YOU THE PATIENT

Дата Апрель 30, 2013 - 5:23 пп Нет комментариев

Being proud of the force, men perfectly cope with the tasks demanding some deprivations, but under one requirement: they should control events! As a result of the man is more successful, than women, drop excess weight and give up smoking. Is much worse they look in the condition checked by others: accepting tablets, laying down on process or recognising that illness is too heavy to cope with it self-contained. As well as any generalisation, this inference prilozhimo not to all men but even if you consider yourselves as exclusion of a rule, nevertheless read this section.

The word "patient" happens from Old French "suffering affliction", and this sense was saved in it and to the present day. From the originating of mankind any healthy person did not think at all to be converted to the healer, and such standing is saved until now. Idea that the doctor is capable to help the person whom and so itself well feels, was born in the second half of XX-th century in few industrially developed western countries and while widely it was not spread.

It is paradoxical, but the is better you feel, being converted to the doctor, the above your characteristic liability. If at you the leg is broken, the doctor will not have problems at diagnosis setting, but at incidental stethalgias you should answer on some light problems, and at malaises at weather changes the doctor will ask you more in detail. If at you excellent health and you have come on the regular visual inspection a lot of information which one it can gain only from your mouth is required to the doctor. Having led before visit to the doctor some "probes", you pleasantly surprise with its rationality and organisation. Therefore before the maiden visit make the following.

1. Talk to mother. She will tell, you have tolerated what illnesses in the childhood (very few people remembers, than he was ill in three-year age). Specially ask on the diseases demanding hospitalisation, and the most important problem should be: «And what then the doctor spoke?» But try to store the facts, instead of its personal judgement on the happening. Be referred it is critical to constant mentions that you had any particular allergy our mothers routinely are rather active in diagnosing of allergies of one of principal problems of their descendants. For an example I will tell that 90 % of the adult men stating, according to mother, about the allergy to Penicillinum, were not right. Besides the salutary properties Penicillinum almost has no by-effects. At its substitutes much more contraindications. Therefore if your taint can be cured Penicillinum is better to use it.

Your mother can state that you the allergic person, because:

Your father was the explicit allergic person;

You had an asthma, and the doctor mentioned that would prefer to avoid assignment of certain medicines;

In the childhood you had time to accept too much any drug;

From any drug at you diarrhoeia began.

All enumerated does not bear to an allergy and if you did not test a typical allergic response, can consider itself healthy in this plot. Many events of a rash of which one charged Penicillinum, actually were a disease symptom, but the doctor, instead of your mum should make such inference. Therefore ask it that then the doctor has told.

2. Find out about illnesses of relatives. In hospital educational institutions of the future doctors learn that it is necessary to know about diseases in monogynopaedium of the patient, however during medical practice such tracings in case histories all become shorter and shorter. Nevertheless, you should know exact age of the well grandmothers and grandfathers, parents and nearest relations, and also their exact age for death date. The same information about djadjah and aunts too is useful; convergence on cousin relatives will matter at discovery of family disease.

Try to learn more about severe illnesses of relatives, but do not theorise and do not allow to make it by another the facts are relevant only. If, for example, your father says that the grandfather has perished from an infarct, ask, whence it is known to it. If he tells that the grandfather sat on a sofa, has suddenly writhed and has perished, the infarct will be only one of ten possible parents of his death. Suicides, alcoholism and severe alienations in the history of monogynopaedium very much the essential information, as well as the running diseases and deflection, for example high cholesterine at someone from the native.

3. Learn, a leah made to you grafts in the childhood and from what illnesses.

In the past the tetanus and a diphtheria were children’s illnesses with what they and now remain in underdeveloped countries. In the USA them adults by whom grafts in the childhood for various reasons have not been made today are ill. What grafts made to you? Some grafts should be iterated periodically that, by the way, concerns both to a tetanus, and to a diphtheria. And in this case also do not theorise («In the childhood I has broken an arm probably then to me have made an antitetanic graft»). If there are doubts ask the doctor to iterate a graft.

4. Be sociable with the doctor. Despite all miracles of production engineering, our knowledges about the patient on 90 % consist from this that he tells. «Talk properly to the patient», learn us the professor. «They will tell about the diagnosis».

But sometimes it is impossible. The information sometimes should be drawn out almost ticks, as a result to the extremity of reception the doctor feels not better the patient. Here an example of how a certain patient complains of a maw troubleing it:

What exactly troubles you?

All has begun, when I have moved to Chicago.

When? Couple of months back?

Three years ago. I have gone at once to the specialist.

Also what?

It has made assayings.

And what were effects?

It has registered to me a drug, and it has helped. You can make out to me it again?

What it to you has made out?

Small white tablets …

Title remember?

No, but they were small and white. For a maw … Here to you a skill to communicate problem in all beauty! But do not think that the fault lies only on the patient it could become a victim of the bad skill to communicate of the previous doctor. If the information expected from you is very relevant, the doctor will try to gain it very much. Easy life both to it, and, following the several regulations basing on simple common sense.

Be detailed and exact. Hardly you will parrot to the motor mechanic: «My machine was broke … broke in itself … probably, it was broke …«. Having met the patient who repeats that not very well feels, the doctor will try to clarify the facts. What for to impede its operation? Think, what not so in following conversation:

I am chilled from past week.

From past week … Means, already seven days?

Yes is not present, three days.

Cold … you mean a cold and a pharyngalgia?

No, tussis and a genyantritis.

The genyantritis means, you mean a pain around dogs?

No, at me the nose is pledged …

At the average the doctor should iterate «you mean» one hundred times a day. Therefore precisely feature that troubles you.

Speak: «I have pains in the ear», instead of «At me is infected an ear».

Speak: «At me a rash, and it is hackled», instead of «At me an allergy to something».

Speak: «all is ill me!» Only when at all other even hair are ill you.

Also do not think that the doctor can «read between lines» do not speak: «My maw all night long did not yield me to sleep» (can be, he all night long played to you a trombone?), tell is better: «I did not sleep all night long because of a nausea (either pains, or vomitings)».

Do not come with the ready characteristic diagnosis. Aberrantly to be on reception with announcement: «In my opinion, at me a nervous breakdown». I, for example, well know that such "sensation of fear" or "trouble" but when the patient reports to me about "nervous breakdown", I am lost it too popular and blanket term which one for miscellaneous people means miscellaneous things, no less than "konjuktivit", "tonsillitis", "taint" or "indigestion". Speak is better: «I have been so killed that could not mass on operation», or «At me the eye is hackled, and in the morning on it there was a crust», or «I have pains in a throat», or «In an hour after meal at me spastic strictures of a maw begin and gases» are dedicated.

Remember a characteristic case history. Do not guess that in that plump case history that lies on desktop before the doctor, everything is recorded that to you happened. Such in appearance the complete history appears very often a dial-up of scrappy data. The best place for basic facts your head.

I see, you lay in hospital in 1973? In what halter?

For survey. (Absolutely useless answer)

Because of a back. (The little it is better)

At me the back has ached and did not transit. (Not bad)

The back began to be ill more strongly customary, and the pain even has started to donate in a leg. The doctor guessed that it could be because of a displaced godet. (Very well)

The doctor has sent me on survey. It was clarified that at me the vertebrae godet is drifted. In some days to me it became better, therefore he has told that it is not necessary to make process, if only again is not becomes worse. (The ideal answer)

Do not consider that the doctor «will send request» and the problem will be solved. The doctor, certainly, can direct request to hospital where you once lay, but it will occupy a lot of time, besides, sometimes requests remain without attention. Therefore words: «I do not remember … It is an old story» very bad answer, and I should auscultate similar some times in day, improving a title once the drug made out to the patient or asking about its state some years ago. To tell the truth, in such forgetfulness it is believed arduously. People usually remember that for them is is relevant. As your way how much inhabitants of Indianapolis or, say, Guadalajara can answer: «Sorry, but I do not remember, I live in what city. This world so is great …»?

