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#16
06.06.2005, 16:31
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Возвращаясь к тексту Антона Владимировича- в эндокринологии практически только одна группа старательно тянула одеяло на себя при разборе СХУ по линии надпочечниоков. энтузиасты предлагали искать дефицит СТГ, совсем уж по деревенски звучало предложение о верхненормальном тТГ.. Сейчас эти идеи из моды вышли.
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#17
06.06.2005, 16:36
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Цитата:
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#18
08.06.2005, 13:19
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Самый важный вопрос: что лечить?
Swiss Med Wkly. 2004 May 15;134(19-20):268-76. Chronic fatigue syndrome (cfs). Adler RH. [Ссылки доступны только зарегистрированным пользователям ] University of Berne Medical School, Kehrsatz, Switzerland. Is CFS a homogenous disorder? The synonymous use of the terms CFS, epidemic neuromyasthenia and myalgic encephalomyelitis and the clinical impression that CFS shares numerous features with fibromyalgia (FM), multiple chemical sensitivity (MCS), irritable bowel syndrome (IBS), effort syndrome, and temporomandibular syndrome raises the suspicion that it is not a homogenous disorder. As many as 70% of CFS-patients showed features of FM, and 35% of MCS. Forty-two percent of female FM-patients share the criteria for CFS [5–9]. Ciccone and Natelson [10] have observed in women with CFS that 37% met the criteria for FM, and 33% those for MCS. With the exception of FM-related pain and disability, there were few differences between CFS only and CFS with comorbid illness groups. Patients with additional illness were more likely to have major depression and a higher risk of psychiatric morbidity compared with patients in the CFS-only group (p <0.01). Rates of life-time depression increased from 27.4% in the CFS-only group to 52.3% in the CFS/FM-group, 45.2% in the CFS/MCS-group and 69.2% in the CFS/ FM/MCS-group. Reviewing the subject of similarities among these syndromes led to the conclusion that patients with CFS, FM and MCS suffer from the shared proneness to somatise or misconstrue the significance of normal physiological sensations. Definitions, symptomatology and comorbidity in the patients with CFS, FM, MCS and IBS led Wessely et al. [11] to suggest that these disorders are different manifestations of the same somatic and psychological disturbances. Other illnesses with fatigue, pain and other symptoms in the absence of physical signs, which overlap with the above mentioned syndromes are temporomandibular disorder, interstitial cystitis, chronic tension-type headaches, post-concussive syndrome, chronic pelvic pain and chronic low-back pain; e.g. 18% of patients with temporo-mandibular disorder meet FM-criteria and 75% of FM-patients show temporo-mandibular disorder criteria [12].
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#19
08.06.2005, 14:25
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Что лечить...это ж, как я понимаю, диагноз исключения. А если причины не нашли - кажется, даже капиталисты не могут придумать толкового лечения CFS, кроме антибиотиков при пов. IgM к хламидии пнеумоние. Ну а если там не CFS, а какой-нибудь гипотиреоз или депрессия, все, наверное, проще
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#20
08.06.2005, 19:36
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Цитата:
Med Hypotheses. 2003 Oct;61(4):419-30. Are syndromes in environmental medicine variants of somatoform disorders? Wiesmuller GA, Ebel H, Hornberg C, Kwan O, Friel J. Institute of Hygiene and Environmental Medicine, University Hospital Aachen, Aachen, Germany. To date, relatively little is known about the etiology, pathophysiology, diagnosis, therapy, prevention and prognosis of environment-related syndromes like multiple chemical sensitivity (MCS), idiopathic environmental intolerance (IEI), sick building syndrome (SBS), chronic fatigue syndrome (CFS), candida syndrome (CS) and burnout syndrome (BS). Part of the reason is that these syndromes have not been clearly defined and classified in scientific categories distinct from each other, and that they show clinical similarities to classified somatoform disorders. Furthermore, there are at least three possible explanations for the existence of these syndromes: (1) The syndromes may result from the interaction of environmental factors, individual susceptibility and psychological factors (i.e., how they are perceived and seen by the patient); (2) they may reflect socially and culturally accepted methods of expressing distress; and/or (3) they may be iatrogenic. Despite all the uncertainties in evaluation of environmental syndromes, physicians have the duty to take the affected person's problems seriously. A comprehensive systematic classification which better accounts for these complex clinical manifestations is long overdue. Until these syndromes are well defined, the terms used for them should definitely not be applied to connote a specific disease process. Int J Hyg Environ Health. 