íå äîâåë ëå÷åíèå äî êîíöà". Ñêàæèòå, ÷òî çà èíôåêöèþ Âû èìåëè ââèäó???? http://forums.rusmedserv.com/showpos...0&postcount=39 |
#250
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Êîëëåãè. Çíà÷èòñÿ òàê. Ïîë÷àñà íàçàä ãîâîðèë ñ Ñåðåæåé Êîçëîâûì ïî òåëåôîíó. Íà â÷åðàøíåì ÊÒ â ñïèííîì ìîçãå îáíàðóæåíû ñâåæèå (íîâûå) î÷àãè. Ðàçìåð ïðåæíèõ (4-5ñì), íà åãî âçãëÿä èñêëþ÷àò öèñ-ç. Ïðîâåäåííîå ïðàçèêâàíòåëîì â âûñîêèõ äîçàõ ëå÷åíèå (äâà êóðñà) îäíîçíà÷íî äîëæíî áûëî ïðèâåñòè ê âûçäîðîâëåíèþ è ôîðìèðîâàíèþ êàëüöèíàòîâ. Êðîìå òîãî îòñóòñòâóåò ýïèäàíàìíåç. ÍÁ (îïÿòü æå ïî åãî ìíåíèþ) åäèíñòâåííî âîçìîæíûé èç èíôåêöèîííûõ äèàãíîçîâ, òðåáóþùèé èñêëþ÷åíèÿ/ïîäòâåðæäåíèÿ. Ïðåäëîæåíèÿ: 1. ÏÖÐ èç èìåþùåãîñÿ ãèñòîëîãè÷åñêîãî ìàòåðèàëà, 2. ÏÖÐ, ÈÔÀ è èììóíîáëîò èç êðîâè.
Ìîè ïðåäëîæåíèÿ - òî æå ñàìîå èç ëèêâîðà + öèòîëîãèÿ ëèêâîðà. Âñå àíàëèçû äåëàòü â Ìîñêâå èëè Ïèòåðå. Êðàòêî - âîò òàê.
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Ñ óâàæåíèåì, Þñèô Àëõàçîâ. |
#251
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Î÷åíü-î÷åíü õî÷åòñÿ óâèäåòü ÊÒ.
Ïðåäïîëîæåíèÿ îñòàþòñÿ, â îáùåì, òàêèìè æå - íó, íå äîëæåí öèñòèöåðêîç áûòü ïîñëå òàêîãî êóðñà ïðàçèêâàíòåëÿ, è âîçìîæíî, êàê ïðàâèëüíî ñêàçàë ä-ð Âåðáèí, ýòî áàêòåðèàëüíàÿ èíôåêöèÿ, êîòîðàÿ ìîãëà "ïðèòèõíóòü" ïîñëå ïåðâè÷íîãî êóðñà àíòèáèîòèêîâ. Âñå îñòàëüíîå Âàì ðàññêàçàë ïðîôåññîð Êîçëîâ, íàñêîëüêî ÿ ïîíèìàþ, è îí æå íàçíà÷èë äîïîëíèòåëüíûå èññëåäîâàíèÿ. Ìîå ëè÷íîå ïðåäëîæåíèå - êâîòó Âàì íàäî ïîëó÷àòü â Ïèòåð èëè â Ìîñêâó, âîò ÷òî, ÷òîáû ñäåëàòü âñå èññëåäîâàíèÿ, êîòîðûå, âåðîÿòíåå âñåãî, ïðîñòî íåäîñòóïíû ïî ìåñòó æèòåëüñòâà, è êàê ðàç êîíñóëüòàöèÿ ïîðô. Êîçëîâà ìîæåò çíà÷èòåëüíî îáëåã÷èòü ïîëó÷åíèå êâîòû... |
#252
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Íå ïîíèìàþ. Íà ÊÒ ïîçâîíî÷íèêà óâèäåòü ÍÁ íåâîçìîæíî ïî îïðåäåëåíèþ.
Õàðàêòåð ïîðàæåíèÿ íåðâíîé òêàíè ïðè ÍÁ è ÍÖ ñîâåðøåííî ðàçëè÷åí, êàðòèíà ÌÐÒ ïðîñòî íåâîçìîæíà äëÿ ÍÁ. Íàäî ðàñøèðèòü ä.äèàãíîç, íî ðàäèîëîãè÷åñêè åòî ìàëîïðîäóêòèâíî, ïîåòîìó ëè÷íîå ìíåíèå - áèîïñèÿ íàèáîëåå ñâåæèõ î÷àãîâ. Äóìàåòñÿ, ÷òî ïðè ÷èñòî áàêòåðèàëüíûõ àáñöåññàõ ñïèííîìîçãîâîãî êàíàëà êëèíè÷åñêîàÿ êàðòèíà áûëà áû èíîé. |
#253
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Ïðåäëàãàþ ðàçæåëòèòü ïðåäûäóùèé ïîñò.  ñâÿçè ñ ñåðüåçíîñòüþ ñèòóàöèè ïðåäëàãàþ ïðîñèòü ðàçðåøåíèÿ àäìèíà äàòü äîñòóï â òåìó ëå÷àùåìó âðà÷ó.
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Åëåíà Åâãåíüåâíà Êîðíàêîâà, ïàðàçèòîëîã. |
#254
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Âèêòîðèÿ, ó ëå÷àùèõ âðà÷åé åñòü âîçìîæíîñòü âûõîäà â èíòåðíåò? Õîòåëîñü áû ïðèãëàñèòü èõ â òåìó è âñåñòîðîííå îáñóäèòü ñ íèìè ñèòóàöèþ. ×åðåç Âàñ - ìîæåò ïîëó÷èòüñÿ "èñïîð÷åííûé òåëåôîí", äà è âðåìÿ ïîäæèìàåò.
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Åëåíà Åâãåíüåâíà Êîðíàêîâà, ïàðàçèòîëîã. |
#255
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Öèòàòà:
P.S. Íî âåäü àíàìíåçà áîððåëèîçà òîæå âðîäå íèêàêîãî íåò? ÈÌÕÎ, ïîêà FRSM ïðåäëàãàåò íàèáîëåå ðàçóìíóþ òàêòèêó. |