Encourage the doctor to be sociable with you. If today you already sixth patient talk of the doctor to you, most likely, will be much shorter, than with the maiden. If you, leaving a cabinet something and have not perceived, it is wine of the doctor, but you will be the unique victim. Therefore before to quit a cabinet, try to gain definite answers on following problems:

In what my illness consists? Be not contented nothing with significant phrases of a type: «the Feeble back», «the Irritable, excitatory maw» or «the Bad circulation of blood». You would pay to the motor mechanic who has told that at your machine «drive shut-downs»?

Any illness has an exact title. If to you will report this long scientific term, it is necessary to learn that it means. Many impressive pseudoscientific words simply are useless this only beautiful title of your symptoms. Examples "dermatitis" (rash), "gastroenteritis" (gastric disturbance) and "arthritis" (an inflammation of knuckles) can minister.

Each illness has a parent. The dermatitis can be effect of action of bacteria, funguses, chemicals or allergenic agents. The majority of a gastroenteritis are caused by viruses, but the parent can be both bacteria, and rotten nutriment. The arthritis originates because of kind ten parents. Never guess that the parent to you is known most likely, you will make an error. About once a week somebody from patients states that at it (or at it) an anaemia. When I ask, why they so think (except an anaemia, there is one hundred more illnesses with similar symptoms), they, as a rule, are surprised: «As, the doctor, unless from the bad delivery does not happen anemias?!» Yes, there is somewhere to Bangladesh, but in America such a scarcity.

Almost any disease yields to treatment. If treatment is not present, to you are bound to tell about it. Many doctors are retouched by type phrases «Anybody from us is not ideal» or «It is the answer of an organism to stress». Some people prefer to hear such inferences instead of accurate determination of disease. If you do not concern to them, ask the doctor, than concretely you are sick, what is necessary treatment and what is the time it can be extended. Thus allow: any serious illness do not treat tranquilizers or Polyvitaminums.

Really it is necessary for me? Besides, that you will spare a time and money, such problem will allow the doctor to be convinced that you the reasonable and severe patient.

The majority of visits to the doctor are connected to insignificant problems which one the medicine besides and does not treat. Tussis, cold, viral infections and gastric disturbances are prolonged so much, how much it is necessary for them to transit in itself, irrespective of treatment. Small injuries also heal in the time assigned by the nature. Doctors a generous arm make out a drug for alleviating of such states as experience has taught them that the majority of patients feel much better, accepting something assigned by the doctor: nyxes, tablets, belts not very well that.

Making out a drug for tussis at cold or kortizonovuju a salve at an itch, I explain that it to some extent will help, but the patient will not recover more promptly. And it is the extremely rare somebody from patients says that in that case this means is not necessary for it. Therefore, if you are not aimed to temporary alleviating, ask to the doctor a problem born in an initiation of section, but at all do not solve what of drugs you do not need.

INTERRELATIONS OF THE DOCTOR AND THE PATIENT

Дата Апрель 28, 2013 - 12:07 пп Нет комментариев

In these interrelations the stand of both sides is relevant. The last decades the judgement has rooted that the patient should be considered as the equal associate. In our interrelations with patients the trust of the patient to the doctor and other medical staff should play a playing key role. During the practice I noted that many patients are afraid of doctors, and should mark that the most unfortunate patients such people, specially if for various reasons also have no in their of faith.

I advise to everyone as it is possible to be acquainted more close with medicine and a science generally, reading books, similar to this, and to set to the doctor flock of problems that it makes. However, we never yield sufficient explanations, and our 100-th answer to a subject «что-ясейчас-буду-делать-с-вашим-геморроеì» will be always shorter than the maiden. But eventually you should check that the doctor really knows that makes. Now I will explain you as to lead, being in a role of the patient.

THAT THE ELECTROCARDIOGRAM DEMONSTRATES

Дата Апрель 27, 2013 - 5:12 дп Нет комментариев

From all assayings and the tests made on reception, the ECG acquaints usually for the first time patients with miracles of developed production engineering. Any pain, any beaming. The patient nestles on a couch or on desktop, to its wrists, to malleoluses and a chest tack welding rods with the wires, going to the small apparatus which one quietly buzzes, clicks and spits out outside metres of the paper strip which has been covered with drawings by blister flourishes. According to many unsophisticated people, on this strip all secrets of their heart enter the name.

The cardiogramme really records something, but, as well as other testas and assayings, is not capable to metre all possible. In order of accuracy of measuring there are three aspects of cordial function, on which one doctors pay attention first of all.

Most precision measurements: frequency of cordial abbreviations (electrical activity, or pace). If your heart is wobbled arhytmicly, dropping shocks or, to the contrary, speeding up pace the ECG very precisely and in details demonstrates that happens actually. The doctor can spot a radiant of abnormal electrical cues, a trajectory of their passing through heart, a severity level in each separate event of an arrhythmia (similar alternatives there are hundreds, and some of them are trivial, and others can be lethal), and also beforehand spots performance of treatment of an arrhythmia.

The ECG perfectly metres electrical activity of heart as it is for this purpose intended. Welding rods trap feeble electrical cues, and the apparatus boosts them. Lines on a strip do not metre muscular activity of heart, and only demonstrate a passing trajectory through it of cues. Even unbreakable heart capable to produce any time electrical cues.

Any of testas for determination nobody argument an indirect route (i.e. by means of something another), is not irreproachable. For example, the best method of preliminary treatment of a bacterial infection of urine stock-taking of bacteria by a dropping of their crop. Discovery in urine of leucocytes which one presumptively should struggle with bacteria, much lighter, but less precisely. The lightest and the least exact testas this dip in urine of an indicator stria, sensitive to suspicious chemicals.

Store it to have the correct idea about that information which one yields the ECG rather two more aspects of cordial function.

Less precision measurements: a cardiac muscle state. Injured, perishing or already dead tissue usually influences passing through it of electrical cues. I can easily distinguish characteristic for an ischemia (a blood supply disadvantage) a picture of the ECG and to anticipate the patient about an infarct capability. I can even spot an occurrence of cultivation of a cardiac muscle under the ECG. The section of the cicatrised dead tissue is changed by an ECG in some other way, therefore I can tell to the patient that at it the infarct (some infarcts transit asymptomatically), apparently, was more narrow.

But always it is necessary to remember a rule: «the Best method of checkout on cardiac muscle disease is looking up of a sick district of a cardiac muscle». At such checkout traces of the radioactive isotopes concentrated in a sick or healthy cardiac muscle are used. The special camera scanning field of heart, yields the image on which one suspicious and explicitly striked districts are selected. Unfortunately, this procedure occupies too much time to be robust.

Passing checkout through heart of electrical cues prompt and frequently rather useful method of preliminary treatment, but nevertheless this indirect survey. In certain cases electrical cues successfully transit through severely damaged districts with an almost inaudible time delay, producing on an instrument output a standard curve or, at its best, a curve with appreciable, but not troubleshot deflection. The doctor who has gained standard tracing of the ECG of the patient with suspicion on an infarct, should hospitalise it, while the repeated ECG or blood assayings (the finding matters selected with perishing cells of tissues of heart one more indirect, but safe enough and exact method of checkout) will not confirm or will not reject the preliminary diagnosis.

Least precision measurements: heart shared state. Though doctors permanently assign its checkout, specialists do not recommend to use for this purpose of the ECG as the cardiogramme not in a state to tap an early coronary atherosclerosis. Actually it does not fix even a moderate atherosclerosis and rarely discovers developed if there are no symptoms. Cholesterine depositions can block completely almost a coronary artery but while the blood flows through it, the ECG will be standard.

The monitoring spent during an intense exercise stress, can dissect the ischemic changes mentioned earlier if reduced groundwater arteries not in a state to give blood enough to tissues. Some specialists recommend to lead regularly the ECG with a load to people with a classified risk to hypertensive patients, smokers and owners of high level of cholesterine, and also quoters of some occupations, for example pilots, whose concealed heart disease can harm to another.

For the man who are coming nearer to an average age, the ECG with a load starts to introduce certain concern, and doctors assign this routine often enough though in it there is a great risk. The positive take can appear crushing news to the man considering healthy, approximately the same as the bad mammogram horrifies the woman of the same age. Odds that the woman with a canker of a chest has before it major advantage as doctors well are able to treat it. But it is much less clear that to make with the man, in general healthy, but from the abnormal ECG at a load (the section «Priorities of health for men for 50» in gl see. 3).

