#1
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Ýòî ïðåäèíôàðêò?
Çäðàâñòâóéòå , óâàæàåìûå âðà÷è.
47ë, 85 êã, 175 ñì, èñïûòûâàþ îäûøêó ïðè îáû÷íîé õîäüáå, áåññîíèöó, äàâíî íå ïðîõîäèëà îáñëåäîâàíèÿ, áûëè ñèëüíûå ñòðåññû. Ñäåëàëà ýêã. Ïëåíêó ïðèêðåïëÿþ. Áóäó î÷åíü áëàãîäàðíà çà êîììåíòàðèè. Èñòî÷íèê ðèòìà: ñèíóñîâûé Ðåãóëÿðíîñòü ðèòìà: ïðàâèëüíûé ×ÑÑ: 78 óä/ìèí Ìèíèìàëüíàÿ ×ÑÑ: 75 óä/ìèí Ìàêñèìàëüíàÿ ×ÑÑ: 80 óä/ìèí Èíòåðâàë PQ: 130 ìñ Ïðîäîëæèòåëüíîñòü QRS: 80 ìñ Èíòåðâàë QT: 370 ìñ Èíòåðâàë QTc: 420 ìñ Èíòåðâàë ST-T: 59 ìñ Èíäåêñ Ñîêîëîâà: 18 ì Øèðèíà P: 100 ìñ ÝÎÑ Ïîëîæåíèå: âåðòèêàëüíîå α QRS: 70 ãðàä Èçìåíåíèÿ ìèîêàðäà Ïîâðåæäåíèå ìèîêàðäà Äèôôóçíûå ïîâðåæäåíèÿ: äà Íàðóøåíèå ïðîöåññà ðåïîëÿðèçàöèè æåëóäî÷êîâ Íàëè÷èå: óìåðåííûå Äèíàìèêà Çàêëþ÷åíèå âðà÷à: Òèï èññëåäîâàíèÿ: ÝÊÃ. Èñòî÷íèê ðèòìà: ñèíóñîâûé. ×ÑÑ: 78 /min. Ïîëîæåíèå ÝÎÑ: âåðòèêàëüíîå. Èçìåíåíèå ìåòàáîëèçìà ìèîêàðäà íèæíåé, áîêîâîé îáëàñòè ëåâîãî æåëóäî÷êà. Ñïàñèáî! |
#2
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Êëèìàêñ?
Åñëè íåò, òî ÷òî ñ öèêëîì (÷åðåç ñêîëüêî ïî ñêîëüêî è ñêîëüêî îáèëüíûõ)? ÀÄ, ×ÑÑ? Ãåìîãëîáèí, ôåððèòèí? ÒÒÃ? ËÏÍÏ õîëåñòåðèí? Ìàììîãðàôèÿ? Öåðâèêàëüíûé ìàçîê íà àòèïèþ è ïàïèëëîìó? Êîëîíîñêîïèÿ? ÂÈ×, ãåïàòèòû  è Ñ, RW? Ôëþîðîãðàôèÿ?
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#3
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Àëåêñàíäð Èâàíîâè÷, çäðàâñòâóéòå.
