Clinical Focus Prof.Sieradzki

Page 7

01/2011

P R Z Y P A D K I

K L I N I C Z N E

'U Q PHG -DFHN 5]HV]RWDUVNL

OHWQL FKRU\ ] FXNU]\FÈ W\SX SU\ZDWQ\ SU]HGVLÚELRUFD EUDQĝ\ EXGRZODQHM ]RVWDï VNLHURZDQ\ GR 3RUDGQL 'LDEHWRORJLF]QHM ] SRZRGX Z\VRNLFK ZDUWRĂFL JOLNHPLL XWU]\PXMÈF\FK VLÚ ZHGïXJ FKRUHJR RG RNRïR URNX FHOHP PRG\ILNDFML OHF]HQLD L SU]HSURZDG]HQLD HGXNDFML Wywiad: FXNU]\FÚ W\SX UR]SR]QDQR ODW WHPX QD SRGVWDZLH GRXVWQHJR WHVWX WROHUDQFML JOXNR]\ 'R WHM SRU\ FKRU\ SR]RVWDZDï SRG RSLHNÈ OHNDU]D SRGVWDZRZHM RSLHNL ]GURZRWQHM 3RF]ÈWNRZR OHF]RQ\ W\ONR GLHWÈ SR URNX GR OHF]HQLD ZïÈF]RQR PHWIRUPLQÚ D ODW SöěQLHM GUXJL OHN GRXVWQ\ SRFKRGQÈ VXOIRQ\ORPRF]QLND Schemat aktualnie stosowanej terapii: PHWIRUPLQD ļ PJ [ G]LHQQLH Z F]DVLH JïöZQ\FK SRVLïNöZ JOLPHSLU\G ļ PJ [ G]LHQQLH UDQR SU]HG ĂQLDG FLOD]DSULO ļ PJ [ G]LHQQLH ELVRSURORO ļ PJ [ G]LHQQLH DWRUYDVWDW\QD ļ PJ [ G]LHQQLH ZLHF]RUHP NZDV DFHW\ORVDOLF\ORZ\ ļ PJ [ G]LHQQLH WDPVXOR]\QD ļ PJ [ G]LHQQLH ZLHF]RUHP 3RZLNïDQLD FXNU]\F\ VWDELOQD SU]HZOHNïD FKRURED QLHGRNUZLHQ QD VHUFD UR]SR]QDQD ODWD WHPX ] WHJR SRZRGX FKRU\ SRG RSLHNÈ 3RUDGQL .DUGLRORJLF]QHM &KRURE\ ZVSöïLVWQLHMÈFH QDGFLĂQLHQLH WÚWQLF]H KLSHUOLSLGHPLD PLHV]DQD VWïXV]F]HQLH ZÈWURE\ ïDJRGQ\ SU]HURVW SURVWDW\ 3UREOHP NOLQLF]Q\ Z\VRNLH ZDUWRĂFL JOLNHPLL V]F]HJöOQLH QD F]F]R L JRG]LQ\ SR ĂQLDGDQLX Z\VRNL SR]LRP +E$ F QDGZDJD SRGZ\ĝV]RQH 55 :DUWRĂFL JOLNHPLL ļ SURILOH PJ GO >Z RSDUFLX R GDQH ] ]HV]\WX VDPRNRQWUROL@

WDE

1D F]F]R

141

129

138

JRG] SR ĂQLDGDQLX

211

182

196

JRG] SR RELHG]LH

144

129

140

JRG] SR NRODFML

156

147

161

3URILOH JOLNHPLL 300 270 240 210 180 150 120 90 60 30 0

JRG] SR RELHG]LH

JRG] SR NRODFML

%DGDQLH SU]HGPLRWRZH :]URVW ļ FP 0DVD FLDïD ļ NJ %0, ļ NJ P2 55 ļ PP+J Badania dodatkowe: 'QR RND ļ EH] ]PLDQ FXNU]\FRZ\FK /LSLGRJUDP ļ FKROHVWHURO FDïNRZLW\ ļ PJ GO +'/ ļ PJ GO /'/ ļ PJ GO 7* ļ PJ GO .UHDW\QLQD ļ PJ GO +E$ F ļ & SHSW\G ļ QJ PO