X-ray analysis. Many men are deeply convinced that X-rays are capable to glance deeply in a band, causing its disturbance, and promptly to discover that has failed. If they suffer affliction headaches, it seems to them that they need a roentgen of a skull and if the back is ill give them a back radioscopy. However both these surveys are ineffective in respect of discovery of severe disorders. The roentgen as the instrument of probe merits kind words, but helps only with certain situations.

The X-ray image it not a photograph. Unlike light beams which one the photocamera lens can focus, the X-radiation is spread strictly as the crow flies from a radiant through a skew field to Membranula. Consistenter parts of a skew field (for example, bones) delay a part of rays in a greater degree, than less dense (for example, muscles). The lungs almost completely filled with air, almost do not delay rays. As a result on Membranula the dial-up of shades of miscellaneous consistency which one raspingly iterates circuits of parts of a skew field is gained.

Using for an example rentgenosnimok a thorax, I will tell that can also that cannot discover X-rays.

Shades there where they should not be. The swelling or the infected fluid at a pneumonia in the field of lungs are visible clearly as malignant tissues and fluids are much more dense than lungs and yield on a snapshot clearly discernible hulls. The swelling in the field of heart or a maw will be, was interquartile, is not so perceptible or even is invisible, as density of tissues of heart, a maw and the swelling are approximately equal.

The broken shades there where they should be plain. The broken rib is routinely visible absolutely accurately, specially if the extremities on a fracture have slightly dispersed, but the fine check can be indiscernible. Generally the roentgen is unreliable for identification of any object in diameter less than 12 mm.

Abnormally major or small shades. The roentgen is capable to tap too enlarged heart or the slept lungs. The infarct does not modify delineations or a heart size, the attack of an asthma does not modify anything in lungs, therefore rentgenosnimok a thorax looks standard even if the patient is really sick.

Blanket diseases. The standard snapshot of a thorax encourages often smokers. If it taps the maiden signs of an emphysema, someone swears immediately to give up smoking. At an emphysema the pulmonary tissue simply disappears, therefore the band of lungs looks on a snapshot more darkly standard. But a roentgen nevertheless rasping enough instrument to demonstrate shading earlier, instead of at a stage when the majority of a pulmonary tissue already is not present. So «the maiden sign of an emphysema» on rentgenosnimke actually means farly gone disease. The bones staggered with an osteoporosis, on a snapshot also look is more light, than usually but before such change becomes appreciable, 50 % of a bony tissue, therefore primary preliminary treatment of an osteoporosis on rentgenosnimku should disappear at least, as well as at an emphysema, bears to the heavy form of disease.

When the tuberculosis was an abundant malaise, the regular roentgen of a thorax was good enough for illness detection at early phases. Today the tuberculosis meets rarely (except for an immigrant environment and a HIV-infected), and X-ray survey was exchanged by dermal samples. Using analogy to a tuberculosis, doctors used a roentgen at visual inspection of smokers for detection of a canker of lungs at early phases. It made certain success, but, unfortunately, the canker of lungs promptly progresses, and patients, whose diagnosis has been installed routine rentgenosnimkom, perished so often, as well as what illness was taped after appearance of symptoms.

Being once conventional at periodic physical examination and at employment, the roentgen any more does not minister to the useful purposes, therefore it is necessary to be failed from snapshots if to you tender them to make. Can yield other survey methods slightly more. Despite all reachings of medicine of the last years, only some of them are capable to tap concealed curable diseases at the people feeling well, it is checkout of pression, cholesterine, a chair on an occult blood and, maybe, still checkouts on prostatospetsifichesky an antigen and a glaucoma.

To probe of the running disease or aftereffects of an injury of roentgens it is applied successfully enough, but it, as well as other types of the instrumental probes, produces in the capacity of effect of digit and the bird’s-eye pictures representing the auxiliary information which one the doctor should assemble and consider. However your specification statement of will be the most relevant information source that to you happens. After considering of your story the doctor can gain the supplementary information, having assigned various assayings and surveys, and, the better its talent as the diagnostician, the it is less than assayings and tests to you it is necessary to transit. If to you has had the luck to discover the good doctor and intelligibly to explain it the problems you have ensured to itself a maximum indispensable for the best medical attendance.

The checkouts usually spent by doctors during the regular physical examinations of men are more low reduced.

It once again resembles us the relevant rule which one doctors and ignorant people quite often forget: «the Best checkout checkout of that is necessary».

WHY ASSAYINGS CAUSE SO MUCH COMPLAINTS

Дата Апрель 26, 2013 - 1:20 дп Нет комментариев

Easily to perceive, why inhabitants perceive effects of assayings with such severity. At first, assayings are fulfilled by means of expensive and difficult hardware, and the majority of Americans are deeply convinced that the information received by means of developed production engineering, is bound to be worthy and trust. Secondly, activities of the doctor are always environed with a certain mystery that is why it is difficult to unsophisticated person to guess that they actually mean; printout to decrypt it is is foolproof. Unless the high level of Saccharum does not point diabetes? Unless the ECG does not discover heart diseases? And the answer to both problems is that: sometimes yes, and sometimes also is not present! Any assaying not in a state to answer all problems. The roentgen of a maw will not tell to us all that followed the nobility about it. The urine assaying can dissect something testifying to disease of buds, but it is possible and to select standard urine through sick buds.

And still, despite natural limiting of capabilities and abuse by them, assayings have great value. I will explain to you that it is necessary to know about the most abundant assayings.

The complete count of bloody little bodies. Such assaying guesses measuring of very many arguments, but the machine is controlled with them with such ease that anybody any more does not reserve simple count of haemoglobin or leucocytes. Actually electronic counters of builders of a blood noticeably have progressed us. In former times at count of builders of a blood the laboratory assistant sat, having buried in a microscope, and a leah considered bloody little bodies hardly on setpins. The machine not only spares a time and expenditures of labour it makes this operation much more precisely.

Count envelops all formulated (i.e. visible) blood devices., from half-dozen types of white bloody little bodies (leucocytes), thrombocytes and a rare occurence red bloody little bodies (erythrocytes) here enter in the USA, but a radiant of major trouble if they are discovered various skew fields-parasites.

Erythrocytes tolerate from lungs to tissues of oxygens, in a swap collecting from them carbon dioxide and returning it in lungs. At men usually numbers about 5 million erythrocytes in 1 мм3 bloods (from 4,5 to 5,7 million). Count allows also for haemoglobin a protein in the erythrocytes, bearing gases. The norm for men considers 14-17 g on 100 ml. One more argument of count a hematocrit precisely counted bulk of erythrocytes in certain bulk of a blood (41-50 %).

The impression can be made that count of erythrocytes, haemoglobin and a hematocrit gauges the same value, but actually knowledge of these three arguments allows to carry out certain accounts further. For example, dividing of a hematocrit into an amount of erythrocytes yields actual bulk of one cell. Some illnesses, for example, insufficiency of iron, lead to formation of abnormally small erythrocytes; insufficiency of hepatoflavin, vice-versa, to their too major sizes. Therefore actual corpuscular bulk very useful argument.

When the amount of erythrocytes so, and haemoglobin in a blood impinges below norm, originates an anaemia (anaemia). The term "anaemia", from my point of view, features effect of laboratory analysis more likely, than ministers the diagnosis. The kind one hundred various disorders can provoke an anaemia, and an obligation of the doctor to discover what leads to it of each separate patient. Some events of an anaemia are congenital, incurable and sometimes innoxious, others can point retention of serious illnesses, such, as neoplasms. The anaemia never originates because of stress or overfatigue, besides, in the USA it almost never happens a consequence of the bad delivery.

The anaemia this unhealthy state, but is same also its opposite, a polycythemia (magnification of number of erythrocytes). Too the great number of erythrocytes reduces activity of a blood and contributes in formation of bunches (thrombi). The polycythemia originates at several not abundant diseases of a blood, and also in requirements when tissues do not gain oxygen enough (residing on a high altitude, for example, or a serious illness of lungs or heart). But much more often the order hematocrit, say, 54, defines the malicious smoker.