Êëèìàêñà íåò, öèêë ðåãóëÿðíûé, 28 äí, ïî ìë â ïðåäåëàõ íîðìû. Åñòü ìíîæåñòâåííûå ìèîìû, ðàññìàòðèâàëà ÝÌÀ, íî ñàìàÿ áîëüøàÿ ìèîìà èñ÷åçëà. Ôëþîðîãðàôèÿ ëåãêèõ ïðîôèëàêòè÷åñêàÿ Ôëþîðîãðàô ÐåíåêñÔëþîðî Áàçîâîå èññëåäîâàíèå äëÿ ñðàâíåíèÿ. Äàòà ïðîâåäåíèÿ. 18.08.2023 Îïèñàíèå ðåçóëüòàòîâ Ôîðìà ãðóäíîé êëåòêè: îáû÷íàÿ Ëåãî÷íûå ïîëÿ: ñèììåòðè÷íûå Î÷àãîâûå è èíôèëüòðàòèâíûå èçìåíåíèÿ íå âûÿâëåíû. ˸ãî÷íûé ðèñóíîê: íå èçìåí¸í Êîðíè ë¸ãêèõ: ñòðóêòóðíû, íå ðàñøèðåíû Äèàôðàãìà íà âäîõå: ôîðìà îáû÷íàÿ, êîíòóðû ÷¸òêèå Ïîëîæåíèå äèàôðàãìû: íå èçìåíåíî Ïëåâðàëüíûå ñèíóñû: ñâîáîäíûå Ñðåäîñòåíèå: íå ðàñøèðåíî Ñåðäöå è àîðòà: - òåíü ñåðäöà íå èçìåíåíà - ïîëîæåíèå àîðòû íå èçìåíåíî Êîñòíûå ñòðóêòóðû: êîñòíûõ òðàâìàòè÷åñêèõ è äåñòðóêòèâíûõ èçìåíåíèé íå âûÿâëåíî Çàêëþ÷åíèå Çàêëþ÷åíèå. Ïàòîëîãè÷åñêèõ èçìåíåíèé íå âûÿâëåíî Îáçîðíàÿ ìàììîãðàôèÿ ìîëî÷íîé æåëåçû â äâóõ ïðîåêöèÿõ (äèàãíîñòè÷åñêàÿ) Íàçâàíèå óñòðîéñòâà. ÌÌà Amulet Âèä. ÌÌà Áàçîâîå èññëåäîâàíèå äëÿ ñðàâíåíèÿ. Äàòà ïðîâåäåíèÿ. 17.08.2023 Îïèñàíèå ðåçóëüòàòîâ Íà îáçîðíûõ ìàììîãðàììàõ ïðàâîé è ëåâîé ìîëî÷íîé æåëåçû, âûïîëíåííûõ â ñòàíäàðòíûõ êîñûõ è ïðÿìûõ ïðîåêöèÿõ îïðåäåëÿåòñÿ: D=S ÏÐÀÂÀß ÆÅËÅÇÀ: ACRÀ. Ñòðóêòóðà òêàíè ïðåèìóùåñòâåííî æèðîâàÿ. Êîæà íå óòîëùåíà, ñîñîê è àðåîëà íå èçìåíåíû, ïîäêîæíî-æèðîâàÿ êëåò÷àòêà íå äåôîðìèðîâàíà, óçëîâûõ îáðàçîâàíèé íå âûÿâëåíî, ðåòðîìàììàðíîå ïðîñòðàíñòâî ñâîáîäíî. Èíòðàìàììàðíûé ëèìôîóçåë. Àêñèëëÿðíûå ëèìôàòè÷åñêèå óçëû - íå îïðåäåëÿþòñÿ ËÅÂÀß ÆÅËÅÇÀ: ACR-À. Ñòðóêòóðà òêàíè ïðåèìóùåñòâåííî æèðîâàÿ. Êîæà íå óòîëùåíà, ñîñîê è àðåîëà íå èçìåíåíû, ïîäêîæíî-æèðîâàÿ êëåò÷àòêà íå äåôîðìèðîâàíà, óçëîâûõ îáðàçîâàíèé íå âûÿâëåíî, ðåòðîìàììàðíîå ïðîñòðàíñòâî ñâîáîäíî. Àêñèëëÿðíûå ëèìôàòè÷åñêèå óçëû - íå îïðåäåëÿþòñÿ Çàêëþ÷åíèå Çàêëþ÷åíèå. Ôèáðîçíî-æèðîâàÿ èíâîëþöèÿ. ACR-À. Áåç ñóùåñòâåííûõ äèíàìè÷åñêèõ èçìåíåíèé ïðè ñðàâíåíèè ñ ïðåäûäóùèì èññëåäîâàíèåì îò 2022ã Ïðàâàÿ ìîëî÷íàÿ æåëåçà BIRADS-2 Ëåâàÿ ìîëî÷íàÿ æåëåçà BIRADS-1 Ðåêîìåíäàöèè Òðåáóåòñÿ äîîáñëåäîâàíèå. íåò Ðåêîìåíäàöèè. ÌÌÃ- êîíòðîëü 1 ðàç â äâà ãîäà. Áèîõèìè÷åñêèé àíàëèç ËÏÂÏ-àëüôà 2,78 (0,90 - 2,60) îòêëîíåíèå îò íîðìû ËÏÍÏ-áåòà 2,69 (0,00 - 4,00) íîðìà ìî÷åâèíà 5,4 (2,8 - 7,2) íîðìà òðèãëèöåðèäû îáùèå 1,22 (0,00 - 2,30) íîðìà õîëåñòåðèí îáùèé 6,03 (3,90 - 5,20) îòêëîíåíèå îò íîðìû Îïðåäåëåíèå ñêîðîñòè êëóáî÷êîâîé ôèëüòðàöèè (ÑÊÔ) (æåíùèíû) êðåàòèíèí 65,8 (44,0 - 80,0) íîðìà êðåàòèíèíà 142,45 (90,00 - 130,00) îòêëîíåíèå îò íîðìû ãëþêîçà 5,08 (3,90 - 6,40) íîðìà ÒÒà 1,98 (0,35 - 5,10) íîðìà Êëèíè÷åñêèé àíàëèç Êîëè÷åñòâî ýðèòðîöèòîâ 4,61 (3,90 - 4,70) íîðìà Ãåìàòîêðèò 34,4 (36,0 - 42,0) îòêëîíåíèå îò íîðìû Ñðåäíèé îáúåì ýðèòðîöèòà 74,7 (80,0 - 100,0) îòêëîíåíèå Øèðèíà ðàñïðåäåëåíèÿ ýðèòðîöèòîâ ïî îáúåìó 15,2 (11,0 - 16,0) íîðìà Ãåìîãëîáèí îáùèé 112,0 (120,0 - 140,0) îòêëîíåíèå îò íîðìû Ñðåäíåå ñîäåðæàíèå ãåìîãëîáèíà â ýðèòðîöèòå 24,3 (26,0 - 34,0) îòêëîíåíèå îò íîðìû Ñðåäíÿÿ êîíöåíòðàöèÿ ãåìîãëîáèíà â ýðèòðîöèòå 326 (300 - 380) íîðìà Êîëè÷åñòâî òðîìáîöèòîâ 268 (150 - 390) íîðìà Îáùèé îáúåì òðîìáîöèòîâ â êðîâè (òðîìáîêðèò, PÑT) 0,28 (0,10 - 0,28) íîðìà Ñðåäíèé îáúåì òðîìáîöèòîâ â êðîâè 10,4 (3,6 - 9,4) îòêëîíåíèå îò íîðìû Øèðèíà ðàñïðåäåëåíèÿ òðîìáîöèòîâ ïî îáúåìó 16,2 (11,0 - 18,0) íîðìà Êîëè÷åñòâî ëåéêîöèòîâ 5,54 (4,00 - 9,00) íîðìà Àáñîëþòíîå êîëè÷åñòâî ëèìôîöèòîâ 1,77 (1,20 - 3,00) íîðìà Àáñîëþòíîå êîëè÷åñòâî íåéòðîôèëîâ 2,92 (2,04 - 5,80) íîðìà Àáñîëþòíîå êîëè÷åñòâî ìîíîöèòîâ 0,55 (0,09 - 0,60) íîðìà Àáñîëþòíîå êîëè÷åñòâî ýîçèíîôèëîâ 0,25 (0,02 - 0,30) íîðìà Àáñîëþòíîå êîëè÷åñòâî áàçîôèëîâ 0,050 (0,000 - 0,065) íîðìà Îòíîñèòåëüíîå êîëè÷åñòâî íåéòðîôèëîâ 52,7 (47,0 - 72,0) íîðìà Îòíîñèòåëüíîå êîëè÷åñòâî ëèìôîöèòîâ 32,0 (19,0 - 37,0) íîðìà Îòíîñèòåëüíîå êîëè÷åñòâî ìîíîöèòîâ 9,90 (3,00 - 11,00) íîðìà Îòíîñèòåëüíîå êîëè÷åñòâî ýîçèíîôèëîâ 4,60 (0,50 - 5,00) íîðìà Îòíîñèòåëüíîå êîëè÷åñòâî áàçîôèëîâ 0,80 (0,00 - 1,00) íîðìà Öåðâèêàëüíûé ìàçîê íà àòèïèþ è ïàïèëëîìó?