=DVWRVRZDQH OHF]HQLH &KRUHJR SU]HV]NRORQR Z ]DNUHVLH VWRVR ZDQLD ZïDĂFLZHM GLHW\ FXNU]\FRZHM L SURZDG]HQLD VDPRNRQWUROL =PRG\ILNRZDQR OHF]HQLH KLSRJOLNHPL]XMÈFH :REHF GXĝHM KLSHUJOLNH PLL SRUDQQHM ]ZLÈ]DQHM ]H Z]PRĝRQÈ ZÈWURERZÈ SURGXNFMÈ JOXNR]\ Z JRG]LQDFK QRFQ\FK GR OHF]HQLD GRïÈF]RQR LQVXOLQÚ ED]RZÈ MHGQR F]HĂQLH RGVWDZLRQR SRFKRGQÈ VXOIRQ\ORPRF]QLND = XZDJL QD QDG ZDJÚ FKRUHJR Z\VWÚSXMÈFH ]DEXU]HQLD OLSLGRZH L VWïXV]F]HQLH ZÈWUR E\ SU]\ EUDNX SU]HFLZZVND]Dñ ]ZLÚNV]RQR GDZNÚ PHWIRUPLQ\ GR [ PJ 1RZ\ VFKHPDW OHF]HQLD FXNU]\F\ Z\JOÈGDï QDVWÚSXMÈFR $YDPLQD ļ PJ [ G]LHQQLH Z F]DVLH JïöZQ\FK SRVLïNöZ *HQVXOLQ 1 ļ M RNRïR JRG]LQ\ 6NRU\JRZDQR UöZQLHĝ OHF]HQLH KLSRWHQV\MQH JG\ĝ FKRU\ QLH VSHï QLDï NU\WHULöZ 37' ļ ]ZLÚNV]RQR GDZNÚ LQKLELWRUD NRQZHUWD]\ FLOD]DSULOX GR PJ [ G]LHQQLH UDQR 'RERZH SURILOH ļ SR PRG\ILNDFML OHF]HQLD PJ GO

WDE

1D F]F]R

107

102

98

K SR ĂQLDGDQLX

141

133

127

K SR RELHG]LH

129

126

116

K SR NRODFML

142

132

121

3URILOH JOLNHPLL 300 270 240 210 180 150 120 90 60 30 0

, SURILO ,, SURILO ,,, SURILO VWDQGDUG\ 37'

QD F]F]R

JRG] SR ĂQLDGDQLX

JRG] SR RELHG]LH

JRG] SR NRODFML

+E$ F SR PLHVLÈFDFK WHUDSLL ļ

,, SURILO

5RG]DM VWRVRZDQHM WHUDSLL KLSRJOLNHPL]XMDFHM ļ NRU]\ĂFL ľ ]PLDQD OHF]HQLD SROHJDMÈFD QD RGVWDZLHQLX SRFKRGQHM VXOIR Q\ORPRF]QLND L ]ZLÚNV]HQLX GDZNL PHWIRUPLQ\ RUD] ZïÈF]HQLH LQVXOLQ\ 13+ SU]HG VQHP Z GDZFH M SR]ZROLïR QD OHSV]H Z\UöZQDQLH JOLNHPLL QD F]F]R L SR SRVLïNDFK ľ SR PLHVLÈFDFK WDNLHJR OHF]HQLD VWZLHUG]RQR Z\UDěQÈ UHGXN FMÚ +E$ F L ļ FR QDOHĝ\ SRGNUHĂOLÊ ļ QLH REVHUZRZDQR Z]URVWX U\]\ND QLHGRFXNU]Hñ ľ SRïÈF]HQLH LQVXOLQ\ ED]RZHM ] PHWIRUPLQÈ MHVW EH]SLHF]QH SRQLH ZDĝ PHFKDQL]P G]LDïDQLD ELJXDQLGöZ SROHJD QD KDPRZDQLX V\QWH]\ JOXNR]\ SU]H] ZÈWUREÚ L MHVW RGPLHQQ\ RG PHFKDQL]PX G]LDïDQLD LQVXOLQ\ ZLHOX OHNDU]\ GRGDMÈF GR OHF]HQLD FXNU]\F\ LQVXOLQÚ 13+ ]DOHFD NRQW\QXRZDQLH SU]\MPRZDQLD ZV]\VWNLFK GRXVWQ\FK OHNöZ SU]HFLZFXNU]\FRZ\FK QDOHĝ\ MHGQDN SDPLÚWDÊ R U\]\NX KLSRJOLNHPLL Z SU]\SDGNX MHGQRF]HVQHJR VWRVRZDQLD LQVXOLQ\ L SRFKRGQ\FK VXOIRQ\ORPRF]QLND ľ ]ZLÚNV]HQLH GDZNL LQKLELWRUD NRQZHUWD]\ DQJLRWHQV\Q\ FLOD]D SULOX GR PJ [ G]LHQQLH SR]ZROLïR QD X]\VNDQLH ]DOHFDQ\FK GOD FKRU\FK QD FXNU]\FÚ ZDUWRĂFL 55 SRQLĝHM PP+J

VWDQGDUG\ 37'

JRG] SR ĂQLDGDQLX

ļ PO PLQ P2 ļ ,8 O ļ ,8 O ļ EH] ]PLDQ ļ ZÈWURED R SRGZ\ĝV]RQHM HFKRJHQLF]QRĂFL SRZLÚNV]RQD

, SURILO

,,, SURILO

QD F]F]R

H*)5 ZJ 0'5' $VS$7 $O$7 %DGDQLH RJöOQH PRF]X 86* MDP\ EU]XV]QHM

4. 'U Q PHG -DFHN 5]HV]RWDUVNL

Przypadek 4.

Podsumowanie: 3RGF]DV ZL]\W\ NRQWUROQHM Z 3RUDGQL 'LDEHWR OR JLF]QHM SR PLHVLÈFDFK ĂUHGQLH ZDUWRĂFL JOLNHPLL QD F]F]R Z\QRVLï\ PJ GO D JRG]LQ\ SR SRVLïNDFK PJ GO +E$ F PDVD FLDïD NJ 55 PP+J

5