Leucocytes participate in immune responses. At a blood usually is present not less than semidozen varieties of these cells, including monocytes, neutrophils, eosinocytes etc. the Amount of leucocytes should constitute 4-10 thousand on ml. During a taint this index can be doubled or even to be trebled, but sometimes and impinges to 3 thousand on ml means, or the taint has killed production of leucocytes by a marrow, or they have prepared in the becoming infected nucleation site for owing to what their concentration in a blood flow has dropped. The low level of leucocytes is discovered at immune disorders or at violation of function of a marrow (where they will be organised) because of a taint, malignant formations or activity of drugs.

Some doctors are convinced that the high level of leucocytes points a bacterial infection, and low on the virus. It not absolutely so. Level of leucocytes introduces for me concern only in the event that I am not assured, a leah is a taint generally. Abnormal level at the obvious zymotic patient demonstrates nothing and does not help at treatment.

The leukocytic blood count. Though machines in most cases work better the person, count of miscellaneous types of leucocytes still remains destiny of the laboratory assistants considering them under a microscope. In most cases it is the doubled information, but sometimes it is useful to know a differential between an amount of cells of a various type. Too a considerable quantity of eosinocytes accurately bears to the strong allergic response or a parasitogenic taint. If an amount of leucocytes standard, but among them young (unripe) cells dominate, means, the organism tries to struggle with a taint. When the laboratory assistant notes atypical lymphocytes, at the patient most likely a zymotic mononucleosis. Once again I will iterate that the doctor should rely more to the own harm, than on laboratory analysis. The mononucleosis, as a rule, leads to formation of a considerable quantity of atypical lymphocytes, but the same happens and at some other viral infections.

Thus, the differential in number of types of leucocytes which one is termed as the leukocytic blood count, can minister a hint on retention of various diseases, but extremely rarely helps to make the accurate diagnosis.

Why it is not necessary to make assayings without good causes. 20 years ago, when I was the regular doctor of clinic, to us the young man with a small injury was converted. Though it also was not required, its attending physician has assigned some assayings of a blood, including the complete count of bloody little bodies. All effects were standard, except for last which one has given all in horror. According to count, the young man had a leukaemia (a canker of a blood).

The primitive cells of a marrow oscillating red and white bloody little bodies, usually do not circulate in a blood flow. At a leukaemia they are divided in an unusual amount and consequently often fall in a blood stream that is customary and is discovered by the laboratory assistant defining the leukocytic blood count under a microscope. Leukemic cells can occur in a blood for months or even years before the person feels the patient. And that young man perfectly felt.

You think, to it has carried, what we have discovered in it a leukaemia so early? By no means! For treatment of some forms of a leukaemia there are effective drugs, but for its form of treatment was not. Naturally, nobody would like to report to it such news: neither to its doctor, nor managing separation, to the chief medical officer of clinic. pomuchivshis, all of them have reported to the patient that in its assaying of a blood «a certain deflection» was taped, and have channelized in hematological clinic. That has happened to that guy further, I so never and have not learnt.

Thrombocytes it is small pieces of cells which one prepare at fault locations of veins to originate formation of a bunch (blood clotting). As the diseases connected to thrombi are not spread, the evaluator usually skips thrombocytes if only not to program it specially for their count. At determination of the leukocytic blood count the laboratory assistant views a slide and writes the commenting to it as a rule, it is a standard statement «thrombocytes in an adequate amount».

Blood lipids: Triglycerides; low and high density of cholesterine. The assaying of lipids (the most useful assaying of a blood for the healthy person) foretells predisposition of the person to an atherosclerosis and its aftereffects.

Triglycerides a hospital title of fats. At each of us in a blood the certain amount of grease which one level increases after meal, therefore before to hand a blood circulates, it is not necessary to eat since evening. 20 years ago at level of triglycerides from 150 to 175 mg on 100 sm3 was considered that the patient is subject to a major hazard. Unlike cholesterine which one norm has been diminished, in relation to triglycerides doctors have displayed where larger liberalism, and now we do not trouble, while their level will not reach 250 mg.

Judgements in medicine permanently change. 20 years ago at clearing up of hazard of an atherosclerosis Triglycerides were considered not less relevant, than cholesterine, but today doctors are not so convinced of it. Confirmation to doubts was yielded by some probes though effects were not so all-inclusive, as for cholesterine. But, though neither doctors, nor writers-popular writers do not spend major efforts for denunciation of triglycerides, it is better to you to maintain their level not above 100. Reaching of low level of triglycerides is easier, than cholesterine decrease. It is attained at the expense of a diet with low content of fats. The majority of men with high level of triglycerides suffer affliction excess of weight and should struggle permanently with it.

Cholesterine represents that material which one is sidetracked on walls of veins at an atherosclerosis. Cholesterine is contained in animals (instead of vegetative) tissues, but your organism too works out it as an indispensable ingredient for synthetizing of Cortisonum and sexual hormones. Alimentary cholesterine plays less significant role at an atherosclerosis, than your characteristic, therefore dietary changes not strongly influence cholesterine level in a blood. In this connection to hand a blood on cholesterine not necessarily next the heart. The doctor should assign such assaying at your maiden visitation. If level exceeds norm (i.e. above 200 see gl. 2), to iterate assaying follows approximately every 5 years.

Low and high density of cholesterine. If you already read something about cholesterine, probably, know about its miscellaneous types: high density lipoproteinovyj cholesterine "good" (HDL), and nizkoplotnyj lipoproteinovyj "bad" (LDL). In borderline cases level measurement of subtypes can help with a treatment select. For example, if the overall level of cholesterine 220 (not so well), but HDL is high, businesses are not too bad: your hazard pertaining to an atherosclerosis is approximately peer to hazard at overall level 200. However as soon as the overall level becomes more low 180, level of components will cease to play any role, and the hazard will sharply drop.

Glucose (Saccharum in a blood). In norm glucose level lays within the limits from 60 to 100 mg on 100 sm3 of a blood (handed on an empty stomach). Inching (hardly it is less 60), was interquartile, is not of great importance. "On an empty stomach" in this case means that before the assaying the patient did not eat within 8 hours, but even in some days of starvation the blood glucose remains in norm as the yielded level is indispensable for a supply of tissues. For lack of nutriment the organism starts to laminate a muscular tissue and grease for obtaining from them glucoses. After meal glucose level is moderately increased, but within 3 hours should be returned to norm.

The hormone termed as insulin, allows a glucose to transfer from a blood directly in cells. When it is not enough insulin, tissues arduously capture a glucose from a blood therefore its level in a blood after meal is increased more strongly and is returned to norm much later, than in standard conditions. At diabetes "the hungry" glucose appears above norm (fortunately, the brain and heart do not demand for standard operation of obligatory retention of insulin and prolong normally to eat even at a heavy diabetes). At diabetes of a medial level there are no special symptoms, but at Saccharum rising in a bud blood strenuously try to be saved of an excess, and the patient notes that is wetted more than the customary. If buds are healthy, Saccharum does not occur in urine until its level in a blood will not exceed 200 mg. The reinforced emiction demands reception of an additional fluid, therefore at the patient the sense of thirst is boosted, and he drinks more. Tissues, without gaining from a blood glucose enough, start to fast, therefore the patient loses flesh.

Troubleshot and retroubleshot diabetes. Being the most abundant hormonal disease, diabetes attacks from 1 to 2 % of the population, thus hazard increases with the years. In the presence of symptoms state stabilising is light. Retention in one assaying of a glucose with level above 200, tracked by sense of thirst, the reinforced emiction and a requirement lose of weight, sufficient for diagnosis setting.

Case is was more difficult, if the patient well feels (i.e. in the absence of symptoms). Doctors forget often that it is impossible to troubleshoot a serious illness ground unique laboratory analysis for lack of other evidences (that I and I imply "rediagnosing"). The diagnosis "diabetes" at the person who does not have symptoms, demands at least two assayings of a "hungry" glucose exceeding level 140. If the glucose does not attain this level, but in both events exceeds 110, the doctor should assign the so-called assaying on «a sugar curve» (an acceptability of a glucose). Having come to lab in the morning on an empty stomach, the patient drinks a solution inclusive 75 g of a glucose then the laboratory assistant within 2 hours takes from it a blood with half-hour intervals. If after the lapse of 2 hours (and at least at least in one earlier sample) the glucose remains at level 200 and above it is possible to troubleshoot diabetes.