â ïëàíàõ Êîëîíîñêîïèÿ? íå äåëàëà ÂÈ×, ãåïàòèòû  è Ñ, RW? ïðîøëîãîäíèé, îòðèö  ïðîøëîì ãîäó âîò òàêèå öèôðû, ïåðåñäàì, êîíå÷íî Îïðåäåëåíèå æåëåçà (Fe) 9,7 (10,7 - 32,2) îòêëîíåíèå îò íîðìû ÎÆÑÑ 84.3 (45.0 - 72.0) îòêëîíåíèå îò íîðìû Èññëåäîâàíèå ôåððèòèíà 10.1 (10.0 - 150.0) íîðìà Ñïàñèáî áîëüøîå, ÷òî óäåëÿåòå âðåìÿ |
#4
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Öèòàòà:
Âû ìíå îòâåòèëè äóðàöêîå ñëîâî íîðìà... Âû çíàåòå êàêèå-òî íåâåäîìûå íîðìû? À Âû çíàåòå, ÷òî ôåððèòèí ó Âàñ íå â íîðìå, à â ðàìêàõ ìàõðîâîé æåëåçîäåôèöèòíîé àíåìèè? Âîò "íîðìû" ôåððèòèíà: [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì] Íå ïèøèòå, ïîæàëóéñòà, áîëüøå äóðàöêîå ñëîâî "íîðìà". Âàì íóæíî ëå÷èòü ÆÄ àíåìèþ. Èëè ïîëãîäà åæåäíåâíîãî ïðèåìà 25-50 ìã áèñãëèöèíàòà æåëåçà. Èëè äâå èíúåêöèè ôåðèíäæåêòà 500 ìã ñ ïåðåðûâîì â íåñêîëüêî äíåé. Öèòàòà:
Êîëîíîñêîïèþ ïîñëå 45 ëåò 1 ðàç â 5 ëåò. Ðàê î÷åíü ëåãêî ëå÷èòñÿ íà ðàííèõ ñòàäèÿõ è íèêàê íå ëå÷èòñÿ íà çàïóùåííûõ. Ò-ò-ò.
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#5
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Ñïàñèáî áîëüøîå.
Äà, ïðî ÆÄÀ çíàþ, äåëàëà êàïåëüíèöû ãîä íàçàä, ïîìîãëî íà âðåìÿ. Ïðè÷èíà íå âûÿñíåíà. Èçâèíèòå çà äóðàöêîå ñëîâî, ýòî áûëà öèòàòà ãèíåêîëîãà, ÿ îáñëåäîâàëàñü â ïðîøëîì ãîäó. Ìàçîê äåëàëà â ïðîøëîì îêòÿáðå, ïëàíèðóþ òàêæå â ýòîì ãîäó. Àëåêñàíäð Èâàíîâè÷, ïîäñêæàèòå, ïîæàëóéñòà, ÷òî ïî ÝÊÃ? Ñïàñèáî |
#6
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èñêàòü ïðè÷èíó àíåìèè ïðî ìíîæåñòâåííûõ ìèîìàõ = ïî óðîâíþ ñëîæíîñòè äèàãíîñòèêè êàê èñêàòü ïðè÷èíó çàäåðæêè ìåñÿ÷íûõ ïîñëå ìíîãîêðàòíûõ íåçàùèùåííûõ ïîëîâûõ êîíòàêòîâ ñ ìóæ÷èíîé; íè îäèí ãèíåêîëîã íå ìîæåò çíàòü âàøèõ ìåíñòð. ïîòåðü, èìåííî âû äîëæíû ïîäñ÷èòàòü ïî øêàëàì è âûäàòü öèôðó; ïðèìåðíî ó 1/2-2/3 æåíøèí ñ "íîðì." ïîòåðåé ïðè ïîäñ÷åòå îíè âûøå íîðìû èëè èçáûòî÷íû
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#7
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Âàäèì Âàëåðüåâè÷, çäðàâñòâóéòå.
