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RGF stand. PA-opaciatate masiva ocupand intreg hemitoracele dr., cu tractiunea secundara a mediastinuluispre dreapta si denudarea coloanei vertebrale.

Fibrobronhoscopie NO: 115/21.07.2011- La nivelul 1/3 inferioare a traheei- proces proliferativ vegetant,

albicios ce obstrueaza total bronsia pimitiva stanga si se continua in interiorul lumenului traheal. Arborebronsic drept liber. Se recolteaza biopsie.Biopsie - atasat copie

Fibrobronhoscopia nr. 112/2!.07.2011- Traheea libera in /3 sup., apoi obstruata aproape complet 1/3inf. prin formatiune albicioasa cu punct de plecare !"S. #ormatiunea acopera ca o supapa si !"$ sieste mobila la tuse si respiratie.%lectrorezectie cu dezobstructie mecanica -trahee. &amane obstructie completa a !"S.

PFR NO: !"7"7- disfunctie ventilatorie mi'ta, restrictie moderata, obstructie moderata segment central sisevera in periferie. &educerea (%)S cu 3*+.

#P$%R$&A- "acienta in varsta de de ani, nefumatoare, diagnosticata in februarie 11 cu Sarcom

mediastinal - confirmat 0"- interpretat initial ca sarcom leiomiomatos, ulterior ca sarcom stromal cu oformatiune tumorala pulmonara la niv. br. "S interpretata ca determinare secundara pulmonaraconfirmata histopatologic, precum si cu determinari pulmonare sec. la niv. plamanului dr.,aflata subtratament chimioterapic cu $o'orubicina, este adresata serviciului nostru pentru evaluare clinico-paraclinica in vederea stabilirii oportunitatii protezarii/dezobstructiei endotraheale in conditiile in carestarea clinica a pacientei este critica2 prezinta dispnee severa cu ortopnee, tira supracostal, dureritoracice la nivelul toracelui anterior, tuse seaca, astenie, inaptetenta, scadere ponderala 1 4g in 5 luni.6n A"" recente pacienta a prezentat un nev melanic la nivelul toracelui posterior care a fost e'cizat inmartie 11. 6n iunie 11 s-a efectuat drena pleural pt. pleurezie paraneoplazica stg. cant. medie.

7biectiv - la internare2 starea generala sever influentata, tegumente palide, degete hipocratice8p'()onar 2 9eezing, tira intercostal, torace normal conformat, )( abolit, matitate si silentiumauscultatoric la nivelul hemitoracelui stang.

!iologic- leucocitoza, hipoproteinemie.%'. sputei evidentiaza suprainfectie cu % coli.&adiografia pulmonara - ridica suspiciunea de atelectazie totala stg.#ibrobronhoscopia - initiala, evaluatorie, releva e'istenta unui proces proliferativ vegetant - la nivelui 1/3inferioare a traheei- cu punct de plecare bronsia primitiva stanga, mobil cu respiratia si tusea ce acoperasi !"$. :lterior s-a efectuat fibrobronhoscopia in scop interventional cu electrorezectia cu dezobstructiemecanica. "ostprocedural evolutia este buna, cu ameliorarea starii generale, a dispneei si tusei."#&- disfunctie ventilatorie mi'ta, restrictie moderata, obstructie moderata segment central si severa inperiferie. &educerea (%)S cu 3*+.

"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus. A urmat tratament antibiotic, antialgic, antitusiv, bronhodilatator, de'amatazona, a continuat trat. pe careil urma ambulator, cu evolutie favorabila dpdv clinic.