Any level more low 200, but above norm, bears to tolerance violation to a glucose. It not a medial level of diabetes, both not an early diabetes and not a boundary state with diabetes, and the ominous diagnosis oppressing many patients. Three quarters of people with tolerance violation to a glucose never are ill with diabetes, but almost each of them suffers affliction the ovenweight enlarging hazard and diabetes, and some other diseases. Treatment of violation of tolerance to a glucose consists in excess weight reset: loss of 4-8 kg frequently returns Saccharum level in a blood to norm.

Usage of data about Saccharum level in a blood. This assaying assign for monitoring of effects of treatment of diabetes. As diabetes can originate without symptoms, is reasonable include it in periodic physical examinations, and doctors and make more often. However almost each adult, sick of diabetes, suffers affliction in excess weight. Certainly, stout men should be saved of excesses. When at them diabetes unstrands, the best treatment are not drugs or insulin, but excess weight dropping, therefore assignment of the assaying will not modified a treatment method.

THE URINE ASSAYING

Like the blood assaying, the assaying of urine does not tap something especial. Under the customary assaying of urine validate about half-dozen arguments. In most cases the assaying is made by means of an indicator stria of a plastic lamina on which one the impregnated-paper small squares impregnated with various reagents, changing painting at dip in urine sample are pasted. Assaying accomplishment occupies one minute.

Despite simplicity, the assaying of urine does not justify charges, except for its accomplishment for patients with a classified risk of renal diseases of diabetics and expectant mothers.

I will enumerate the major devices which are validated at the assaying of urine.

Protein. Healthy buds make filtering with such performance that no major moleculas, similar to protein, in urine fall. Discovery of major moleculas in urine bears to a departure from normal, but not necessarily is an ominous sign as protein can be displayed and during a viral infection of a type of a grippe, and at a heat, and even after a major exercise stress. Indications of indicator strias are always rasping enough, and in case of discovery of protein of a discoloration point either traces, or on small, medial or its major amounts. Physicians frequently skip retention of traces and even protein trace amounts. If the doctor considers it necessary to spend more in-depth study collection of "diurnal urine» for measuring of exact bulk of protein and determination of its type will be a following step.

Glucose. The assaying conventional, but surprisingly useless. As I already spoke, the glucose does not fall in urine until its level in a blood will not exceed 200 that is why indicator strias are not capable to discover early phases of diabetes.

Blood. The blood in urine can sometimes (but not always!) to occur at taints of buds, an urinary bladder or a prostate, at internal injuries, for example from rocks in buds, or in the presence of malignant formations in an urinary tract. As such formations become with the years more abundant, some specialists encourage realisation of this assaying at elderly patients.

Blood stock-taking helps with urine, if I suspect rocks of buds at the patient with dorsodynias or to a sheer plan. At taints the assaying is less useful, as symptoms are in most cases obvious.

Nitrites, leikotsitnaja esterase. This substance is sometimes discovered in the infected urine. They concern to that bunch of effects which one are useful only in case of an affirmative reply.

Ketones. They occur in urine when tissues start to laminate grease for energy production. Though it happens in typical events of an output of diabetes from under the control, I had to interfere with with such appearance and at patients with grippe or a gastroenteritis which one for any parents did not gain nutriment. At starvation by duration even less than one day the organism has time to expend all stored carbohydrates and starts to incinerate grease.

Bilirubin (gall). The lien removes grown old erythrocytes from a blood, laminates them, returning iron in circulation, and then will converse haemoglobin to bilirubin which one too is returned in a blood. Bilirubin falls in a liver which one uses it for production of the gall cosecreted then in small intestines for the best assimilation of fats. The sick liver experiences handicappings with bilirubin absorbing, therefore its level in a blood increases, and ultimately it falls in urine. The urine containing bilirubin, acquires brown bloom, therefore usually I foresee an assay value still before the detecting instrument will modified painting to positive, but anyway it is the good, prompt assaying on a hepatitis.

rn and an urobilinigen. These indexes though turn on almost in all indicator strias, are almost useless. rn (pH-value) metres acidity or alkalinity of urine which one deliveries and as a result flocks of diseases change as a function of. I will not recollect an event when the knowledge rn has helped me though in something.

I will confess also that for all life I about 10 times paid attention to an urobilinigen for the only purpose: to recollect that it means. Having written these lines, I am forced to confirm that have again forgotten it, therefore it is necessary to climb again in the reference manual. And so, fatend bacteria laminate a quantity of gall and shape an urobilinigen which one then is inhausted again in a blood then either it is immersed by a liver, or is excreted with urine. Various diseases of a blood and a liver can raise the level an urobilinigen in urine.

Specific gravity. Urine is a bit more dense some water, and the indicator stria easily gauges its density. If you consume a lot of fluid, a specific gravity of urine impinges; dehydration enlarges it. Illnesses can reduce either in magnification, or to reduction of a specific gravity of urine, but this information rarely benefits.

Settlings, or "microscopic test". This probe usually turnes on in all types of assayings of urine and is, perhaps, the only thing to useful to the doctor suspecting at the patient disease mocheispuskatelnogo of a tract. The laboratory assistant seats urine in a bottle, puts it in the centrifugal machine, ferries out a liquid builder, and the precipitate considers under a microscope. Retention more than several leucocytes boosts suspicion on a taint and inflammatory disease. Presence more than several erythrocytes points a bleeding even if it was uncovered by an indicator stria. Sick buds lose characteristic cells and other waste metal taped as a result of a whizzing.

Under a microscope bacteria are discovered also, but we do not attach it great value as urine made on the test happens rather often is soiled. Usually the doctor assigns treatment when taint symptoms are discovered in the patient, and the precipitate assaying taps leucocytes. Confirmation of a bacterial infection demands several days on bacterial culture cultivation. At pollution of urine the crop will tap or a compound of bacteria, or what usually do not cause taints mocheispuskatelnogo a tract.

WHAT TO MAKE, IF TO YOU HAVE MADE OUT TOO MANY DRUGS

Дата Апрель 24, 2013 - 10:30 пп Нет комментариев

Not to make anything quite reasonable tactics, as, however, and at the solution of many other problems.

If you do not want, that to you made out waste drugs, at the very beginning of reception let to the doctor know that you differ from "the medial" patient, and further at times resemble to it of it. Telling about the disease, interpose something of a type: «I cough a week, and it alarms me. It would be desirable to know, a leah is a real halter for trouble, and a leah it is possible to make something. If all transits in itself antibiotics will not be necessary for me». If it sounds as a hint on that, the doctor in your event how should work, means, you will achieve the necessary effect.

More often wonder: a leah «it Is necessary for me actually?» Aspirin for a pair of clocks takes out acute pains. Drugs for tussis do not treat tussis, and only kill it. Antihistamine drugs do not cure of an allergy, they take out a sharpness of an attack. Cortisonum easies almost all on light, but cures nothing. Decrease of a sharpness of symptoms quite lawful and pertinent activity of medicine, therefore an expected treatment will be not obligatory «excessive assignment», but doctors, wishing to easy your travails, can overdo. If symptoms tested by you are tolerant enough, tell about it to the doctor, but do not solve self-contained, to accept this or that drug or not.

ASSAYINGS

Throughout a larger part of our century when the lab gained a bottle with a blood, the laboratory assistant sitting in a surrounding of flasks with reagents, weights and several simple apparatus, made any assaying which one was reserved by the doctor. Occupied it from 5 till 10 minutes.

In 60th years in labs there were indeed wonderful hardware the multiphase evaluators known under a title "Counter Koultera" which one on one extremity loaded a portion of a blood and dropped it through any amount of chemical reagents, using electron and colorimetric handling of sample, and then on other extremity produced the printout containing from semidozen to several tens of data.