Ñïàñèáî çà êîììåíòàðèé.  ïðîøëîì ãîäó ïî Âàøåé ðåêîìåíäàöèè ÿ ïðîêàïàëà æåëåçî, ïîìîãëî íà âðåìÿ. Ïðàâèëüíî ÿ ïîíèìàþ, ÷òî áåç êîëîíîñêîïèè è ãàñòðîñêîïèè íå îáîéòèñü? Íå ïîíèìàþ, îòêóäà ýòà àíåìèÿ ñòîëüêî ëåò, óñòàëîñü õðîíè÷åñêàÿ òîæå..., âèäèìî, êàê ñëåäñòâèå. |
#8
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Òùàòåëüíî ïîñ÷èòàéòå
https://forums.rusmedserv.com/showthread.php?t=29743 è âûëîæèòå ÷èñëî ìë, à íå "íîðìà". Öèòàòà:
È, äà, àíåìèÿ åñòü ïðåäûíôàðêòíîå ñîñòîÿíèå. [Èçîáðàæåíèÿ äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì]
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Àëåêñàíäð Èâàíîâè÷ ñ ïîæåëàíèÿìè êðåïêîãî çäîðîâüÿ |
#9
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ñêàæèòå, ãäå âû âèäèòå ñëîâà ãàñòðî-êîëîíîñêîïèÿ? è áåç ÷åãî âàì íå îáîéòèñü, åñëè íå õîòèòå ïîâòîðèòü ñóäüáó ýòèõ íåñ÷àñòíûõ?
Case 1 was of a 34-year-old woman who was transported to the emergency department ...Her hemoglobin level was 11 g/l. She had been experiencing excessive and prolonged menstruation for many years but had not sought medical help. A 5-cm uterine submucosal leiomyoma was detected and the patient underwent hysteroscopic myomectomy. Case 2 was of a 36-year-old woman with a history of blood transfusions owing to severe anemia who was presented with progressive dyspnea. A Her hemoglobin level was 17 g/l. Multiple uterine fibroids and adenomyosis were detected and total hysterectomy was performed. Case 3 was of a 49-year-old woman who was transported to the emergency department ... abdominal pain and severe anemia. Blood testing revealed a hemoglobin level of 19 g/l. Multiple uterine fibroids with a maximum diameter of 8.5 cm were detected.... Total hysterectomy was performed.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#10
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Âàäèì Âàëåðüåâè÷, çäðàâñòâóéòå.
ñåãîäíÿ ñäàì êðîâü íà æåëåçî è äð ïîêàçàòåëè. Êàêèå ÿ äîëæíà ïðåäïðèíÿòü äåéñòâèÿ äëÿ ïîíèìàíèÿ ïðè÷èíû ñòîëü äîëãîé àíåìèè: èññëåäîâàíèÿ, àíàëèçû ïðî÷? Ïî ïîâîäó ìåñÿ÷íûõ ïîíÿëà, ïîñ÷èòàþ â ñëåäóþùåì öèêëå. Ñïàñèáî óâàæàåìûì Âðà÷àì çà êîììåíòàðèè |
#11
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ìíîæåñòâåííûå ìèîìû - èñòî÷íèê ïîòåðü; èëè âû çàëèâàåòåñü â/â æåëåçîì 1-2 ðàçà â ãîä ÄÎ ìåíîïàóçû; èëè ñíèæàåòå îáüåì òåðÿåìîé êðîâè ñ î÷íûì ãèíåêîëîãîì õèð. èëè òåðàïåâòè÷åñêèìè ìåòîäàìè
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#12
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Çäðàâñòâóéòå, óâàæàåìûå Âðà÷è.
