Просмотр полной версии : Our medicine the diagnosis, its or his reason and an outcome for the patient.
Nesterov Sergey (s-ness@mail.ru) - - ---Dear endocrinologists! Our city medicine has forced to address to you, the technology of rendering honey is more exact. Services. I shall pass to business though and it is necessary to begin from apart. We with the wife to both for 26 years now, live in a of Sochi have wanted the child. In current of year it was impossible to us. I shall lower or omit the most part of our bustle on clinics, I shall stop on a result - at the wife have defined or determined raised or increased Prolactinum, have appointed or nominated treatment by Parlodelum. After 3 monthly courses there has come or stepped pregnancy spravochno: last tablet is drunk in the extremity or end of December 1999, last monthly 19/12/99, a fertilization, in opinion of the husband, - 7/1/2000. In February, 2000 there was a threat to a fetus he has tried otorvatsja from a wall of a uterus. After US and hormonal analyses 17 treatment djufastonom and by Microfollinum, a course - 1 month till March 2000 is appointed or nominated. The control US has shown, basically, normal current of pregnancy and a fetation on a place of an abruption there was a hematoma behind prescription of time has forgotten as it in a scientifically way sounds, is shorter zaroslo, its or her sizes were insignificant, the rest - in norm or rate. 1/10/2000 the son, all its or his parameters of development - norm or rate was born. 19/12/2000 wife has unexpectedly found out augmentation in the field of a larynx hardly below an Adam's apple, on the right. Eyes on a place, on a cold appetite normal does not aspire, the sweating is not present, the skin if dries, on arms or hand from washing diapers? And a sole of legs or foots in my opinion almost at all there dries, personally I have written off or have copied nervousness and irritability on presence of 3 monthly children. The augmentation insignificant, at a palpation is not present a pain, does not throttle. Especially I wish to note, that earlier this business did not notice, though my wife very close or attentive to everything, as to health, and hypochondriac enough, i.e. Almost always exaggerates the importance of any problem or a question a little is shorter, pass or miss gradual occurrence of this augmentation we, most likely, could not. Have gone 21/12/2000 on US to nearby sanatorium!. I quote results of research: the Thyroid gland is located usually; a contour equal; the sizes are increased; an isthmus 5,0; the left share 582118 mm.; the right share 582219 mm.; ehogennost it is raised or increased; ehostruktura homogeneous; sites are defined or determined between an isthmus and the right share, echoic spherical education with precise equal contours 141011 mm. The diagnosis - the Is diffusive-nodal hyperplasia of II item With it or this the US have gone to the endocrinologist of the same institution. The diagnosis - a is diffusive-nodal struma of II item Plainly about the reasons, treatment and those consequences or other actions of the patient the doctor has told or said nothing. Last said offer of the doctor was: buy or purchase a medicine I shall write out. Can accept, can not accept, Can will help or assist, can - is not present, then it will be necessary to operate. The doctor has not suffered above there was a unsuccessful phrase, but my wife was in a shock from such dialogue since without a direction on analyses about them it has not been told or said words!!! The medicine - a L-thyroxine on 50 mg has been written out. In the morning right after a dream 3 months. Repeated visit has been appointed or nominated to March, 2001 So, it was the first circle. The second circle was initiated with our restless brains both of us people with higher education, let and economic, but fairly clever, there is an Internet, and in itself the directory on endocrinology... - have gone or send in city poliklinku, a cabinet or study of the endocrinologist. The granny sitting there approximately - from 70 up to... Has touched a throat of the wife, has looked at results of US see above and has born or has taken out a verdict: Yes, the site is, operation is necessary, treatment to it or this is not present, come behind a direction... As my wife has not fainted - I do not know. From a shock have not taken a paper with the diagnosis, however the granny and did not write it or her even. Through familiar have found the normal endocrinologist. So our third circle has begun. The doctor has directed us on repeated US. I quote result: a locating usual; a contour equal; an isthmus of 5,8 mm.; the