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PostSubject: solution of the day   Fri Apr 06, 2007 10:45 am

The differential diagnosis of MQM in pubertatne ages of gormonalno-aktive ovarian tumors, миомой, uterine sarcoma crucial : ultrasound examination of uterus and ovaries, a sign of increasing and changing their эхо-структур and бимануальное ( pramokishechno-bruchnos enerne) study evacuated in the gut and bladder. In cervical cancer (in pubertatne age is very rare) can provide with some disorders, in neglected cases gnilostnam smell. The diagnosis is confirmed by inspection of the cervix with the help of children's vaginal mirrors or вагиноскопа with lighting system. Diagnosis прервавшейся pregnancy out on the basis of indirect signs of pregnancy (bloating mammary glands, dark nipples and околососковых circles, цианоз vulva), the uterus, detection излившейся blood clots, parts amniocentesis eggs. Great educational value is ultrasound examination uterus, in which the increase in its size and characteristic ehoskopica picture of the contents of the cavity. Treatment Juvenile MQM consists of two phases : stop bleeding (гемостаз) and the prevention of the recurrence of bleeding. The choice of a hemostasis dependent on the patient. In poor condition when symptoms of anemia and гиповолемии (paleness skin and mucous membranes, the content of hemoglobin in the blood below 80 g / l, гематокритное number below 25%), and continues bleeding shows Surgery гемостаз-scraping mucous membrane uterus followed Histologic study scraping. In order to safely virginity test should use vlagalischnami's view, wilderness plev before surgery obkoloti dissolved in 0.25% solution novokaina lidasa. There is also a therapy, which aims at bridging the anemia and restoration hemodynamics : giving plasma, whole blood, реополиглюкина (8-10 ml / kg), the introduction of a local 1% solution ATF to 2 ml per day for 10 days, the appointment of vitamins C and Group B, iron products (oral-ферковен, ферроплекс, конферон, гемостимулин, intramuscularly or intravenously, ferrum Lec). Recommended rich foods, the full premium food. When the patient moderate or satisfactory when symptoms of anemia and gipovolemii nerezko expressed (hemoglobin content in the blood of up to 80 g / l, gematokritnoe number above 25%), a conservative gemostaz hormonal drugs : эстроген-гестагенным drugs like birth control pills or clean estrogenami followed gestagenov reception. Estrogen-gestagenne drugs (non-ovlon, ovidon, anovlar, bisekurin etc.) appoint 4-5 tablets a day to stop the bleeding, which usually occurs by the end of the first day. The lower dose of the pill a day, bringing up to 1 pills, and then continue to care for 16 to 18 days. Микрофоллин (levonorgestrel) apply to 0.05 mg inside 4-6 times a day to stop the bleeding, then dose of the drug reduced the daily, bringing to 0.05 mg a day, and retain the dose for the next 8-10 days, after which immediately appoint гестагены (норколут, progesterone). Norkolut appoint 5 mg per day into within 10 days. Progesterone injection type 1 ml of 1% solution for 6 days, or 1 ml of 2.5% solution of the day trehkratno, progesterone capronat-injection to 1 ml 12.5% solution twice at intervals of 2-3 days. Menstrualnopodobne that after cessation of gestagenov are relatively abundant; To reduce krovopoteri apply calcium gluconate into the 0.5 g 3-4 times a day kotarnina chloride on the interior of 0.05 g 2-3 times a day, if necessary uterotonicescie funds.

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