Standards for diagnosis and treatment based on the presence of a sufficiently well developed and accepted in one way or another standard classifications: diagnoses (nosological forms), medical procedures or methods of medical exposure; complications illnesses, medical procedures and actions; stages of the disease; phases of chronic diseases (exacerbation remission, relapse, etc.), outcomes (results) of treatment.
One of the most important principles of standardization of classification is to provide not only regional, national, and international comparability of DATA. No country can develop normally in isolation from the international community. The introduction of standardization in isolation from the lessons of the past decade of international experience can only lead to isolation and wasting, and so is extremely limited resources.
According to the requirements of the WHO standard classification must meet the following requirements.
They should be open for expansion - both in terms of detail, and for use in compressed form.
They should include all types of procedures recorded for statistical, administrative, clinical or research purposes.
They should be applicable for both stationary and for outpatients.
The next important principle of standardization is to match the standards of the modern level of medical science and practice that ensures the organization of the harmonization process of proposed projects with scientific medical societies and associations, testing, alternative models, the organization of the review process for proposals involving the main experts for finalization and approval.
We can not allow haste with the adoption of the revised document is not enough. An example of such an approach can brand viagra serve as a refusal to take the next revision of the WHO classification of medical procedures simultaneously with the adoption of ICD-10: advice, which should have been preceded by the statement were deemed insufficient and did not complete the process of developing proposals and comments to them.
However, at the request of the Expert Committee and a number of countries has been prepared by an experimental version of the class "surgical procedure" and agreed that it would serve as a guide for national presentations and publications on statistics about the surgical procedures, and to facilitate comparability of national classifications.
In the development of medical standards need to be considered extremely high rate of development of medical science. It is known that the amount of knowledge in medicine is growing roughly twice as fast as any other science. Therefore, another important principle of standardization is the regular revision of classifications and standards in accordance with the achievements of medical science, as is customary in international practice.
International Classification of nosological forms (ICD-10) has a hierarchical structure with subdivisions and therefore subject to varying levels of detail. Thus, it admits the possibility of how to identify a single disease, and provide statistical data on broad groups of different levels of hierarchy. IBC is not purely theoretical classification, and it made some compromises between classifications based on etiology, anatomical location, etc. The classification is divided into 21 classes, each of which corresponds to the letter. Class structure of IBC presented as "special" groups, which unite the disease, which for epidemiologic studies would be inconvenient to throw on the anatomical localization (epidemic diseases - for example, infections), constitutional or general diseases, illnesses, developmental (congenital abnormalities, trauma), and "local diseases, grouped by anatomical location, which include the ICD classes for each major body systems. In this case highlighted the following body systems.
metabolism
inhibitory effects
many years
quantitative and qualitative
stable remission
Rabu, 26 Januari 2011
Kamis, 20 Januari 2011
Minimal operations
In 2 patients with duodenal ulcer rebleeding appeared in the later stages at 11 days of initiation of treatment. He was stopped endoscopically, patients assigned to injectable forms of proton pump inhibitors. Favorable outcome.
Thus, at this stage has changed surgical tactics in case of recurrent bleeding: if earlier, according to the canons of surgery, rebleeding in hospital is an absolute indication for urgent surgery, to date, this tactic should be reviewed:
* Rebleeding in the first three days is associated with brand viagra online inadequate endoscopic hemostasis and properly selected patient management in high risk groups for the localization of ulcers in the stomach. In this case, really need to address the issue of urgent surgical intervention, as hopes of endoscopic hemostasis are unjustified;
* Rebleeding at 4-day 6 is associated with inadequate antisecretory therapy and the growth of multiple organ failure in elderly patients. Tactics of treatment in this case is individual, depending on the aggressiveness of the disease, but preference should be given to endoscopic methods of hemostasis and increased antisecretory therapy;
* All late rebleeding after 10 days of duodenal ulcers associated with inadequate antisecretory therapy and can be treated conservatively. It should be noted that the nature of the treatment of gastrointestinal bleeding depended on the localization of ulcers, so that stomach ulcers were operated in 2 times more patients than in duodenal ulcer.
This is due to the fact that peptic ulcer worse amenable to standard schemes of conservative therapy, gastrointestinal bleeding, the need for surgery occurs in every fourth patient in the elderly. Indeed, the secretory function of gastric ulcer patients "elderly" age lowered, Hp-negative ulcers occur much more frequently, which leads to inefficiency of standard schemes antiulcer quadrotherapy. More common forms of atrophic generic levitra gastritis, which leads to the large size of ulcers and difficulty of endoscopic hemostasis. Therefore, in solving practical problems of surgical treatment of peptic ulcer disease should take into account significant differences in the pathogenesis of gastric and duodenal ulcers.
Declined by nearly 10 times the number of such minimal operations for ulcer bleeding, as suturing wounds. These operations were not given the anticipated hemostatic effect: rebleeding after flashing ulcers - 55,5%, while the fatality rate - 47,2%.
At the present time, given the objective assessment of the severity of the condition of elderly patients by scores MODS and APACHE II, we try to perform radical surgery. Due to new tactics and an objective assessment of the severity of the patients is almost 2-fold increase in the number of conservative surgery: 56% from 33% in 1990-2000. Do not change the percentage of resection of operations - 43% in 1990-2000. and 42% in 2001-2008. this is due to the fact that most surgical interventions for patients with gastrointestinal bleeding is satisfied with the localization of ulcers in the stomach. However, if you had a group of elderly patients in all cases, an extensive resection with a mortality rate 13,2%, in the last 10 years, we prefer economical resection with vagotomy.
Change the surgical treatment of this complication in elderly patients has led to a decrease in postoperative mortality from 15.8% in 1990-2000. to 5,8% in 2001-2008. and overall mortality from 15.8 to 9.6% and corresponds to the global trend.
reproductive function
emerging with a level
bloxa
pregnancy
Thus, at this stage has changed surgical tactics in case of recurrent bleeding: if earlier, according to the canons of surgery, rebleeding in hospital is an absolute indication for urgent surgery, to date, this tactic should be reviewed:
* Rebleeding in the first three days is associated with brand viagra online inadequate endoscopic hemostasis and properly selected patient management in high risk groups for the localization of ulcers in the stomach. In this case, really need to address the issue of urgent surgical intervention, as hopes of endoscopic hemostasis are unjustified;
* Rebleeding at 4-day 6 is associated with inadequate antisecretory therapy and the growth of multiple organ failure in elderly patients. Tactics of treatment in this case is individual, depending on the aggressiveness of the disease, but preference should be given to endoscopic methods of hemostasis and increased antisecretory therapy;
* All late rebleeding after 10 days of duodenal ulcers associated with inadequate antisecretory therapy and can be treated conservatively. It should be noted that the nature of the treatment of gastrointestinal bleeding depended on the localization of ulcers, so that stomach ulcers were operated in 2 times more patients than in duodenal ulcer.
This is due to the fact that peptic ulcer worse amenable to standard schemes of conservative therapy, gastrointestinal bleeding, the need for surgery occurs in every fourth patient in the elderly. Indeed, the secretory function of gastric ulcer patients "elderly" age lowered, Hp-negative ulcers occur much more frequently, which leads to inefficiency of standard schemes antiulcer quadrotherapy. More common forms of atrophic generic levitra gastritis, which leads to the large size of ulcers and difficulty of endoscopic hemostasis. Therefore, in solving practical problems of surgical treatment of peptic ulcer disease should take into account significant differences in the pathogenesis of gastric and duodenal ulcers.
Declined by nearly 10 times the number of such minimal operations for ulcer bleeding, as suturing wounds. These operations were not given the anticipated hemostatic effect: rebleeding after flashing ulcers - 55,5%, while the fatality rate - 47,2%.
At the present time, given the objective assessment of the severity of the condition of elderly patients by scores MODS and APACHE II, we try to perform radical surgery. Due to new tactics and an objective assessment of the severity of the patients is almost 2-fold increase in the number of conservative surgery: 56% from 33% in 1990-2000. Do not change the percentage of resection of operations - 43% in 1990-2000. and 42% in 2001-2008. this is due to the fact that most surgical interventions for patients with gastrointestinal bleeding is satisfied with the localization of ulcers in the stomach. However, if you had a group of elderly patients in all cases, an extensive resection with a mortality rate 13,2%, in the last 10 years, we prefer economical resection with vagotomy.
Change the surgical treatment of this complication in elderly patients has led to a decrease in postoperative mortality from 15.8% in 1990-2000. to 5,8% in 2001-2008. and overall mortality from 15.8 to 9.6% and corresponds to the global trend.
reproductive function
emerging with a level
bloxa
pregnancy
Minggu, 09 Januari 2011
Prosthetic testicle
Implantation of silicone prosthesis testicle. Indications for prosthetic testicle.
Although many men do not experience physical discomfort brand viagra associated with the absence of one or two eggs, this aesthetic defect hinders their social and sexual adaptation. The testicles are a sign of manhood to every man and no less important than the breasts for women.
Implantation of prosthetic testicle is one of the most common operations in andrological practice associated with prosthetics - the operation is simple in execution, the risk of complications is minimal.