left share 201542 mm, 6,0 kub.sm.; the right share 19,61654 mm., 8,1 kub.sm.; ehostruktura it is saved, focal changes on border of the right share and an isthmus; echoic 138,812 site mm., homogeneous, has... Illegibly..., it is illegible on a contour. The site has been found one. And itself UZIst after 10- minute driving by the gauge on a throat has asked to show where at you the site... After US the doctor has directed us on analyses at last!!! - TTG and 3. Result of research: a kind of the analysis - free 3=14,66 pmol/L norm or rate 4,4-9,3, TTG 3-rd =0,002 mIU/L norm or rate 0,32-3,73. Both of the analysis method IFA from Roche Diagnostics. The diagnosis - a nodal toxic struma, a decompensation. It has been in words told or said - a thyrotoxicosis gipertieoz. Purposes or Appointments - 1 Mercazolilum of 15 mg/?OO, 2 30 mg/?OO 3 1 tab/?OO. At survey like the tachycardia not from nerves would be listened?. On subjective sensations the sick site has a little decreased during all this bustle, its or her mother like too would feel decrease, however the doctor has skeptically concerned to it or this. TOTAL they questions to you, dear endocrinologists: I and have not understood - that all the same with shchetovidnoj a gland of my wife? Why I ask - in the specified textbook of endocrinology located on *lt; A HREF = and quot; http: // www.vsma.ac.ru / pharm/koi8/library/books/endo/content.htm*quot; TARGET = and quot; _top*quot; *gt; http: // www.vsma.ac.ru / pharm/koi8/library/books/endo/content.htm*lt;/A*gt;, I have not found the description among diseases of the thyroid gland, inspection of the wife corresponding or meeting results - whether the specified treatment will help or assist? Whether it is treated? - whether there is no risk onkozabolevanija? - whether the probability of necessity of operation is great? - What reasons of disease? How them to eliminate or erase;remove? - that will be as a result of treatment? Whether there will be any restrictions pregnancy, a diet...? - how much or as far as in general it threatens health? I apologize for so long narration, but on my first letter Fadeev Valentine Viktorovich has complained about confusion of a statement, therefore it was necessary so longly to describe. Very much we ask you if it is possible or probable as it is possible to consider or examine more in detail our situation and to inform everything, that it is possible to extend from this information. If something is necessary in addition analyses and pr...., we shall necessarily try to make and inform you. We ask to not postpone for a long time since the wife is nervous strongly and experiences, that as I understand, does not promote its or her convalescence. Yours faithfully, Nesterov Sergey. *lt; A HREF = and quot; mailto:s-ness@mail.ru*quot; *gt; s-ness@mail.ru*lt;/A*gt;
Nesterov Sergey (s-ness@mail.ru) - - ---p.s. Wished to send a picture of US, but attempt to scan screen listing has failed.
G.Gerasimov - - ---Dear Sergey, the Case of your wife is a little bit confused because of divergences of results of US. Of what it is possible to think? 1. Rather possibly data of hormonal research TTG speak about it or this and 3, that for your wife is available tirotoksikoz. It specify both researches and to them, obviously, it is possible to trust. Excuse, that I write with many clauses since understand, correspondence diagnostics and treatment - ungrateful or thankless business. 2. Whether is the reason tirotoksikoza the site? Considering age of yours spouses, the small sizes of the site which as you have told, have hardly found at US is not so typically. At the given age, after pregnancy more often razvaetsja other disease - diffusive or diffuse toxic struma DTZ. He has rather specific displays on US. It is a pity, it is impossible to see a picture. Besides for acknowledgement or confirmation of diagnosis DTZ use immunologic tests - to tiroglobulinu, thyroid peroksidaze mikrosomalnomu antigens and to receptor TTG. Whether it is possible to execute these tests in Sochi? 3. Purpose or appointment of Mercazolilum in the given situation it is possible to consider or count spent treatment adequate. It or him appoint or nominate at all variants tirotoksikoza. 4. The forecast concerning operation, etc. while to define or determine difficultly; the diagnosis is not absolutely clear. You, however, should calm the to the spouse. The essential oncologic risk in the situation described by you is not present. It is necessary to understand with the diagnosis for now to continue to begin? Treatment by Mercazolilum. The truth in this connection is a question - and whether your wife of the child nurses?