The majority of printouts happen are covered by such commentings, as (see gl. 5) not less than 5 % of effects of the assayings executable for the healthy person, always are beyond tolerances. As a result each such patient is on reception, shocking by printout, and it is necessary me, having learnt it, to convince the person that:

The urea nitrogen at it is too low, but it doesn’t matter;

Leucocytes are underrated, but it can be a consequence of customary cold. Nevertheless, we will iterate the assaying;

The alkaline phosphatase of his son is high, but for the child it normally growing bones work out it in a considerable quantity;

It laktat-degidroginaza vysokovata, but the yielded assaying not so specifies its level. To routinely it it is not attached great value. Nevertheless, we will iterate the assaying;

Level of a thyroid hormone of his wife has raised, because it accepts contraceptive tablets. At the use of estrogens analysis findings are always predatory in comparison with a real state of affairs;

Saccharum level in its blood below the norm accepted in this lab, but under other standards is normal;

Phosphorus nizkovat, however at the healthy person with a standard calcareous content, most likely, means nothing it, but all of us will iterate the assaying. #5

Eventually doctors have realised that numerous assayings in a greater degree create problems, than help their solution. We spend time a great lot for an explanation of a trivial departure from normal and repetition of assayings, without discovering even insignificant diseases. Therefore multiphase assayings so popular in 70th years began to get out of fashion.

SORCERY "MUMBO-JUMBO", OR SACRAMENTAL

Дата Апрель 24, 2013 - 1:38 дп Нет комментариев

Doctors save lives, cure illnesses, alleviate suffering and fulfil flock of other not less noble functions, and still participate that doctors-cynics term "mumbo-jumbo", and I prefer to name sacramental. I imply the activities of doctors directed not on improving of preliminary treatment or treatment of illness this term, and only on making at the patient of feel that before it really aware the doctor.

Almost each fallen ill person, having come to the doctor, involuntarily waits from it for any activities. Young doctors are sincerely convinced that well carry out the task, putting the right diagnosis and explaining to the patient that it to wait further. Therefore they it is always offensive are surprised, when the majority of patients, leaving, very chilly give thanks to them. The matter is that many doctors are rather sensitive to expressions of gratitude and attach great value to behaviour of the patient in the end of reception. Explicitly contented patient always will demonstrate it to the doctor. And polite and cold «I give thanks to you» usually ministers the unique and convincing evidence of deep disappointment and discontent.

Abandoning educational institution, the young American doctor is convinced that encouraging and instruction of patients to the correct behaviour constitute an indispensable part of cares of the patient. However patients look at operation of the doctor absolutely from other point of view, and it is specially displayed at light diseases. It is pleasant to patients, when it assign the drugs, therefore many doctors misuse with prescriptions as the western crop envisions that on reception to you are bound to make out a certain drug not very well, what.

The specialist on acupuncture utykaet you the rollers, the dietarian will produce flock of oracles on a delivery and if you come to the shaman, it will make that it is necessary to make to the shaman. In any company the healer should heal that guesses certain activities. Therefore traditionally any doctor will not tell that else any time you will feel not very well, and it becomes then better, and its any keyings will not accelerate a course of world development. Being scientific discipline, the medicine at all does not obligate doctors to any activities if they know that anything but as it is difficult to resist tempting in this case will not help! And the patient with the strong tussis, a misshapen rash or red eyes will not check to such words of the doctor.

I continually catch myself that I explain to the patient, than it is sick, where has picked up illness, as it will flow further how to treat its house means etc., and at the same time I think about myself: «Yes, he does not listen … to It is necessary … to make out Perhaps the prescription to it something innoxious?.« Sometimes I and make. And about a miracle! To the patient at once becomes lighter and before a maintenance it awards me expressions of the deepest gratitude. Fairly to admit, I am not so generous on certain drugs as the majority of colleagues, and it is specially careful with antibiotics.

More often antibiotics work exceptional as platsebo. Doctors make out them at colds, a grippe, tussis of a virus parentage and anginas, and in similar events antibiotics are useless. Having read this announcement, unsophisticated sceptics will be assured of a volume that I have expressed only own judgement. I will not begin to argue. But actually prescription of antibiotics at viral infections became so common case that it it is possible to use in the capacity of criteria of the competence of the doctor. Even good doctors occasionally trespass with it.

THE MAN AND ITS DOCTOR

Дата Апрель 23, 2013 - 12:47 дп Нет комментариев

Approximately 50 % of patients come on reception with respiratory taints, cold, a grippe, a gastric disturbance or other so abundant light malaises. The diagnosis in similar events is obvious at once as soon as the patient will enumerate symptoms.

Beginning doctors frequently immediately report to its patient, but soon enough discover that such skill of preliminary treatment impresses unsophisticated people much less, than colleagues. Some patients feel shamed, having learnt that case is so simply that hardly it was necessary to trouble the doctor with the ward. Others start to doubt, paternal the doctor so promptly makes the diagnosis, at all without having set any problems and without having inspected the patient whether it is incompetent, whether to it laziness to be engaged in the patient properly, whether it hurries and wants to be retouched more promptly.

Therefore grown wise experience the doctor even outwardly is in earnest about routine diseases very much. It asks problems (more than it is necessary), inspects (even if it is completely not necessary: the yielded routine too has therapeutic effect) and only then declares the diagnosis and assigns treatment. If at a row of light viral infections or small injuries the doctor assures you that soon all will transit by itself and treatment is not necessary, he tells a gospel-truth, however very few patients at these words lighten.

MEDICAMENTAL TREATMENT

Дата Апрель 21, 2013 - 7:44 пп Нет комментариев

Men and women work out the same staminate and female sexual hormones, their ratioes differ only. From this it follows that barren men and women can be treated the same hormones, only women react to treatment better. Thorough flaw of glands can sometimes make the woman barren, but more often at it changes in a drawing of magnification and reduction of hormonal levels, obligatory are watched at an ovulation. To correct this violation it is not so difficult. And here at men hormonal disorders rarely happen simple and easily reparable.

Treatment of hypogonadotrophic reduction of interior secretion of sex glands. Though on such determination it is possible to break tongue, it most precisely defines all events of hormonal insufficiency. It is possible to term this violation as "slackened function of sex glands (gonads)» that is at the bottom of miscellaneous forms of infertility easier. Gonads it is sex glands: testicles at men, ovaries at women. Determination "hypogonadotrophic" points the parent of the yielded disorder. The word "gonadotrophic" means «influencing sex glands», "gipo" "reduced"; perform this influencing gipofiznye hormones FSG and LG. The assaying of hormonal level with effect as 2 (see above section «Estimate of hormonal activity») with the under levels of Testosteron-Depotum, FSG and LG points hypogonadotrophic decrease of interior secretion of sex glands.

At men with such deflection testicles are routinely dwarfish. For correction it is necessary to accept HG human chorionic Gonadotropinum in injections triply in a week. Reception natural LG would be ideal, but its extraction from a pituitary body or urine of the woman in a postmenopause state is rather difficult. The gene engineering has already deduced a bacterium making LG, therefore in the near future there will be its radiant. While doctors use HG, worked out in considerable quantities expectant mothers and similar on LG.

In 6 or more months when testicles will settle into shape, the doctor will add to injections hormone FSG for stimulation of yield of a semen. Will transit even more many months before the amount of spermatozoons becomes reasonable from 2 to 5 million. Though it, basically, low enough indexes, quality of a semen will raise so that approximately 50 % of such men will find capability to paternity.

Klomifen (klonid). Often helping women, this drug, apparently, heads the agenda of the means registered to barren men, though at them its effect more low. Klomifeja boosts production LG and FSG. In some months after an initiation of treatment almost at all patients the gain of number of spermatozoons and Testosteron-Depotum level is watched. Such improving contributes in moral sufficing and maintains invariable popularity of a drug, but, nevertheless, does not render special influencing on ability to conceive.

Bromocriptinum. The drug normalises heightened level of Prolactinum in a blood, recovering capability to a fertilization and a potency. At standard level of Prolactinum treatment does not yield effects.