Se e'terneaza cu recomandarile2

Reco)andari-tratament cu 2 Avelo' 1 tb/zi in ca 1 zile

-revine dupa rezultatul histopatologic al biopsiei endobronsice din piesa post-rezectie-continuarea trat. oncologic conform recoamndarilor medicului spec. oncolog

1

7/24/2019 69625104-epicrize


-reevaluare cardiologica, continuarea tratamentului recomandat de catre medicul specialist

-control pneumologic peste o luna, cu bilet de trimitere de la medical de familie si dovada de asiguratcupon de pensie din ultimele 3 luni calendaristice

S-a eliberat reteta compensate seria ;S!! nr. 3<<

SUPURATIE CRONICA ACUTIZATAASPERGILOZA PULMONARA INVAZIVA

FISTULA BRONHOPULMONARA

Analize de laborator:

21.07.11 07:26 : Gran#=8.6 *10!"L Gran$=%%.& $ HCT='8.6 $ HGB=11.& (!) L+,-#=1./*10!"L L+,-$=1'.1 $ MCH=/.& -( MCHC=.% (!) MCV=8.& 2L

M3)#=1 *10!"L M3)$=./ $ MPV=8.1 2L PCT=0.6 $ P45=16 $

PLT='66 *10!"L RBC=/.6 10*10!"L R45CV=1&.1 $ R45S4=/&.& 2 5BC=11 *10!"L VSH 71=/1 ,, VSH 7=8% ,, ALAT=8 U!L ASAT=8

U!L B33r9:3na ;<;aa=0.' ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=0 U!L

GGT=% U!L G3@,3= ,(!) Ur=/0 ,(!)

Pa@3n; 3n ar>;a ) ) an3 a2a; 3n 3)n;a C3n3@33 ) Pn9,<<(3 r@n; ;rna; )33n

>r3@39 n<>;r9 @9 S9-9ra;3 -9,<nara @r<n3@aA>-r(3<?a -9,<nara F3>;9a :r<n<-9raa>3 -9r<;(9,n;ara > r3n;rna?a -n;r9 a;rara >;ar33 (nra a@9?an) )9rr

a;r<;<ra@3@a >;an(a >@a)ra ;<ran;3 a 2<r; )3>-n a 2<r;9r3 ,<)ra; an3;a;

2a;3(a:33;a; a>;n<a)3na,3 >3,-;<, @ >a9 3n>;aa; @9 < >a-;a,ana na;r3<r 3n;rnar33 )ar >a9 a@9;3?a; 3n 9;3,3 / <r.

B3<9,<ra 9@<@3;<?a 9><ara (ran9<@3;<?a an,3 >@9n)ara ,3@r<@3;ara 3-<@r<,a.

In 3>;<r3@9 -a@3n;993 ,n;3<na, @a a ar>;a ) % an3 a 2<>; <-ra; ) TBC @a?<a>a 3ar 3n

;3,-9 3n;rn;33 @3r9r(3@a a -r?n;a; ,<-;3?3 ,a>3aD>a9 2@;9a; >9;9r3 ) n@>3;a;@ a9 ,<)323@a; ,a3 -r<:a:3 ;ra3@; a><r ) >an( >3 a :r<n>33<r. In 9r,a @9 11 an3 a a9;

< >9-9ra;3 ) -r; 3n;r-r;a;a @a (ran9<, ) 23r @9 n@r<?a -n;r9 @ar >a 2@;9a;

3n;rn;3 @3r9r(3@aa )<ar a n39 -r;93 ;<ra@3@. In 9r,a @9 ' an3 r3n @9 >9-9ra;3 )

-r; 2ara 3n>a >a @<n;3n9 3n>;3(a;33 -n;r9 >;a:33ra )3a(n<>;3@993. R3n )9-a 1 9na @9>9-9ra;3 ) -r; @9 ,n;39na @a 3n a@>; 3n;ra7' an3 >3,-;<,a;<<(3a a -r>3>;a;.

Pa@3n;9 a ;,-<r3?a; 2@;9ara 3n;rn;33 @3r9r(3@a -r<-9> an;r3<r. 49-a 9n3 );ra;a,n; ,)3@a,n;<> @9 In;ra@<na?< / 00 ,(!?3 4<3@3@3na 100,(!?3 >3 A<

/00,(!?3 > ra9a?a @a?9. Mn;3<na, @a a 23:r<:r<n<>@<-3a 2@;9a;a a 3n;rnar;a

-r@)n;a a @<n23r,a; -r?n;3 9n3 23>;9 :r<n<-9,<nar >3 -9r<;(9,n;ar.

Examenul bacteriologic specific: din sputa este BAAR negatiD 3ar n>-@323@ a:>n;a

A>-r(39>=A>-r(39> >--.