Melnichenko - - ---Sergey, joining the remark prof. Gerasimov about groundlessness of alarms, and about necessity now softenings tirotoksikoza it is unconditional, existing, Mercazolilum, and also about importance of use only small doses of this preparation or propitsila if prododolzhaetsja feeding, I wish to explain, that exist three variants of a situation - in the-first, the wife can have a diffusive or diffuse toxic struma in a combination to a nodal colloid struma this last could be up to pregnancy, arise during it or her, etc., in the second, really, the changes of density typical for DTZ In third, can wrongly be accepted to the site can be with the least probability tirotoksicheskaja an adenoma. These statuses - to a miscellaneous are treated all, but to one of them your history with Parlodelum has no attitude or relation. To understand a situation - week and even it is less than job as for ENTSRAMN Dm. Ulyanov, 11, and for us MMA, pogodinskaja, 5. I wish to believe, that for endocrinologists of Kiev Vyshgorodskaja, 69 it too not higher mathematics.
Melnichenko - - ---By the way, one more variant - transient puerperal tirotoksikoz silent is possible or probable, mute tiroidit at the patient with a nodal colloid struma I Repeat, for internal consultation the decision of these problems typically enough, and partially ways of the decision are specified to G.A.Gerasimovym.
G.Gerasimov - - ---Galina Afanasevna, What for you direct or refer the patient from Sochi the Russian Federation abroad, to Kiev? In the rest you are right, only internal consultation at the qualified expert can establish or install the exact diagnosis.
Nesterov Sergey (s-ness@mail.ru) - - ---Good afternoon, all with the come or stepped year a century or blepharon, etc.! ogrmnoe thanks for answers and consultations. Treatment is begun 29.12.2000 in the dosages specified by the doctor, though k.m.n. Troshin Ekaterina Anatolevna its or her variant - treatment including more acute cases specifies in the letter twice greater or big probably.... The State of health while normal, aches a bit only a head tiresomely and practically daily, can from nedosypa?. On Saturday 6.01.01 visit to the doctor is appointed or nominated. Whether it is necessary to us to do or make any check analysises now? Ekaterina Anatolevna wrote about risk of a leukopenia... At our dosages it is how much probable? Before new year were at the doctor after the beginning of the given conference, she has told or said, that treatment will borrow or occupy ~9 months I.e. will resolve, or then all the same it is necessary to cut...? For the morning 3.01.01. This piece, in my opinion, both was, and has remained, i.e. she does not grow, though has appeared 2 weeks ago suddenly enough. Still, if has not strongly tired, some questions: what post at Mr. Gerasimov? Whether you And Serebryakov know son E.Serebrjakova, and that to me is not convenient for asking it or him he too has written to me the letter? Whether it is possible to verify on a course of treatment a course with you, i.e. to continue some time I hope, not so longly to bother you with questions? Yours faithfully, Sergey.
Nesterov Sergey (s-ness@mail.ru) - - ---p.s. Whether will prompt a site similar to yours on pediatrics? Sometimes there are questions about my kid, and in books something is described or that we already know from parents, or not clear... Thanks.
Melnichenko - - ---Sergey, G.A.Gerasimova's post in frameworks interesting you prof.endokrinolog, G.A. Many years worked as manager of unit tireoidologii -that endocrinologies, now works in children's fund Junisef and absolutely fairly does or makes to me the remark because of a geographical mistake or error. The reason that during a writing or spelling I have solved that is a question of Odessa, all the same similar misses of local medicine are more typical for strran the CIS, than for Russia. And mozhe, tse shchos nezalezhne.
Alexander - - ---very useful discussion, only what for to Ukraine to expostulate? If I am not mistaken, the patient to Kiev did not address, it is all imaginations of madam Melnichenko. As that nekollegialno!
Fadeev Valentine Viktorovich (Fadeyev) - - ---I would ask to not withdraw conversation in it or this, that is not medical, a direction. Very well and all of us each other we like.
