Are there complications after permanent makeup? A small digression into history. Spinal pain after surgery

20 interesting facts about PET/CT

1. The first mention of PET appeared in the 50s of the XX century.

2. Already in 1972, this type of diagnostics received wide use in USA.

3. In Russia, the first PET survey was conducted in 1997.

20 interesting facts about PET/CT

4. The accuracy of the information obtained by scanning reaches 99%, while with CT and MRI this figure averages 70-85%.

5. In Europe, the leader in PET / CT examinations is Germany, where over 100 clinics have the appropriate equipment, while in Russia their number does not exceed 30.

20 interesting facts about PET/CT

6. PET/CT results are used by three branches of medicine - oncology, cardiology, neurology.

7. The dose of radiation during PET / CT examination does not exceed the radiation exposure during conventional x-rays.

8. Some types of PET/CT are not performed in Russia. For example, a survey with gallium 68.

20 interesting facts about PET/CT

9. Diagnosis PET/CT detects tumors for more early stages than CT or MRI because metabolic disorders can be captured when structural changes are not yet available.

10. In most cases, the information content of the obtained images is higher than that of the biopsy of the diseased organ. This is especially true for the examination of the brain with methionine.

20 interesting facts about PET/CT

11. PET/CT is the only way to detect metastases in oncology. In CT and MRI examinations, metastases appear only as blackouts on the pictures. The doctor can only assume the presence of onco-markers, while PET / CT can “see” metastases, get comprehensive information about their location and quality.

12. The technique allows to detect pathologies up to 1 mm in size.

20 interesting facts about PET/CT

13. In Russia, PET/CT is available only in 9 cities: Moscow, St. Petersburg, Voronezh, Yekaterinburg, Ufa, Kursk, Orel, Tambov, Lipetsk. The cost of such a survey in our country is much cheaper than in Europe. Therefore, it makes no sense to go to Germany and Israel, where the procedure is much more expensive.

14. Since 2016 in Russia, PET CT can be done free of charge compulsory medical insurance policy. To do this, you need to get an appropriate referral from a doctor and sign up for an examination at one of the clinics where this service is available.

20 interesting facts about PET/CT

15. After PET / CT, there is no need for other types of diagnostics - usually this study provides answers to all questions.

16. Errors in PET/CT are associated only with the human factor: incorrect interpretation of the results, improper preparation for the examination, violation of scanning technology, etc.

20 interesting facts about PET/CT

17. Most tumors actively feed on glucose, therefore, 18F-fluorodeoxyglucose radiopharmaceutical is most often used for examination - it accumulates in the oncological focus. However, this radiopharmaceutical is not suitable for studying the brain, which always actively absorbs this substance.

18. The only absolute contraindication for examination - pregnancy. The rest are relative.

20 interesting facts about PET/CT

19. In some cases, PET / CT with contrast is performed - in addition to radioenzymes, a contrast iodine-containing substance is injected into the patient, which increases the accuracy and information content of the examination.

20. The accuracy of the obtained data also depends on the quality of preparation for PET/CT. The patient is instructed to comply special diet and do not overexert yourself 2-3 days before the scan.

Currently no medical procedures that do not have complications. Despite the fact that modern anesthesiology uses selective and safe drugs, and the technique of anesthesia is being improved every year, there are complications after anesthesia.

After anesthesia, there can be unpleasant consequences

In preparation for planned operation or faced with its inevitability suddenly, each person feels anxiety not only about himself surgical intervention but even more because of the side effects general anesthesia.

Undesirable phenomena of this procedure can be divided into two groups (according to the time of their occurrence):

1. Occur during the procedure.
2. Develop later different time after the completion of the operation.

During the operation:

1. From the respiratory system: sudden cessation of breathing, bronchospasm, laryngospasm, pathological restoration of spontaneous breathing, pulmonary edema, cessation of breathing after its recovery.
2. From the side of the cardiovascular system: quickening (tachycardia), slowing down (bradycardia), and irregularity (arrhythmia) heart rate. A fall blood pressure.
3. From the nervous system: convulsions, hyperthermia (increase in body temperature), hypothermia (decrease in body temperature), vomiting, tremor (trembling), hypoxia and cerebral edema.