Lack of testicle in the scrotum may be due to following reasons:
Congenital absence of one or two eggs (or monorhiya anorchia)
Cryptorchidism (hidden testicle) - testicle not descended into the scrotum and is located in the inguinal canal or abdomen
The effects of trauma, torsion testis, inflammatory and infectious diseases, malignancy, leading to a need for surgical removal of testis
Consequences of failed operations relegated egg with cryptorchidism
As a rule, the remaining testicle takes over the functions of both, a slight increase in size. Men with one normal testicle (monorhiya) in most cases become fathers, they do not need hormone replacement therapy with testosterone, since the remaining testicle carries a double burden. In the absence of both testes and paternity can not be assigned to testosterone.
If for cryptorchidism may perform an operation on being relegated egg, then atrophy, testicular hypoplasia or after the removal of the scrotum back its natural form can only prosthetic testicle.
To do this through a small incision on the lateral surface of the scrotum it is placed silicone prosthesis, which is in the form of inform your doctor elasticity and the size of a fully corresponds to the normal testicle. For each patient, prosthetic testicle is chosen individually.
The operation lasts no visual disturbances more than 15 minutes and well tolerated by patients. The patient is discharged on the third postoperative day.
Postoperative period
After surgery two weeks should be fixing the bandage and keep sexual rest. Incision in the scrotum heals, leaving no trace, as the scrotal skin is a good supply blood and has a high regenerative ability.
Thus, after the operation achieved good aesthetic results. The presence of the scrotum silicone implants can not detect even the most attentive partner. The prosthesis is completely harmless to the body and has no allergenic properties.
Favorite procedure
family planning
Smaller vessels
Although many men do not experience physical discomfort brand viagra associated with the absence of one or two eggs, this aesthetic defect hinders their social and sexual adaptation. The testicles are a sign of manhood to every man and no less important than the breasts for women.
Implantation of prosthetic testicle is one of the most common operations in andrological practice associated with prosthetics - the operation is simple in execution, the risk of complications is minimal.
Lack of testicle in the scrotum may be due to following reasons:
Congenital absence of one or two eggs (or monorhiya anorchia)
Cryptorchidism (hidden testicle) - testicle not descended into the scrotum and is located in the inguinal canal or abdomen
The effects of trauma, torsion testis, inflammatory and infectious diseases, malignancy, leading to a need for surgical removal of testis
Consequences of failed operations relegated egg with cryptorchidism
As a rule, the remaining testicle takes over the functions of both, a slight increase in size. Men with one normal testicle (monorhiya) in most cases become fathers, they do not need hormone replacement therapy with testosterone, since the remaining testicle carries a double burden. In the absence of both testes and paternity can not be assigned to testosterone.
If for cryptorchidism may perform an operation on being relegated egg, then atrophy, testicular hypoplasia or after the removal of the scrotum back its natural form can only prosthetic testicle.
To do this through a small incision on the lateral surface of the scrotum it is placed silicone prosthesis, which is in the form of inform your doctor elasticity and the size of a fully corresponds to the normal testicle. For each patient, prosthetic testicle is chosen individually.
The operation lasts no visual disturbances more than 15 minutes and well tolerated by patients. The patient is discharged on the third postoperative day.
Postoperative period
After surgery two weeks should be fixing the bandage and keep sexual rest. Incision in the scrotum heals, leaving no trace, as the scrotal skin is a good supply blood and has a high regenerative ability.
Thus, after the operation achieved good aesthetic results. The presence of the scrotum silicone implants can not detect even the most attentive partner. The prosthesis is completely harmless to the body and has no allergenic properties.
Favorite procedure
family planning
Smaller vessels
Minggu, 02 Januari 2011
Irritation
In summer, many remain vigilant and "pick up" genital infection.
On prevention of chlamydia, trichomoniasis and other similar diseases tells private medical practitioner, a gynecologist from Moscow.
- Although the female genital infection can not be called summer diseases in the warm season of their "buy" more often. During the general holiday is a lot of acquaintances, which often brand name viagra end in intimacy. But Chlamydia, Trichomonas, ureaplasmas, mycoplasmas and other microbes enter the body most often through sexual contact. Aggravates the situation and the lack of hygiene.
For example, hiking or long journeys a woman is uncomfortable, if not impossible, to conduct an intimate toilet. "Catch" the infection is possible and by household. For example, sitting in a bath without clothes or using a towel with a carrier of infection. " The risk of catching an infection is great and in public toilets, if you touch the sex organs "plantation" - seats. You may not initially know that the sick. Some types of microbes - Chlamydia, Ureaplasma, gardnerellas - can live in peace and quiet. Showing no symptoms of chilling. And that in itself carry germs, you know, after "for no apparent reason," your husband is sick. Many in this situation, begin to suspect each other of treason, and in vain. Just my husband was more susceptible to infection than you do. And you have - a stronger immune system.