Testosteron-Depotum. Staminate hormones do not enlarge semen production, and, to the contrary, kill it; but men sometimes accept course of hormones for provoking of "Testosteron-Depotum saltus». In 3 months reception stops; it is supposed that there will be "saltus" to top level in semen production. Authors of a method, as well as many other "ingenious" developers, have published in due time the most glossy effects of probes. At remaining explorers the success has appeared much smaller, but Testosteron-Depotum reception looks so justified that it while apply, though less frequently.

Vitamins, mineral drugs, zinc, food supplements, exercises, etc. Evidences that all these alternatives of treatment help, while are not present, but they, unlike other enumerated means, are low-cost and innoxious. Many discouraged men accept them.

Treatment of a retrograde ejaculation. Customary means from a cold ("Sudafed", "Ornejd", "Teldrin") reduce puffiness of tissues of a nose, boosting the applicable nerve terminations. Nerves of the same type control squeezing of a pin of an urinary bladder, therefore the course protivoprostudnyh drugs sometimes helps to prevent a semen overpressure in a blister. Other specialists prefer to use light doses of antidepressants ("Tofranilum" type), registering reception of 50 mg daily.

If drugs do not work, doctors can select a semen from an urinary bladder. In it to routinely acid medium the semen perishes; for making of an alkaline condition the man to an ejaculation accepts a heavy dose of Sodium hydrogenum (baking soda). After extraction from a blister a semen wash out, concentrate and use for artificial fertilization.

Semen handling

For the last decade specialists elaborate good methods of upgrading of a semen as at the expense of extraction and concentration of a healthy semen, and at the expense of excision from it abnormal and harmful devices. Among these methods we will mark the following:

Takeoff of the best (active) part of a semen. The laboratory assistant seats a semen on a bottle water compartment head. The most vigorous spermatozoons float hill up where them assemble for the subsequent routine of artificial fertilization; less active remain in a bottle. Depending on the procedure accepted in everyone clinic a select semen can filter, dropping through fibre screens a silicic dust, and to enlarge its movability, dropping through a compound of proteins.

Semen wash. The semen with the component of a special fluid is seated in the centrifugal machine where it is concentrated in the special receiving detector. After a topping of a fluid the laboratory assistant fluidifies again a semen in a solution intended for artificial fertilization. In clinic can wash out a semen several times for the complete excision of chemicals, dead spermatozoons, bloody little bodies and other pollution.

Excision of antibodies. As antibodies adhere to spermatozoons they remain in a semen both after concentration, and after primary wash. If the semen looks healthy, the doctor can initiate with artificial fertilization routine. If needed the man should receive medical treatment for excision of antibodies Cortisonum for inhibition of immune system only after that the semen will be taken from it for later processing.

SURGICAL METHODS OF TREATMENT

Дата Апрель 20, 2013 - 3:32 пп Нет комментариев

Cut of amplate veins of a seed funicle varikotselektomija. The Most abundant surgical method of treatment of infertility at men upgrades semens more than in two thirds of events; 50 % from these men become fathers within several subsequent years.

In comparison with process standing concerning a varicose phlebectasia process on a seed funicle demands larger skill. Urologists can select one of following procedures:

1. Conventional. Through a section in an inguen the surgeon gains access to a seed funicle. Carefully bypassing groundwater artery, nerves, lymphatic ducts and a deferent duct, it superimposes a ligature on the swelled vein. The majority of urologists prefer the yielded method, some use a domestic or spinal anaesthesia (it is always more preferential a blanket narcosis). The man leads some days in hospital. Process occupies about half an hour and it is considered secure though occasionally there are cultivations of other structures of a deferent duct. As well as at any process of amplate varicose veins, the main complication is constituted by backsets (10-20 % of events). They are not severe, but demand a recycling.

2. Microsurgery. Fulfilling process through much smaller section, the surgeon uses an operative microscope, having an opportunity much more accurate and close survey of a funicle thanks to what can easily spot and intersect small tanks without hazard to harm environmental structures. Complications and backsets are more rare, than at conventional surgery. The patient can depart home this very day.

3. Interlock of veins by a bulb. The surgeon makes a small section in an inguen (about 1,3 sm) for obtaining of access to a major femoral vein into which one inducts the long flexible catheter, directing it hill up to a renal vein, and then downwards to a testicle vein. Validating the activities by means of a roentgen, he is convinced that the catheter in a proper place, and inflates a removable bulb being on its extremity, locking an inflated vein. Pulling out a catheter, the surgeon abandons a bulb in a vein for ever. This routine is led in a cabinet under a local anaesthesia and is worthy of it, that it to use, if to you the thought on a surgical operation is hated. Realisation of a catheter to the necessary point can demand 1-2 hours much more, than at conventional surgery, and the resulting effect is equal. Backsets also constitute approximately 10 %. Happens, the bulb bursts, and air with a blood flow falls in heart, quitting therefrom in lungs where remains. Though it and is enough rare occurence, but it is rather similar on aftereffects to a pulmonary emboly or a clottage severe complications.

4. Sanitation of chocked ducts. Using an operative microscope, the urologist can delete or make bypass of a blocked out district of an epididymis and a deferent duct. Duct unlocking allows a semen to reach an output, but does not warrant capability to a fertilization. For example, the epididymis is frequently locked because of a cicatrisation as a result of disease, sexually transmitted. The surgeon eliminates corking, but the epididymis is routinely already damaged by a taint and the semen for a maturation should be in a healthy appendage. Only from 15 to 20 % of the men who have tolerated a taint such, after process recover capability to a fertilization.

The best effects are gained when ducts are healthy in every respect, except corking as that. Cultivations of ducts can originate after unsuccessful processes concerning hernias and are natural at a vasectomy. In both events the capability to a fertilization is recovered.

PRELIMINARY TREATMENT: VISUAL INSPECTION AND ASSAYINGS

Дата Апрель 19, 2013 - 2:41 пп Нет комментариев

Each man disturbed by infertility, merits compilation of a detailed medical card and careful visual inspection. The doctor should learn more about past hospital problems of the patient, processes and bad habits. At visual inspection the special attention is given to skew field ratioes, layout of coats (for the evidence of hormonal insufficiency or chromosomal deflection), and also to genitals. If the length raskinutyh arms on 5 sm or more exceeds growth, the man concerns to an eunuchoid type: it has not transited through puberty. The size of testicles along the long shaft should be more than 3,5 Careful visual inspection see should tap retention of a deferent duct, appendages of testicles and seed vials: though it and rarely happens, but sometimes they miss from a birth.

The doctor can direct you on urine and blood bulk analyses. More complex analyses can be demanded after the semen assaying.

The semen assaying

After two-three days of forgoing of sexual life the man masturbates in sterile laboratory ware, nagretuju to body temperature. Contents are researched within two hours after semen obtaining, and it is better not later than in an hour. Assay values are too relevant, therefore the doctor can demand two samples.

The lab makes following tracings:

1. The ejaculate bulk should be from 1,5 to 5 sm3 (5 cubes it approximately a teaspoon). Deflection in these limits does not play a major role. Every day continences are enlarged by ejaculate bulk approximately by 0,4 sm3, but within a week the worked out bulk is aligned and does not exceed 5 cubes. As more than 95 % of a seed fluid represent a secret of a prostate and seed vials, retention or lack of spermatozoons not too noticeably in ejaculate total amount. That is why men, podvergshiesja vasectomies, do not note scope change ejakuliruemoj a fluid. The small bulk isolated points semens corking or lack of seed vials; the infected prostate can yield excess of a fluid.

2. The ejaculate should be non-transparent, with the pearl outflow similar to egg white. The standard semen promptly thickens, and for half an hour is fluidified. When it will happen, it will drip heavy drips. Slow liquation or its lack does not ensure requirements for prompt excursion of spermatozoons.

3. The number of spermatozoons in a standard ejaculate should constitute from 20 to 150 million on sm3. Count is led simply enough, and a trace amount, probably, was not so relevant as supposed earlier. Lower, the limit the last decade considers 20 million though some specialists still prefer digits from 50 to 60 million at least. Men with number of spermatozoons less than 20 million are not certainly sterile, as doctors own today a procedure of collection and concentration of a semen for the subsequent artificial fertilization.

