#1
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Ñâÿçü ÆÊÁ è äèàôðàãìàëüíîé ãðûæè
Íà÷àëî çäåñü: http://forums.rusmedserv.com/showthread.php?t=195194
Ñîãëàñåí ñ alexdr íà ñ÷åò ãðûæû. Îïòèìàëüíî áóäåò âûïîëíèòü âèäåîëàïàðîñêîïè÷åñêóþ õîëåöèñòýêòîìèþ, ïðîéòè ðåàáèëèòàöèþ è êóðñ òåðàïèè ïî ïîâîäó ãðûæû. Åñëè â ðåçóëüòàòå áîëåâîé ñèíäðîì ñîõðàíèòüñÿ, òîãäà óæå ðåøàòü âîïðîñ î õèðóðãè÷åñêîì ëå÷åíèè ãðûæû(òîæå âèäåîëàïàðîñêîïè÷åñêè). âîçìîæíî ïðè÷èíîé ãðûæè è ÿâèëàñü ÆÊÁ. |
#2
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Öèòàòà:
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#3
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1. ÆÊÁ ÿâèëîñü ïðè÷èíîé äëÿ ðåíòãåíîëîãè÷åñêîãî îáñëåäîâàíèÿ ïðè êîòîðîì âûÿâëåíà ñêîëüçÿùàÿ ãðûæà. Åñëè áîëåâîé ñèíäðîì âûçâàí ÆÊÁ, òî òîãäà ãðûæà ñëó÷àéíàÿ íàõîäêà.
2. Îïîñðåäîâàíî; ÆÊá ìîæåò ïðîÿâëÿòüñÿ õîëåöèñòèòîì, ïàíêðåàòèòîì, ìîæåò áåñïîêîèòü èçæîãà, òîøíîòà, ðâîòà è ò.ä.  îáùåì ôàêòîðû ïðèâîäÿùèå ê íàðóøåíèþ ìîòîðíîé ôóíêöèè ÆÊÒ, ïîâûøåíèþ âíóòðèáðþøíîãî è âíóòðèæåëóäî÷íîãî äàâëåíèÿ. Ñåé÷àñ ýíäîñêîïèñòû î÷åíü ÷àñòî ñòàâÿò òàêîé äèàãíîç, êîãäà ìû îáñëåäóåì áîëüíûõ ñ ÆÊÁ ïåðåä îïåðàöèåé, à ðàíüøå òîëüêî ïðè ðåíòãåí èññëåäîâàíèè ïðè õàðàêòåðíîé êëèíèêå. |
#4
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Áåññìûñëåííûé íàáîð ñëîâ êàêîé-òî....
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#5
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Êîëëåãà, äàâàéòå ïîñòðîèì âîïðîñ ïî äðóãîìó. Ìîæåòå ëè Âû ïðèâåñòè äîêàçàòåëüñòâà òîãî, ÷òî æåë÷íî-êàìåííàÿ áîëåçíü ÿâëÿåòñÿ ôàêòîðîì ðèñêà ôîðìèðîâàíèÿ äèàôðàãìàëüíîé ãðûæè? Îáùèå ðàññóæäåíèÿ è ïðåäïîëîæåíèÿ â ðàñ÷åò íå ïðèíèìàþòñÿ. Ñïàñèáî.
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
#6
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Âèäèìî èìåëñÿ â âèäó ñèíäðîì Ñåéíòà — ñî÷åòàíèå æåë÷íîêàìåííîé áîëåçíè ñ äèàôðàãìàëüíîé ãðûæåé è äèâåðòèêóëåçîì òîëñòîé êèøêè.
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#7
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Âîçìîæíî. Íî àññîöèàöèÿ - ýòî îäíî, à ïðè÷èííî-ñëåäñòâåííàÿ ñâÿçü - íåñêîëüêî äðóãîå.
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |
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#8
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"Âèäèìî èìåëñÿ â âèäó ñèíäðîì Ñåéíòà..."
Âû, íàâåðíîå, èìåëè ââèäó "Òðèàäó Ñåéíòà", ÿâëÿþøóþñÿ ôèëîñîôñêîé êîíöåïöèåé, ïðîòèâîïîñòàâëåííîé "Ëåçâèþ Îêêàìà" è íå èìåþøåé ïàòîôèçèîëîãè÷åñêîé è êëèíè÷åñêîé áàçû. |
#9
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#10
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"Õî÷ó âñ¸ çíàòü" - äàéòå ññûëêó, ïîæàëóéñòà. Ñïàñèáî.
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#11
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Ñèíäðîì îïèñàí â ëèòåðàòóðå, íî ïðàêòè÷åñêîãî çíà÷åíèÿ, âèäèìî íå èìååò. Èññëåäîâàíèé, ïîäòâåðæäàþùèõ íåîáõîäèìîñòü ïîèñêà äèâåðòèêóëåçà èëè ãðûæè ÏÎÄ ó ïàöèåíòîâ ñ ÆÊÁ íå âèäíî. Ñèìóëüòàííàÿ îïåðàöèÿ ïðè êëèíè÷åñêè çíà÷èìîé ãðûæå ÏÎÄ âïîëíå öåëåñîîáðàçíà.
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#12
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Ïðîøó ëèòåðàòóðíóþ ññûëêó, à íå îáøèå ñëîâà.
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#13
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http://www.rusmedserver.ru/med/gastro2/68.html
 êîíöå ñòðàíèöû |
#14
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Ñïàñèáî, áðåäîâàòàÿ ñòàòåéêà, êñòàòè. À âîò òî÷êà çðåíèÿ ñîâðåìåííèêîâ/ïîñëåäîâàòåëåé Ñåéíòà:
Occam's Razor and Saint's Triad. Richard G Fiddian-Green, FRCS, FACS In his review of Painter's medical classic, Diverticular Disease of the Colon, Martin Eastwood wrote, "Such a book at the time could not have been credible without mentioning the association between dietary fibre deficiency, diverticulosis and the associated diseases", notably cholelithiasis and hiatal hernia. The combination of these three diseases is known as Saint's triad. "Saint's triad is named after the British surgeon Prof C.F.M.Saint [trained by Rutherford Morrison in Newcastle] who established the first school of surgery [at Groote Schuur, University of Cape Town teaching hospital] in South Africa. He emphasized the importance of considering the possibility of multiple separate diseases in a patient whenever his or her history and the results of the physical examination were atypical of any single condition. There is no pathophysiological basis for the coexistence of these three diseases. Saint emphasized that more than one disease may be responsible for a patient's clinical signs and symptoms, and his Triad provides a counterexample to the commonly used diagnostic principle that "the explanation of any phenomenon should make as few assumptions as possible," also known as Occam's Razor. The principle underlying Saint's triad is also expressed as Hickam's dictum." (Wikipedia). "Hickam's dictum is a counterargument to the use of Occam's razor in the medical profession. The principle is commonly stated: "Patients can have as many diseases as they well please". The principle is attributed to John Hickam, MD. Hickam was a faculty member at Duke University in the 1950s, and was later chairman of medicine at Indiana University" (Wikipedia). < Eastwood observed that Norman Tanner, famous gastric surgeon at Balham, wrote the introduction to Painter's medical classic. When Jannie Louw, also Professor of Surgery at Groote Schuur and taught by Professor Saint, needed a gastrectomy for his duodenal ulcer he had asked Norman Tanner to do it for him after watching a series of British surgeons do gastrectomies. Professor Jannie Louw was my principle clinical mentor. |
#15
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Öèòàòà:
Öèòàòà:
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Èëþõèí Åâãåíèé Àðêàäüåâè÷ |