Nesterov Sergey (s-ness@mail.ru) - - ---I Thank everything which have taken part or which have participated our destiny. 6/01/01 were at the doctor - the tachycardia is not present anaprilin while is left in a former dose, the site like would decrease. Are directed on the cardiogram and the general or common analysis of a blood. While because of restless behaviour of the kid any is not made. Additional purpose or appointment - karsil under the scheme or plan 2-0-2, vit. E 2 capsules for the night. In process of promotion of process I undertake to report immediately since also to you, probably, it will be interesting to doctors and experts. Yours faithfully, Sergey.
Nesterov Sergey (s-ness@mail.ru) - - ---Good afternoon, dear experts! I supplement the observations: At us in Sochi has considerably become cold up to 0 on Celsius, that for us already a frost. The wife walks with the kid 2-2.5 hours daily, and here on a background of a cold snap? Began to complain of some augmentation in district SHCHZH. I believe, what is it there can be a reaction of a throat/lymphonoduses, etc., characteristic for precatarrhal since she began to sneeze sometimes and shmygat a nose of a status. But the spouse has found in the summary on Mercazolilum zobogennnost a preparation. Who from us is right? Whether it testifies to something disturbing or alarming? Once again thanks for yours oshchutimuju the help. Sergey.
Melnichenko (-212.188.111.170) - - ---Serezha, whether you remember, that we spoke about the control over treatment, and also that from your diagnosis one part - the fact of presence tirotoksikoza is clear only, but its or his reason is not clear, and wrote, that it is necessary to make still, you in fact can show our correspondence to the doctor and ask. Where nearby I am afraid to specify geographical reference points, and that I shall banish to Georgia, it is possible to make about what we wrote. If TTG now high the gland will grow, it and is zobogennost. And the main thing, whether is the site?
Melnichenko (-212.188.111.170) - - ---Leucocytes what? Karsil and vitamin E do not concern to obligatory preparatm in the given situation and even to preparations of the tenth of some. You should not receive medicines for an ornament of a case history, medicines on business are necessary to you.
Nesterov Sergey (s-ness@mail.ru) - - ---I Welcome everyone who yet has not lost to us interest. Was far from the Network, therefore that did not inform. So, 20/01/01 have visited or attended that treating endocrinologist, which the third. On survey improvements are established or installed: the site has decreased a palpation, the tachycardia almost is absent a stethoscope. Mercazolilum is appointed or nominated 10 mg./?OO. Morning/evening, anaprilin it is left without changes, karsil it is removed or is taken off, vit. E too it is removed, added or is taken off, added dekaris for support of immunity the scheme or plan is, but at present not at hand in quantity or amount of 6 tablets for 3 weeks in two series. Naznachey analyses: the cardiogram, obshch. Bloods. It is recommended to make analyses before following visit 3/2/01. US and hormones the doctor yet does not see sense to do or make. Since still or even be small term of treatment like any oshchutimyj result should to 3-4 months to Me, probably, it should be a shame, but I did not begin to show the doctor our correspondence. From reasons of the psychological plan. Like contact with vrachem would go, the wife, basically, is happy or enough with its or her approach, responses of friends the good clients cured earlier are shown. But in view of everything, that is already described above in conference, probably, I shall address to you for advice or council and, certainly to report a situation. By the way, conference is organized so, that last reports, can be and more actual, but less interesting regarding medicine because of small volume of the beginning of correspondence, is constant ottirajut old, already chubby case histories which one reading already, probably, can deliver mass of pleasures to the expert. Here there is a job for the WEB-master. And to you thanks for rendered assistance to all similar patients or patient in ours nowadays to the confused country. Yours faithfully, Sergey.
Melnichenko (-212.188.96.177) - - ---Purpose or Appointment dekarisa in a similar situation - one more especially domestic approach. In the world of superfluous preparations, even with the best feelings. Do not appoint or nominate. All references on dekarisu in this situation - ideas of 7 th years of the last century or blepharon as napiisano in one last book on endocrinology - the extremity or end of the last millenium .v same time in control 4 is quite sufficient reason - it is time or not time to add a thyroxine the scheme or plan block-replace .chto concerns or touches conversation with the doctor - that above all we would like, that on a site there were doctors.