2002 Feb;204(5-6):339-46. An interdisciplinary therapeutic approach for dealing with patients attributing chronic fatigue and functional memory disorders to environmental poisoning--a pilot study. Lacour M, Zunder T, Dettenkofer M, Schonbeck S, Ludtke R, Scheidt C. Nonspecific symptoms and a general feeling of ill health that is difficult to objectify are the commonest health problems with which patients present to an Environmental Medicine Outpatient Department (OPD). Of this group, a great proportion meets the classification criteria for Chronic Fatigue Syndrome (CFS) or Functional Memory Disorders in association with Idiopathic Chronic Fatigue (FMD-ICF). This is a longitudinal study of the OPD of Environmental Medicine, Freiburg University Hospital, Germany, to determine the feasibility and impact of an interdisciplinary therapeutic approach (self-help program, acupuncture, psychosomatic support by group interventions) in 8 patients with CFS, FMD-ICF, or CFS in association with self-reported Multiple Chemical Sensitivities (sr-MCS). The intervention took into consideration the patients' need for treatment of physical aspects of their disease. This is an important step to motivate patients into required psychosomatic support. Although none of the patients was willing to accept psychosomatic support or psychotherapy at study outset, acceptance of psychosomatic group interventions was high during the study course. Additionally five patients started with personal counseling at the Psychosomatic Clinic, and, without feeling stigmatized, 4 patients started with specific psychotherapy. The patients' quality of life showed no increase after four months, but, as shown by the Sum-Score of SF-36, it had improved significantly at the end of the study, which covered eight months' treatment (p = 0.015). Two follow-up investigations showed that this improvement probably persisted in part (mainly in the dimensions mental health, social function, physical role function, and vitality). In conclusion our interdisciplinary therapeutic approach indicates successful treatment of patients attributing CFS, CFS/sr-MCS, and FMD-ICF to environmental poisoning. We now plan to conduct a randomized controlled trial in the future. Occup Med (Lond). 2005 Jan;55(1):20-31. A systematic review describing the prognosis of chronic fatigue syndrome. Cairns R, Hotopf M. AIM: To perform a systematic review of studies describing the prognosis of chronic fatigue (CF) and chronic fatigue syndrome (CFS) and to identify occupational outcomes from such studies. METHOD: A literature search was used to identify all studies describing the clinical follow-up of patients following a diagnosis of CF or CFS. The prognosis is described in terms of the proportion of individuals improved during the period of follow-up. Return to work, other medical illnesses and death as outcomes are also considered, as are variables which may influence prognosis. RESULTS: Twenty-eight articles met the inclusion criteria and, for the 14 studies of subjects meeting operational criteria for CFS, the median full recovery rate was 5% (range 0-31%) and the median proportion of patients who improved during follow-up was 39.5% (range 8-63%). Less fatigue severity at baseline, a sense of control over symptoms and not attributing illness to a physical cause were all associated with a good outcome. Return to work at follow-up ranged from 8 to 30% in the three studies that considered this outcome. CONCLUSIONS: Full recovery from untreated CFS is rare. The prognosis for an improvement in symptoms is less gloomy. This review looks at the course of CF/CFS without systematic intervention. However, there is increasing evidence for the effectiveness of cognitive behavioural and graded exercise therapies. Medical retirement should be postponed until a trial of such treatment has been given. Sleep Med Rev. 1999 Jun;3(2):131-46. Review of clinical and psychobiological dimensions of the chronic fatigue syndrome: differentiation from depression and contribution of sleep dysfunctions. Fischler B. Chronic fatigue syndrome (CFS) is a disabling condition characterized by subjective fatigue, mental and physical fatigability, a whole range of somatic symptoms and a poor quality of sleep. Its physiopathology is largely unknown. Several clinical and biological differences were observed between CFS and major depression. A classical conceptualization of masked (or somatized expression of) depression is therefore no longer tenable. Sleep anomalies were reported in all studies published to date. However, these sleep anomalies do not seem to explain a major part of the symptomatology of CFS. The contribution of sleep abnormalities to the development and chronicity of CFS should be further studied. CFS can be considered as a somatoform condition. CFS is like most functional disorders a clinically and biologically heterogeneous condition. The best available treatment to date is cognitive-behavioural therapy.
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