During the operation, the patient is constant surveillance to avoid complications

All complications during the procedure are controlled by an anesthesiologist and have strict algorithms medical actions aimed at their relief. The doctor has drugs on hand to treat possible complications.

Many patients describe visions during anesthesia - hallucinations. Hallucinations cause patients to worry about their own mental health. There is no need to worry, as hallucinations are caused by some narcotic drugs used for general pain relief. Hallucinations during anesthesia occur in mentally healthy people and do not recur after the end of the drug.

After completion of the operation

After general anesthesia, a number of complications develop, some of them require long-term treatment:

1. From the respiratory system.

Often manifested after anesthesia: laryngitis, pharyngitis, bronchitis. These are the consequences mechanical impact equipment used and inhalation of concentrated gaseous drugs. Manifested by coughing, hoarseness, pain when swallowing. Usually pass within a week without consequences for the patient.

Pneumonia. A complication is possible when gastric contents enter the Airways(aspiration) during vomiting. Treatment will require an additional hospital stay after surgery and the use of antibacterial drugs.

1. From the side of the nervous system.

Central hyperthermia- an increase in body temperature that is not associated with an infection. This phenomenon may be a consequence of the body's reaction to the introduction of drugs that reduce the secretion sweat glands administered to the patient before surgery. The patient's condition is normalized within one or two days after the termination of their action.

Elevated body temperature is frequent consequence anesthesia

Headache after anesthesia are a consequence side effects drugs for central anesthesia, as well as complications during anesthesia (prolonged hypoxia and cerebral edema). Their duration can reach several months, pass independently.

Encephalopathy(impaired cognitive function of the brain). There are two reasons for its development: it is a consequence toxic action narcotic drugs and prolonged hypoxic state of the brain with complications of anesthesia. Despite the widespread opinion about the frequency of encephalopathy, neurologists say that it develops rarely and only in individuals with risk factors ( background diseases brain, old age, preceding chronic action alcohol and/or drugs). Encephalopathy is reversible, but requires a long recovery period.

To speed up the process of restoring brain function, doctors suggest prophylaxis before the planned procedure. In order to prevent encephalopathy, prescribe vascular preparations. Their selection is carried out by the doctor, taking into account the characteristics of the patient and the planned operation. Should not be carried out self-prevention encephalopathy, since many drugs can change blood clotting, as well as affect susceptibility to anesthetics.

Peripheral neuropathy of the extremities. It develops as a consequence of a long stay of the patient in a forced position. Manifested after anesthesia paresis of the muscles of the extremities. It takes a long time, requires physical therapy and physiotherapy.

Complications of local anesthesia

Spinal and epidural anesthesia

Spinal and epidural anesthesia replaces anesthesia. These types of anesthesia are completely devoid of side effects anesthesia, but their implementation has its own complications and consequences:

Often after anesthesia the patient suffers from a headache

1. Headache and dizziness. Frequent side effect, manifests itself in the first days after the operation, ends with recovery. Rarely headaches are persistent and continue long time after operation. But as a rule, such a psychosomatic state, that is, due to the patient's suspiciousness.
2. Paresthesia(tingling, goosebumps) lower extremities) and loss of sensation in the skin of the legs and torso. It does not require treatment and resolves on its own within a few days.
3. Constipation. Often occur during the first three days after surgery as a consequence of anesthesia of the nerve fibers innervating the intestine. After restoring the sensitivity of the nerve, the function is restored. In the early days, taking mild laxatives helps and folk remedies.
4. Neuralgia of the spinal nerves. The consequence of nerve injury during the puncture. characteristic manifestation — pain syndrome in the innervated area, lasting for several months. Helps speed up the recovery process physiotherapy and physiotherapy.
5. Hematoma (bleeding) at the puncture site. Accompanied by pain in the damaged area, headaches and dizziness. During resorption of the hematoma, there are increases in body temperature. As a rule, the condition ends with recovery.