The best way out - both screened. And with medical treatment. Can cause confusion and the other scenario. For example, if a woman has no male or she had long parted. And suddenly she finds a delicate symptoms of the disease. Surprise is even greater if infection confirmed by the analysis. The truth here is also "buried" in the mysteries of the immune system. Before the body resisted, did not allow the microbe to raise his head. And now, for various reasons, protection waned - the microbe actively. This sometimes happens with teenage girls and young women who have never had sexual intercourse. Mom suspect in their promiscuity. And in fact, themselves could infect more daughters at birth or while they were young. There is nothing strange: some species of Chlamydia, children can pick up airborne and through the laundry.
Preventive loyalty
So, to avoid getting infections, follow simple rules.
1. Keep faithful conjugal love. Unfamiliar, and even more casual sexual partner may be looking healthy, but actually wearing a full bouquet of Venus. "
2. If proximity is unavoidable, use a tool such individual prevention, like condoms. True, and it does not matter vysokozaraznyh protects against papillomavirus and herpes.
3. Observe the rules of personal hygiene. If you do not have my water and soap, for example, when traveling, take advantage of children's sanitary napkins with cleaning and sanitizing impregnation.
4. If there were irritation, itching, discharge, try to remove them with a weak solution of potassium permanganate or camomile infusion. In this case it would be nice to have on hand any special anti-inflammatory drugs - in tablets or candlelight. This method - a good test: if you have thrush banal, it will Viagra erection enhances soon pass. And for genital infections such tools do not work. So, we need as quickly as possible to see a doctor.
5. Once or twice a year checkups with a gynecologist. Do not forget that you can get sick symptoms. First, the doctor will swab the flora. And then, if the analysis shows a deviation, you will conduct a more complex diagnosis of infection and appoint-targeting therapy.
Emergency care
Combination
On prevention of chlamydia, trichomoniasis and other similar diseases tells private medical practitioner, a gynecologist from Moscow.
- Although the female genital infection can not be called summer diseases in the warm season of their "buy" more often. During the general holiday is a lot of acquaintances, which often brand name viagra end in intimacy. But Chlamydia, Trichomonas, ureaplasmas, mycoplasmas and other microbes enter the body most often through sexual contact. Aggravates the situation and the lack of hygiene.
For example, hiking or long journeys a woman is uncomfortable, if not impossible, to conduct an intimate toilet. "Catch" the infection is possible and by household. For example, sitting in a bath without clothes or using a towel with a carrier of infection. " The risk of catching an infection is great and in public toilets, if you touch the sex organs "plantation" - seats. You may not initially know that the sick. Some types of microbes - Chlamydia, Ureaplasma, gardnerellas - can live in peace and quiet. Showing no symptoms of chilling. And that in itself carry germs, you know, after "for no apparent reason," your husband is sick. Many in this situation, begin to suspect each other of treason, and in vain. Just my husband was more susceptible to infection than you do. And you have - a stronger immune system.
The best way out - both screened. And with medical treatment. Can cause confusion and the other scenario. For example, if a woman has no male or she had long parted. And suddenly she finds a delicate symptoms of the disease. Surprise is even greater if infection confirmed by the analysis. The truth here is also "buried" in the mysteries of the immune system. Before the body resisted, did not allow the microbe to raise his head. And now, for various reasons, protection waned - the microbe actively. This sometimes happens with teenage girls and young women who have never had sexual intercourse. Mom suspect in their promiscuity. And in fact, themselves could infect more daughters at birth or while they were young. There is nothing strange: some species of Chlamydia, children can pick up airborne and through the laundry.
Preventive loyalty
So, to avoid getting infections, follow simple rules.
1. Keep faithful conjugal love. Unfamiliar, and even more casual sexual partner may be looking healthy, but actually wearing a full bouquet of Venus. "
2. If proximity is unavoidable, use a tool such individual prevention, like condoms. True, and it does not matter vysokozaraznyh protects against papillomavirus and herpes.
3. Observe the rules of personal hygiene. If you do not have my water and soap, for example, when traveling, take advantage of children's sanitary napkins with cleaning and sanitizing impregnation.
4. If there were irritation, itching, discharge, try to remove them with a weak solution of potassium permanganate or camomile infusion. In this case it would be nice to have on hand any special anti-inflammatory drugs - in tablets or candlelight. This method - a good test: if you have thrush banal, it will Viagra erection enhances soon pass. And for genital infections such tools do not work. So, we need as quickly as possible to see a doctor.
5. Once or twice a year checkups with a gynecologist. Do not forget that you can get sick symptoms. First, the doctor will swab the flora. And then, if the analysis shows a deviation, you will conduct a more complex diagnosis of infection and appoint-targeting therapy.
Emergency care
Combination
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