Nesterov Sergey (s-ness@mail.ru) - - ---Dear Galina Afanasevna! Thanks for your references, one of these days we shall make necessary analyses i.e. 3, 4, TTG, an electrocardiogram, bloods - I so understand the general or common. About dialogue of doctors - you have absolutely correct section Conference for doctors can was mistaken with a synonym. However and for patients such outlet too is very necessary. A little, alas, in Russia good doctors, their circle is narrow, they are terribly far from people, in sense the best, as a rule, is concentrated in capitals, and peripheries Would get to us scraps glory so happens not always. About an output or exit of doctors on a site I shall add still, that in our city of ALL users of the Network nearby 3000 chel, i.e. less than 1 %. If to consider specific age, professional and t.d.strukturu users, that, I am afraid, from Sochi you in general in the Network will not find doctors. Especially with your specialization. A computer in hospitals for us dikovinka, a computer at the doctor of the house - a miracle wonderful or strange, since Incomes are simply non-comparable to expenses. I here too from job in the Network leave, I shall not be going to in any way a computer to get - dorogovato while. Coming back to medicine... To Saturday 18/2/01 we go to lechashemu to the doctor, I hope already we shall collect analyses by then; next week I shall be reported to you. Nearly has not forgotten, - whether it is necessary to do or make US the doctor speaks, that for such term of change will be still insignificant and sense to do or make while is not present...? Thanks you and your colleagues. Sergey.
Melnichenko (-212.188.104.41) - - ---Let's receive TTG
Nesterov Sergey (s-ness@mail.ru) - - ---All good afternoon! After cataclysms with an electricity in of Sochi has failed a computer, therefore I contact you with some delay. So, we have handed over analyses on TTG Result: 10 at norm or rate 0,32-3,73. The Attending physician has removed or has taken off Mercazolilum absolutely, has appointed or nominated l-thyroxine 12,5 mg. In the morning once a day, the control - in 2-3 weeks. It is More than anything yet we do not accept. Sergey.
Melnichenko (-212.188.110.35) - - ---Serezha, I also expected it or this. In the-first, it is impossible in given sttuatsii to remove or take out Mercazolilum absolutely as treatment by Mercazolilum DTZ lasts one and a half year the same as pregnancy lasts nine months. To anybody in a head does not come to interrupt an idea beremennost if wish to receive healthy rrebenka. What for I asked to look or see TTG and your doctor so persistently resisted .potomu, that during treatment the moment almost always inevitably comes. When TTG raises or increases there will be time, shall explain why .v such situation pass to the scheme or plan block and replace - i.e. 10 mg of Mercazolilum and 50-100 mkg of a thyroxine are given. Well you can learn to ask the doctor questions?
Nesterov Sergey (s-ness@mail.ru) - - ---Galina Afanasevna! 1. I congratulate you and your colleagues-women on March, 8th! The best regards this day and all blessings. 2. Before the analysis we accepted Mercazolilum in a dose, in my opinion, 5 mg. In day 2 times on 1/2 tablets. The doctor, probably, has removed or has taken off it or him temporarily, before homing TTG to norm or rate since, how much or as far as I have understood, we already send away or have left in GIPO instead of giper... oza. The Check analysis is appointed or nominated in 2-3 weeks. 3. About a thyroxine. The doctor, on its or her explanations, has given the minimal dosage to not cause intimate or cardiac questions, for example, a tachycardia since does not wish to feed us with intimate or cardiac preparations unduly. You write about 50-100 mg of 1-2 tablets?, can to us and will increase purpose or appointment, I do not know. 4. About rising TTG she has told or said, that Mercazolilum zadavlivaet excessive in our case activity of a gland, then the site, i.e. That us also disturbs that, would treat a thyroxine like he influences structure or frame of a tissue of a gland, and as the thyroxine causes activity of a gland Mercazolilum do not remove or take out completely, but at us TTG too vyskoj while... Here so I have understood a situation. What we should specify, ask? Whether Correctly we operate or work? Once again with a holiday, Sergey.