Stem and infiltration anesthesia

1. Hematomas (hemorrhages). Occurs as a result of damage small vessels in the anesthesia area. They present with bruising and pain. They go away on their own within a week.
2. Neuritis (inflammation of the nerve). Pain along the way nerve fiber, sensory disturbance, paresthesia. You should consult with a neurologist.
3. Abscesses (suppurations). Their occurrence requires additional treatment antibiotics, most likely in a hospital setting.

A complication of any type of anesthesia, from superficial to anesthesia, may be the development allergic reactions. Allergies happen varying degrees severity, from hyperemia and rash, to the development anaphylactic shock. These kinds of side effects can happen to any drug and food. They cannot be predicted if the patient has not previously used the drug.

The operation itself is safe. Complications can be due to several reasons:

• General anesthesia, just like during any other operation;
• Infection, inflammation, injury facial nerve, numbness in the ear, temporary disturbance of taste and balance, noise in the head, colds;
• Implant displacement at strong blow head, too active mobility for the first time after the operation. At the same time, it is possible re-holding operations.

Such cases are extremely rare due to the high qualification of surgeons performing cochlear implantation operations.

According to patients, the seam after the operation rarely causes discomfort, after a few days you can already sleep peacefully on the side of the implanted ear. Within a month after the operation, everything heals, and the patient is ready to connect the speech processor to the implant.

QUESTION 11

WHAT DOES A BILATERAL COCHLEAR IMPLANTATION NEED FOR?

Bilateral cochlear implantation is the method of choice for the rehabilitation of deaf people in the United States, Germany and some other developed countries. At the end of 2008, only North America there were 3600 patients with two implants.

Bilateral cochlear implantation provides:

• The formation of the patient's ability to localize sound.
• Improved intelligibility in silence.
• Improving speech intelligibility in noise.
• Bilateral stimulation of the auditory pathways and auditory centers.
• The best dynamics of auditory and speech development in children.
• If one implant fails, the patient will not lose the ability to perceive sound.

Currently in Russia there are two to three dozen patients implanted on both sides. Wherein Russian surgeons perform bilateral implantation only at the St. Petersburg Research Institute of Ear, Throat, Nose and Speech - 10 patients by the beginning of 2009.

Unfortunately, with funds federal budget the operation is performed on one side, the second implant is paid for by the patients themselves. But at the same time, there is a unique opportunity to perform the operation at once - without additional anesthesia.

This is Max from Germany - the world's first binaurally implanted child (Med-El implants).

And this is an X-ray of our child with two implants (operated at the St. Petersburg Research Institute of ENT).

QUESTION 12

HOW DOES SOUND BE HEARED IN A COCHLEAR IMPLANT?

Cochlear implants do not completely restore hearing. Since the number of points stimulated by the implant electrode auditory nerve immeasurably less than number hair cells in a normally functioning cochlea, a person with an implant hears at first sounds that are not what we are used to. The sounds perceived through the implant and the speech processor are slightly different from the sound of speech and surrounding sounds through hearing aid, or when perceived by a normal hearing ear. Immediately after turning on the speech processor, it can be difficult for patients to understand what kind of signals are currently sounding.

It takes time to learn to hear and distinguish between speech and environmental sounds when using a cochlear implant system. Required a long period rehabilitation and training special program to restore a person's ability to understand speech addressed to him or to teach a child to speak. At the same time, immediately after the implant is turned on, a person gets the opportunity to hear the sounds of the surrounding world, which makes his life safer, and the child is interested and becomes an incentive for development.

Experts often recommend wearing a speech processor and a hearing aid on the non-operated ear at the same time, so these two devices can be optimally adjusted in combination with each other. Such recommendations are directed to those patients who have preserved the perception low frequencies. However, after connecting a speech processor, many children refuse to wear hearing aids on the opposite ear. In such cases, specialists usually do not force the patient or his parents to use the device.

QUESTION 13

WHAT IS COCHLEAR IMPLANT REHABILITATION?

