#1
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Áîëè â ïîÿñíè÷íî êðåñöîâîì îòäåëå ïîçâîíî÷íèêà
Äîáðûé äåíü. Ïðîøó êîíñóëüòàöèþ. ×óòü áîëüøå ãîäà íàçàä ó ïàïû ïîÿâèëèñü áîëè â ïðÿìîé êèøêå ñ èððàäèàöèåé â ïàõ, áåäðî. Ðàñöåíèë êàê ïðîÿâëåíèå ãåìîððîÿ, îáðàòèëñÿ ê ïðîêòîëîãó. Íàçíà÷åíî ëå÷åíèå, íàëîæåíèå êîëåö íà ãåìîððîèäàëüíûå óçëû. Ïîñëå ïðîöåäóðû ëåã÷å íå ñòàëî. ×åðåç 8 ìåñ îáðàòèëñÿ ê íåâðîëîãó. Îñìîòðåí, êàê îáû÷íî ðàñöåíåíî îñòåîõîíäðîç, íàçíà÷åí êóðñ ÍÏÂÑ, âèòàìèíû ãðóïïû Â, â îáùåì ñòàíäàðòíûé êóðñ. Áåç îñîáîãî ýôôåêòà. Áîëè óñèëèâàþòñÿ. Ïàïà îïÿòü ïîøåë ê ïðîêòîëîãó, âíîâü ïðåäëîæèëè óäàëåíèå óçëîâ è óäàëèëè. Ñîñòîÿíèå íå óëó÷øàåòñÿ, à äèíàìèêà áîëåâîãî ñèíäðîìà îòðèöàòåëüíàÿ. Íà ôîíå áîëåé íà÷àë õóäåòü, îí ìíèòåëüíûé.  èòîãå ïðîêòîëîã íàçíà÷èë ÌÐÒ ìàëîãî òàçà è ïîÿñíè÷íî êðåñöîâîãî îòäåëà ïîçâîíî÷íèêà. Çàêëþ÷åíèå ïðèêëàäûâàþ. Ïðîøó ïîìî÷ü , ò.ê êà÷åñòâî æèçíè çíà÷èòåëüíî ñíèæåíî, ÷åëîâåê íå ìîæåò äîëãî ñèäåòü, ñîîòâåòñâåííî íå ïîëüçóåòñÿ ìàøèíîé. ñòàë íå àêòèâíûì â ñîöèàëüíîì ïëàíå
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#2
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Äàííàÿ ñèòóàöèÿ íà ñòàäèè äèàãíîñòè÷åñêîãî ïîèñêà ïðè÷èíû áîëè. Íóæíî âûïîëíèòü óæå ðåêîìåíäîâàííûå íàçíà÷åíèÿ âðà÷åé. ÌÐÒ êîñòåé òàçà, ÓÇÈ áðþøíîé ïîëîñòè è ìàëîãî òàçà. Íåîáõîäèìû î÷íûå êîíñóëüòàöèè íåâðîëîãà è óðîëîãà. Åñëè ïîñëå ýòîãî âîçíèêíóòü âîïðîñû, Âàø îòåö äîëæåí ëè÷íî îáðàòèòüñÿ íà ôîðóì, ñîáëþäàÿ ðåêîìåíäàöèè îôîðìëåíèÿ òåìû.
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Êîãäà çíàåøü ïî÷åìó íåëüçÿ, òî óæå ìîæíî (ñ) Ñ óâàæåíèåì, Ãóñåéíîâ Òèìóð Þñóôîâè÷ Ñàéò dr-timur.ru |
#3
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Äåëàë ÑÊÒ áð ïîëîñòè è ÌÐÒ ìàëîãî òàçà- ïðèçíàêè õðîíè÷åñêîãî ïðîñòàòèòà. Ó óðîëîãà íàáëþäàåòñÿ, ÏÑÀ è âñå îñíîâíûå îíêîìàðêåðû â íîðìå. Ñàì îáðàòèòüñÿ íå ñìîæåò, åìó 70 ëåò è ñ èíòåðíåòîì íå äðóæèò. Ó íåâðîëîãà áûë 4 ìåñ íàçàä- íàçíà÷åíî6 íèîòèíîâàÿ êèñëîòà, âèò Â6, òåêñàðåä 6 óêîëîâ ÷åðåç äåíü, ãåëü Äîëãèò áëîê, èïèäàêðèí â óêîëàõ. Ýôôåêòà íåò. Áîëè íà ïàðó ÷àñîâ íåìíîãî êóïèðóþòñÿ îò äèêëîôåíàêà â/ì. ÌÐÒ êîñòåé òàçà- íå óâåðåíà ÷òî ýòî äàñò êàêóþ òî äîïîëíèòåëüíóþ èíôîðìàöèþ.