Giljarov M. (-195.178.201.130) - - ---Dear Galina Afanasevna! I Congratulate you on a holiday and I wish you all blessings and successes. Let you always, despite of weather, will have a spring mood. With the best regards, M. J.Giljarov.
Melnichenko (-212.188.103.20) - - ---Is not present, Serezha, interpreting not absolutely correct .davajte we shall recollect, that at us and remains obscure - whether the zone is changed ehogennosti really site or it is the lymphocytic center at DTZ .v communications or connections with your remoteness the decision to spend normal treatment by Mercazolilum - within one and a half years is accepted. With depression up to minimal supporting or maintaining in 10 mg. With addition 4 at rising TTG. The more shortly the period of treatment by Mercazolilum, the is less probability of a permanent cure .v a principle. Internal consultation is necessary all the same. As at each stage of the standard treatment we collide or face with problem local decisions. Thanks all for congratulations.
Nesterov Sergey (s-ness@mail.ru) - - ---Good afternoon all! Last information on ours with the wife to a problem: 18.03.2001 have visited or attended treating endocrinologist, the oncology has directed on US and on consultation to the surgeon from onkodispansera since as she said he the best on these SHCHZH to a part did not direct or refer in view of a nervous status and reaction spouses on words the surgeon earlier. Results of US: a locating usual, a contour equal, the left share - 181434, volume of 4,1 sm, the right share - = 181337, volume of 4,1 sm, total - 8,2 cube. See ehostruktura it is saved, focal changes - in the field of an isthmus gipoehogennyj 7,76,3 site mm., homogeneous, in... What it is-is not clear... Departments of the right share a nodule new!? diam. 5 mm. gipoehogennyj with a hyperechoic frill, the conclusion - colloid sites of an isthmus and the right share. Have gone or send with this result and a heap previous bumagk to the surgeon. That rather severe on a kind djadechka, selection of words for the concrete patient obviously not anxious has looked or seen only at US old see above in conference and new, an interval - 3 months, has noted positive dynamics or changes, has felt a throat and summarized: Certainly it is necessary to delete... After have recovered from a shock -were treated - and suddenly operation... Have found out, that: 1 promptness in operation is not present 2 basically it or her it is possible to not do or make at all 3 possible to continue easy conservative treatment 4 master of surgery in general skeptically concerns to treatment of similar things, preferring 5 site is better for removing more radical agents all the same since he can regenerate in cancer SHCHZH!??, but literally... After have again gone or send again to the treating endocrinologist. That has calmed us, that a surgical intervention it is not required, dynamics or changes positive, etc. the Nature of the site have left in the party or side... Purpose or Appointment of the doctor: has left for 2 weeks a thyroxine in a dose 12,5 mg./?OO. Unitary, with prospect of augmentation in 2 times. Mercazolilum is not entered, since under the version of the doctor: our gland sharply enough perceives lek. Preparations, the minimal appointed or nominated dosage of a thyroxine does not demand dop. Introductions of Mercazolilum, it is expedient to enter it or him later, at augmentation of a dosage of a thyroxine. In view of described that us to wait? Whether we can cure a gland, or all the same it is necessary to cut? Somehow it would be desirable to believe more to the endocrinologist, than to the surgeon among friends there are some people with not the most successful consequences of operations, down to loss of a voice... The scheme or plan of our treatment and what its or her consequences, your way to opinion is how much effective? The approach of our attending physician the minimal dosages and the control, how much or as far as I understand, secondary attributes of activity SHCHZH - pulse, a tremor of fingers of arms or hand..., without special monetary expenses for frequent monitoring TTG and so forth differs from recommended by you including dosages a little, but strongly to press on the doctor your authorities it would not be desirable, since With the same success it is possible to manage and it or him the doctor, receiving consultations on the Network, and it, probably, too not the best way to correct for health... Excuse for importunity and thanks for consultations. Sergey.
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