By itself, cochlear implantation does not allow deaf children to distinguish between sound signals and use speech for communication purposes immediately after connecting a speech processor. Therefore, after the first adjustment of the processor, the child needs pedagogical assistance in development auditory perception and speech development. In connection with this, the main objective rehabilitation of young children with a cochlear implant - to teach the child to perceive, distinguish, recognize and recognize the surrounding sounds, understand their meaning and use this experience to develop speech. For this postoperative rehabilitation children preschool age includes the following components:

1. Setting up the speech processor of the cochlear implant.

2. Development of auditory perception and speech.

3. General development child (non-verbal intelligence, motor skills, memory, attention, etc.).

4. Psychological help the child and his loved ones.

3-4 weeks after the operation, the speech processor is connected to the cochlear implant and the speech processor is initially adjusted. From this point on, the patient can hear surrounding sounds. The speech processor, after connection, is configured to receive maximum effect at the user. The settings are carried out by an audiologist, his work is aimed at shaping a person's full-fledged auditory sensations.

The main direction of postoperative auditory-speech rehabilitation for all patients is the development of perception sound signals with the help of an implant. A cochlear implant provides the ability to hear, but the perception of sounds environment and speech comprehension is much more complex processes which also include the ability to distinguish signals, highlight features important for recognition in them, recognize isolated words and words in continuous speech, understand the meaning of statements, distinguish signals from noise, etc.

Then classes begin with the teacher in order to develop auditory perception and development oral speech. The teacher teaches the child to use his emerging hearing. The main process of rehabilitation should be provided by parents at home.

Rehabilitation classes after include training in the following aspects:

In addition, classes are held for the development of oral speech and language skills for children who have lost their hearing before mastering speech.

Pediatrician Sergey Butria's answer to the heartbreaking post of a mother whose child received a complication after being vaccinated against measles, rubella and mumps.

Pediatrician Sergey Butriy could not pass by, tried to thoroughly understand the situation and reacted to it with a long fasting. We publish the entire text.

I often have a dilemma: to comment or not to comment on high-profile cases negative reactions for vaccines.

On the one hand, such comments of mine continue to spread this information on the Internet, and if you keep silent, many people simply will not know about what happened and will not be afraid (and this is in many ways a plus). No matter how tactfully you choose words, no matter how carefully you argue what was said - it works known to doctors the “stop word” phenomenon; for example, it is impossible to use the word “cancer” during the first conversation with a cancer patient (the patient is shocked by the associations and fears that arise and for a while becomes completely inaccessible to a constructive dialogue), in the same way it is impossible to say the phrase “complication from vaccination” with impressionable parents - everything you say after this, will not be perceived adequately, will look like pathetic excuses.

On the other hand, silence in such cases is, let's face it, vile. I'm writing about resonant case death of a child from, I write about whooping cough in the unvaccinated, I write about measles epidemics- that is, about the negative consequences of not vaccinating, and when Negative consequences from the vaccinations themselves - suddenly I am silent, and this is not fair. In addition, many of my patients themselves have already read the sensational post on Facebook about a girl whose Priorix vaccine provoked Guillain-Barré syndrome, moreover, they wrote to me in a personal request to speak out about it, and to remain silent after that is absolutely ugly.

So, 10 days ago, someone Marina Voropaeva posted on her Facebook page a heartbreaking and detailed fast about how the Priorix vaccine (imported live vaccine against measles, rubella and mumps) provoked Guillain-Barré syndrome in her daughter, as well as what horrors she experienced afterwards. Both mother and child, of course, are very sorry, they deserve only sympathy and support. But let's look at the essence of the stated problem. Let's not touch on diagnostic defects, ethics and communication defects and other unpleasant things described in her post now; if all this is true (and we cannot be completely sure of this - we have not heard the version of the “accused” side, that is, the attending physicians), then yes, this is terribly unprofessional, but the vaccine has nothing to do with it, this is a completely different layer of problems.

Let's focus on the main fact for now: the vaccine caused the Guillain-Barré syndrome (hereinafter referred to as GBS), how to respond to this?