Âàäèì Âàëåðüåâè÷., ìîè àêòóàëüíûå öèôðû, ïîæàëóéñòà, ïîñìîòðèòå : Ïîâðåæäåíèå ñîñóäîâ Ãîìîöèñòåèí 7.2 ìêìîëü/ë < 15 Ïðè äîïîëíèòåëüíîì óïîòðåáëåíèè ôîëàòîâ <12 ìêìîëü/ë Òðîïîíèí I (âûñîêî÷óâñòâèòåëüíûé) 0.9 ïã/ìë < 15.6 Ñòðàòèôèêàöèÿ ðèñêà ÑÑÇ ó æåíùèí áåç âûðàæåííûõ ñèìïòîìîâ: Íèçêèé <4 ïã/ìë Ñðåäíèé 4-10 ïã/ìë Ïîâûøåííûé >10 ïã/ Ôåððèòèí 7.3-- (ïîñìîòðåëà, â 2020ã öèôðà 6.0) ÎÆÑÑ (ñûâîðîòî÷íîå æåëåçî, ËÆÑÑ) Ñûâîðîòî÷íîå æåëåçî 7.7 ìêìîëü/ë 5.8 - 34.5 Ëàòåíòíàÿ æåëåçîñâÿçûâàþùàÿ ñïîñîáíîñòü 69.6 ìêìîëü/ë 24.2 - 70.1 ÎÆÑÑ 77.3++ ìêìîëü/ë 45.0 - 63.0 Òðàíñôåððèí 3.3 ã/ë 2.5 - 3.8 Âèòàìèí Â12 514 ïã/ìë 191 - 663 Îáùèé áåëîê 65.2 ã/ë 64 - 83 Ãëèêèðîâàííûé ãåìîãëîáèí (HbA1c) 5.7 % Ïîæàëóéñòà, ïîäñêàæèòå, êàêàÿ äàëüíåéøàÿ òàêòèêà? Íóæíû äîîáñëåäîâàíèÿ, êàïåëüíèöû ïðåïàðàòîâ æåëåçà? Ñïàñèáî áîëüøîå |
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ïîéòè ê âìåíÿåìîìó î÷íîìó ãèíåêîëîãó è ñêàçàòü - ó ìåíÿ àíåìèçàöèÿ èç-çà ìèîìíûõ êðîâîòå÷åíèé, êàêèå îïöèè ìû ìîãëè áû ïîïðîáîâàòü, ÷òîáû óìåíüøèòü ïîòåðè?
ôåðèíäæåêò ïî 500 ìã êàæäûå ïîëãîäà, ïîêà ñ î÷íûì ãèíåêîëîãîì íå óáåðåòå ìèîìû, íàïèøèòå ìíå çà íåäåëþ, ïåðåä òåì êàê ââîäèòü ôåðèíäæåêò
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
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Âàäèì Âàëåðüåâè÷. çäðàâñòâóéòå.
Ãîòîâà êóïèòü ïðåïàðàò, ò.ê., ÷óâñòâóþ ïîñòîÿííóþ óñòàëîñòü..  îáùåì, ÷åðåç íåäåëþ ãîòîâà áóäó ê êàïåëüíèöàì. Ïîäñêàæèòå, ïîæàëóéñòà, àëãîðèòì ( ñ ôèçðàñòâîðîì? èíòåíñèâíîñòü êàïåëüíîãî ââåäåíèÿ..., íóæíû ëè àíòèãèñòàìèííûå) Ñïàñèáî áîëüøîå Âàì çà ïîìîùü! |