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#4
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Áîëåâîé ñèíäðîì â ñïèíå ó ïàöèåíòîâ 60+ íå êóðèðóåìûé íà ôîíå ïðèåìà àíàëüãåòèêîâ-êðàñíûé ôëàã- íåîáõîäèì îíêîïîèñê
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Ñ óâàæåíèåì, Àíàñòàñèÿ Âàëåðüåâíà. Ìîé Instagram àêêàóíò @asarycheva |
#5
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ÿ âðà÷ îíêîëîã- õèìèîòåðàïåâò. Ñòàæ áîëåå 15 ëåò, ëå÷ó âñå ëîêàëèçàöèè, êðîìå ëåéêîçîâ. Âñå îñíîâíûå îíêîìàðêåðû â íîðìå. Ñòðàííî èñêàòü îíêîëîãèþ ïðè åå îòñóòñòâèè íà ÌÐÒ è ïðè ÿâíîì ïðèñóòñòâèè ïåðèíåâðàëüíîé êèñòû, è êó÷å äåãåíåðàòèâíûõ èçìåíåíèé. Ðàê êèøå÷íèêà, áûë áû âèäåí íà ÌÐÒ. Áîëè áîëåå ãîäà. Çà ýòî âðåìÿ óæå áû ìåòàñòàçû ïîøëè. Ìîé âîïðîñ- êàê ëå÷èòü òî ÷òî íàøëè? Íå ïðîøó êàêèå òî òàáëåòêè, à â ïðèíöèïå - ëå÷èòüñÿ êîíñåðâàòèâíî, ëå÷èòüñÿ îïåðàòèâíî, íå ëå÷èòüñÿ íè êàê, âûëå÷èòü íåëüçÿ, ìîæíî ïðèîñòàíîâèòü? Õî÷ó ïîíÿòü ìàøòàáíî- êóäà äâèãàòüñÿ.
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#6
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Áîëè íå â ñïèíå, à â ïðÿìîé êèøêå ñ èððàäèàöèåé â ïàõ, âíóòðåííèå ïîâåðõíîñòè áåäðà.
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#7
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Âûëîæèòå äèñê ñ ìðò è êîíñ íåâðîëîãà, âñå ïðåïàðàòû è äîçû êàêèå ïðèíèìàë ïàöèåíò
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Ñ óâàæåíèåì, Àíàñòàñèÿ Âàëåðüåâíà. Ìîé Instagram àêêàóíò @asarycheva |
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#8
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êàê íå ñïåöèàëèñò, ïðèâåäó ïðèìåð ïîõîæåãî ïðîÿâëåíèÿ ïðè ïîõîæèõ êèñòàõ Òàðëîâà, è êàê ïîðîé êðàéíå ñëîæíî îïðåäåëèòü ïðàâèëüíóþ òàêòèêó
Multiple Tarlov Cysts as a Cause of Coccygeal, Vulvar, and Rectal Pain: A Case Report [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#9
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Öèòàòà:
Íå íàøëè íè÷åãî íåîáû÷íîãî.
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Êîãäà çíàåøü ïî÷åìó íåëüçÿ, òî óæå ìîæíî (ñ) Ñ óâàæåíèåì, Ãóñåéíîâ Òèìóð Þñóôîâè÷ Ñàéò dr-timur.ru |
#10
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Íåìàëàÿ âåðîÿòíîñòü, ÷òî ýòî ìîæåò áûòü ñëó÷àåì õðîíè÷åñêîé òàçîâîé áîëè. ×òî äèàãíîñòèðóåòñÿ è ëå÷èòñÿ áëîêàäàìè â óñëîâèÿõ öåíòðîâ ëå÷åíèÿ áîëè. È àíòèäåïðåññàíòàìè (äóëîêñåòèí).
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Êîãäà çíàåøü ïî÷åìó íåëüçÿ, òî óæå ìîæíî (ñ) Ñ óâàæåíèåì, Ãóñåéíîâ Òèìóð Þñóôîâè÷ Ñàéò dr-timur.ru |
#11
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Ñïàñèáî çà âàø îòâåò. Âîò è ïûòàþñü ïîíÿòü, òî ÷òî âûÿâëåíî íà ÌÐÒ ( â ÷àñòíîñòè ïåðèíåâðàëüíàÿ êèñòà) ìîæåò äàâàòü òàêîé áîëåâîé ñèíäðîì èëè íåò... ó ÷åëîâåêà çíà÷èòåëüíî ñòðàäàåò êà÷åñòâî æèçíè, ïðàêòè÷åñêè íåò ñîöèàëüíîé àêòèâíîñòè. Íà ñ÷åò îïèñàíèÿ áîëè- âîò îïèñûâàåò òàê- îùóùåíèå ææåíèÿ è îíåìåíèÿ â îáëàñòè ïðÿìîé êèøêè, êîï÷èêà, ÿãîäèö ñ èððàäèàöèåé â ïàõ, âíóòðåííþþ ïîâåðõíîñòü áåäðà. Áîëü ïîñòîÿííîãî õàðàêòåðà. Ìíèòåëüíîñòü òîæå åñòü, çà àíòèäåïðåñàíò îòäåëüíîå ñïàñèáî.