This question obviously worries a lot of people - publications are only 10 days old, and she already has more than 2500 reposts only on Facebook; in the comments to the post, a coven of anti-vaccinators gloats and rages, and you can be sure that for thousands of people this tragic case will be a reason to refuse to vaccinate their children with Priorix because of fear of complications, or even push them to the full.

Personally, this publication upset me very much and plunged me into prolonged dysphoria. Given that I administer Priorix several doses a week, I imagined myself in the place of the doctor who injected that ill-fated dose of Priorix: what kind of pressure is he now under (checks, accusations from parents, possibly prosecutors and courts), and how it should be worries about what happened (I do not know a doctor who would not worry, would not be executed and would not blame himself for everything after this).

When I digested what I had read a little, I formulated for myself the questions I wanted to answer, and began to read-read-read, in order, first of all, to thoroughly understand everything myself, in order to put my own thoughts in order. These questions were:

1. Is Priorix to blame for the development of Guillain-Barré syndrome in the case under discussion?
2. Is the doctor who introduced Priorix to the child to blame for the development of such a complication?
3. Should the doctor have warned the mother in advance about the possibility, even the smallest one, of developing GBS?
4. Was it necessary to somehow examine the child in a special way, take some prophylactic drugs before vaccination, to prevent the disaster that happened?
5. Do parents now need to be afraid of vaccination with Priorix and refuse it?

I have read a lot on this issue, delved into the materiel, and now I will try to formulate my thoughts on this matter.

Let's start with an abstract comparison.

Planes sometimes crash and people die in them. However, this is not a reason to refuse air travel.

Moreover, the risk of dying in a plane crash is extremely small, much lower than, say, the risk of dying in a car crash, although the latter worries people much less. The relatives of people who died in a plane crash are very sorry, and it is quite understandable for them if they can never bring themselves to get on a plane again. Such people often develop an irrational fear of flying, although statistically their personal risk of dying in a crash has not changed at all from the fact that their relative died in such a way. Thus, their personal fear can be understood, but it will be very strange if they start to stray into VK groups like “I am against air travel”, comment under each news about the crash “aircraft are weapons mass destruction”, hysteria on the topic “airplanes were invented by the Freemasons to reduce the population of Russia”, etc., etc., but this is exactly what anti-vaccinators do after every case of a vaccine complication, real or imagined.

It is far from always that something bad that happened after a vaccination happens because of a vaccination.

We all remember the saying “after that does not mean because of that”. It is easier for parents to survive grief if they see the culprit and hate him (a specific doctor and a specific vaccine, for example), but at the same time, parental hatred is often unfair. Here is an example of a completely far-fetched and contrived connection between vaccination and the death of a child: and.

Despite the apparent obviousness of a causal relationship, it is not here. Vaccination does not increase the risk of disease in any way. bacterial meningitis. The case is very tragic, and I sincerely sympathize with the parents of the deceased child, but the vaccine had nothing to do with it - the child became infected meningococcal infection and died from it, this happened regardless of whether he was vaccinated from the day before or not. No matter how cynical it may sound - such is life, children also die sometimes and not always through their fault bad doctors or negligent parents - sometimes no one is to blame, evil sometimes happens on its own.

But in the case of Priorix and GBS, the daughter of Marina Voropaeva cannot deny the causal relationship, here it was the vaccination that caused GBS. And it's incredibly embarrassing and painful to realize.

What do we know about Guillain-Barré syndrome? World Organization Health provides such information. It's extremely rare disease, its frequency is about 1.2-3 cases per 100,000 population: prooflink. The causes of the disease are not fully understood, it is only known that triggers ( trigger factors) most often serve infectious diseases, surgical operations, some medicines and very rarely vaccines: pruflink. The association with vaccines is questionable, and the incidence of GBS as a complication of vaccination is methodologically extremely difficult to quantify. For the flu vaccine (which has the most well-founded scientific claims of causing GBS), for example, it is about 1.7 cases per million vaccinated: pruflink.