4. The most relevant merit figure of a semen movability of spermatozoons can compensate their low amount. Laboratory assistants record two index: the amount of propelled spermatozoons, norm constitutes more than 50 %; movability qualitative behaviours how fast and endways they float in a seed fluid. In order to avoid influencing of individual perception of lab use video cameras, lasers, computers and special counters.

5. Semen morphology: more than 60 % of spermatozoons should be standard. Spermatozoons can exist in an amazing diversity of sizes and forms, including mnogogolovye and mnogohvostye copies. Standard spermatozoons should have an oval head, the proportional midpoint and the active tailing.

6. A laevulose: if the bulk of a semen or an amount of spermatozoons are small, the lab should produce the assaying on this Saccharum which one is implemented in seed blisters. Lack of a laevulose points a chocked duct.

7. Crops: though taints lead to infertility, they disappear how the person will be converted to the doctor. But if semen learning taps suspicious cells or bound together spermatozoons the doctor assigns sowing of crop for looking up of causative organisms, specially in the capacity of security measures before artificial fertilization realisation.

8. Antibodies: with a problem of immunodefence of a semen standard assayings have the majority of barren men; the stuck together spermatozoons or obvious deflection are discovered in minority in their excursion. As conclusive proofs usually are not present (and consequently that the immunology is an attractive mission field for many interested explorers), specialists even more often assign the assaying on antibodies at survey concerning infertility, and some make it always.

The best assaying after sexual intercourse

Isolated assayings have limiting. Eventually only pregnancy ministers the irrefutable evidence of that the semen carries out the task. Though it is almost accessible, tracking of tryings of spermatozoons to fertilise a human ootid still remains especially exploratory method. Overseeing by ootids of females of hamsters yield the valuable information, but this difficult and cost intensive occupation. Therefore the assaying directly after the intercourse it is necessary to demonstrate the best and readily available means capability of the man to a fertilization.

The pair should commit sexual intercourse approximately during an ovulation of the woman. This very day the doctor takes sample from mucus of an uteral cervix for a microscopic test. Discovery in sight of five or a larger amount of the active spermatozoons ensures the best evidence of capability of the man to a fertilization, than any insulated testas. The abnormal effect should not be considered as an ultimate sentence as in this case can play a role purely female problems.

Estimate of hormonal activity

As endocrine violations infrequently cause infertility, doctors are not engaged in their looking up until assayings and effects of visual inspection will not cause suspicions on their retention or will not be discovered that the semen has low density or when, to affliction of the doctor and the patient, routine assayings will not yield effects.

Except Testosteron-Depotum level measurement, the doctor assigns the blood assaying on the content of two hormones of the pituitary body controlling operation of testicles: follicle-stimulating (FSG) and a luteinizing hormone (LG). Abnormal effects are usually added in three typical patterns:

1. The low level of Testosteron-Depotum and high levels of hormones of a pituitary body point flaws of testicles. Reacting to low Testosteron-Depotum, the pituitary body works out excesses FSG and LG in useless trying to boost testicles.

2. Testosteron-Depotum low levels, FSG and LG point disease of the pituitary body. Testosteron-Depotum remains low, despite standard testicles, because of insufficient gipofiznoj to stimulation. Though this situation meets rarely, such diseases of central excitatory system easily enough recover.

3. The standard or a bit predatory level of Testosteron-Depotum along with predatory levels FSG and LG is a sign of reduced responsiveness of testicles to androgens: hormones are adequate, but sex cells are failed on them to react. Redundant production of other hormone of a pituitary body of Prolactinum, whose activity on men is occasionally watched while is obscure. It is connected to rarely meeting swellings of a pituitary body along with activity of drugs and other concealed diseases. Redundant Prolactinum is capable to kill other hormones, therefore doctors can metre at you and its level.

The same as the organism of the woman makes a small amount of staminate hormones, men work out Oestradiolum, a female hormone. Men with reduced responsiveness to androgens work out it too much; the same activity is rendered by rare occurences of swellings of testicles or adrenals, but liver diseases happen the principal originator. Normally operating liver reduces Oestradiolum level, and the patient works more slowly why its content in a blood increases. Alcoholics with a cirrhosis always have the heightened level of Oestradiolum combining with small testicles, major thoracal glands and infertility.

More complex analyses

The chromosomal assaying. One man from 500 is born with superfluous X-chromosome: its chromosomal complement XXY instead of XY that is named by a syndrome of Klajnfeltera. Being in remaining ratios healthy people, such men outwardly can differ nothing from others, and sometimes look a little womanly, but at all of them small testicles and they are always barren. For preliminary treatment of it and other rare deflection of lab grow cells of such patient on histic crop, then treat them for rendition of chromosomes and count (the person has 46 fallow) under a microscope. Similar abnormalities sometimes manage to be taped at people with small testicles or a trace amount of spermatozoons. At physical standard people meets very rarely.

Treatment can refine appearance or a potency, but infertility at men with chromosomal violations incurably.

Biopsy of testicles. It is simple "study" routine when the doctor takes sample in the form of a small slice and directs its pathologist on probe under a microscope. Unlike a priority of the yielded routine by swelling looking up, at treatment of infertility it costs in the end of the agenda of various checkouts and assayings. If in an ejaculate of the patient the amount of standard spermatozoons is enough, the probability of a certain pathology of testicles is rather low.

If the man with standard testicles makes sufficient bulk of a semen, but containing there are not enough spermatozoons, the doctor will consider a biopsy capability. If the microscopic analysis does not tap characters of production of spermatozoons, most likely, the man is born with such flaw. In this case no treatment here will help.

If probe demonstrates that the semen is standard, means, somewhere throughout a deferent duct there is a corking.

Checkout on corking: a vasogram. Making a vasogram, the doctor, as well as at an angiography of coronary arteries, inducts into a duct contrast medium (through a small section in a scrotum) and tracks its passing by means of a X-ray apparatus, marking a corking place. Basically, a vasogram simple routine, but the doctor should be very skilful to get in a thin deferent duct, without having damaged its tender walls and without having rubed anything on the way. Well trained and experimental surgeon fulfils this routine, having nearby a set of tools and an operative microscope promptly to eliminate the discovered corking (and to patch any cultivation caused by the routine).

Some specialists search for corking, making in a duct an eyelet for the purpose of fluid sampling. Semen retention in sample affirms that corking is further. The doctor can inject physiological solution into a duct: if it flows past up to the end, means, the duct is free. Otherwise the doctor can interpose the most thin catheter into a duct and poputatsja to grope a corking place. The vasogram is made only then if the yielded surveys do not yield effect.

Homjachkovaja sample. If the semen looks standard and remaining probes of both associates suspicious have not taped anything, doctors guess that in a semen there are latent defects. Though overseeing by spermatozoon implementation in an ootid became routine case in the clinics which are taking up the issue of a fertilization in vitro, the perspective at all does not smile to customary doctors to assemble at women of an ootid only for the assaying. Ootids of a female of a hamster ordinary became practical changeover to them.

Intact ootids of a hamster perceive only a semen of a hamster. Laboratory assistants treat their ferments resolving an external coat zona pellucida. This coat environs an ootid and women, and any other mammal for the purpose of preventing of a fertilization by an alien semen, and also hinders with infiltration into an ootid more than one spermatozoon. After commixing of ootids of a hamster with a human semen laboratory assistants record percent of ootids into which one spermatozoons, and also an amount of the spermatozoons successfully attacking them have penetrated.

It is difficult testas, therefore specialists in miscellaneous labs use various procedures for obtaining of effects. However there is a blanket agreement: the semen which one is implemented less than in 10 % of the ootids of a hamster refined of the containment admits barren. Successful passing of this paste a good sign though some men and at positive effect as before are almost barren on not clear still to the parents. The negative take though discourages, is not an ultimate sentence. From 5 to 10 % of such men nevertheless are capable to a child-bearing by means of production engineering of concentration of a semen or a fertilization in vitro.

After all assayings. Despite constant growth of diagnostic capabilities, doctors are capable to discover the infertility parents only at 60 % of men. In due course we will learn larger, but also for the remained 40 % the prognosis is not remediless. If they prolong tryings the quarter from them becomes fathers.