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#12
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#13
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Êîíå÷íî ïðî÷èòàëà, ïîíÿëà, ÷òî êèñòû íå ÷àñòî ÿâëÿþòñÿ ïðè÷èíîé áîëåâîãî ñèíäðîìà.
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#14
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ïåðåâåäèòå èíôó íèæå - âûäåëåíî ìíîé:
Perineurial Tarlov cysts (TC) are extrathecal CSF-filled cavities in the perineurial recesses around dorsal spinal nerve roots. Composed of vascularized connective tissue lined with flattened arachnoid tissue, TCs characteristically contain nerve root fibers and ganglion cells in their walls or cavities and tend to be sacral. Diagnosis preferentially begins with dedicated sacral MR imaging, which is more sensitive than CT or standard lumbosacral MR imaging.17 TCs are visualized (but not always reported) on 1%–2% of sacral MRIs, with approximately 25% of these believed to cause symptoms.18 It is often necessary to evaluate subarachnoid connectivity with myelography to distinguish TCs from intradural ectasias, subarachnoid cysts, and meningeal diverticula—cystic abnormalities that are frequently confused with TCs and for which intracystic injection is contraindicated to avoid intrathecal spread and arachnoiditis. Despite misimpressions in many clinical circles that TCs are always asymptomatic, there has been steady progress in developing the interventional treatments required for definitive management of symptoms. Conservative approaches including analgesic/anti-inflammatory medication and physical therapy have achieved varying degrees of success in reducing cyst-associated symptoms.19 Surgical methods, meanwhile, include lumbar-peritoneal and cystosubarachnoidal drainage and shunting20,21; bipolar cautery to shrink cysts17; decompressive laminectomy22–24; and laminectomy with either total cyst resection,1,10,25,26 partial cyst wall resection,27 or duroplasty/plication of cyst walls. The aspiration-injection procedure used 2 needles and was performed with the patients under local anesthesia and intravenous anesthesia. In the fibrin-injection stage of the procedure, a commercially available fibrin sealant was injected into the cyst through the deep needle (Tisseel VH). One year postprocedure, excellent results were obtained in 104 patients (54.2% of patients followed), and good or satisfactory results were obtained in 53 patients (27.6%). Thus, 157 patients (81.8%) in all were initially satisfied with the outcome of treatment. At 3–6 years postprocedure, 74.0% of patients followed were satisfied with treatment.
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |
#15
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åùå êàê êåéñ ðåïîðò î æåíùèíå - 14 ëåò ìó÷åíèé îò áîëè â ïîëîâûå ãóáû è ïðÿìóþ êèøêè ñëåâà, óñèëèâøèåñÿ â ïîñëåäíèå 2 ãîäà - òîæå êòî-òî ãäå-òî ùèòàë ÷òî îíè, êèñòû, íå äàþò ñèìïòîìîâ, âîò îïèñàíèå - ðàçìåð, ñäàâëåíèå, ýðîçèÿ êîñòè - ýòî îïèñàíî ó ïàöèåíòà? òàì òîëüêî îäèí ðàçìåð 1.3 ñì - ïî÷åìó? çàäàéòå âîïðîñû îïèñàíòàì, èëè ïóñòü ïîñìîòðèò êòî-òî áîëåå ãðàìîòíûé ñïåöèàëèñò
bilateral Tarlov cysts at the level of S2, within the sacral canal. The left cyst was slightly larger than the right (see arrow pointing to left cyst) and measured 1.9×1×1.3 cm. The left cyst also compressed the left S1 nerve root. There was also some mild bony erosion associated with the left cyst. Tarlov cysts can cause backache, sciatica, perineal, buttock and lower extremity pain as well as sexual, urinary and bowel dysfunction but are often ignored on MRI or thought to be of little significance in causing back pain. è òàì â òåêñòå êàê îïèñûâàåò ïàöèåíòêà ñâîè îùóùåíèÿ: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ]
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Èñêðåííå, Âàäèì Âàëåðüåâè÷. |