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R?9;a;9 an;3:3<(ra,3 :a@;r3<<(3@ n<nTBC S;a-+<@<@@9> a9r9>7,;3@33n<r?3>;n;.

C9 >n>3:33;a; a C<ra,2n3@< 4<3@3@3na L3n?<3) Van@<,3@3na >3 3n;r,)3ar a

M<32<a@3na.

Examenul bacteriologic specific )3n >@r;3a )3n -a(a 2@;9a;a >; BAAR n(a;3D

nespecific S;a-+<@<@ @<a(9a?< n(a;3 7 ,;3@33n< r?3>;n; .S;a-+<@<@@9> a9r9>

7 ,;3@3@3n< r?3>;n; Sa 2@;9a; ra)3<(ra23 ;<ra@3@a @ar )>@r3 3-r;ran>-arn;a @9 -r; -r<-r39 a-3@a >;an( @9

;ra@;39na ;ra3 >3 a ,)3a>;3n993 @ar -r?3n;a @3r@9,>@r3>a < <-a@3;a; ) 3n;n>3;a; @<>;aaD

a>@n>3<nara 3993D <-a@3;a;3 ,3@r<n<)9ar >3 3nar a n39 a-993 )r-;. A>-@;>@ar -<>;TBC. 4a;<r3;a a>-@;993 )@a; a ra)3<(ra23a ;<ra@3@a >a r@<,an)a; ra9ar

-r3n a,n !t toracic @ar 3)n;3a?a 9n a>-@; 3)n;3@ @9 a,3nara -r@)n;a In )ra-;a

23:r<?a -9,<nara a-3@aa @9 @ara@;r r;ra@;3 @9 -r?n;a 9n<r @a3;a;3 ar3@ 3n@9> ) a-ana a

/@, )3a, @ar 9n -ar >a a3:a @<n;3n9; ;3>9ar @9 @a@323@ar37n9 > @9) 9n a>-@; )a>-r(3<,. In r>;9 2<@ar993 > @<n>;a;a ,9;3- a>-@; ) 23:r<?a @9 :9 ) ,23?, ,3@3

>3 @a@323@ar3 ,9;3- 2<@a.In >;an(a F3:r<?a -9,<nara a-3@aa @ar 3n@9) ) a>,na

@a3;a;3 ar3@ )3n;r @ar 9na ) %@,D ,)3a>;3n9 >9-r3<r >; r;ra@;a; >-r >;an(a a>-@; @

@<3>;a @9 ,<)323@ar3 ) >;a;3@a r;:raa7>@<3<?a );r<@<n@aa. M)3a>;3n9 @9 )3>;r<>39n33,-<r;an; 2ara a)n<-a;33. C<n@9?3 C; ;<ra@ M<)323@ar3 ,a>3 >@ar @a3;ar

-r)<,3nan; a-3@a )r-;7@9 >9>-3@39n a>-r(3<,. 43>;<r>39n3 ,)3a>;3na >3 ar:<r :r<n>3@ -r3n ;ra@;39n >@ara 23:r<;3@a.

P -ar@9r>9 3n;rnar33 >a r9a; @<n>9;9 @3r9r(3@a @ar >9>;3n n@>3;a;a 3n;rn;33 @9

2@;9ara 9n3 2r>;r E<>>r7-n;r9 <:;3nra 3n@3)r33 23>;93 :r<n<-9ra. O 3n;rn;3ra)3@aa -n;r9 < n;9aa <:@;<,3 n9 >; r@<,an)a;a aan) 3n )r 3>;<r3@9 -a@3n;993

3n 3n;rn;33 an;r3<ar.

P :a?a a,n993 @3n3@ra)3<<(3@ :a@;r3<<(3@ >3 :3<9,<ra > >9>;3n )3a(n<>;3@9 ) ,a3

>9>.P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@ 7C3-r3n<

I;ra@<na?<7/100,(!?3an;3a(3@7A(<@a,3n an;3-3r;3@ 7Para@;a,< 3;a,3n7B1 B6

an;3,3@<;3@7S;a,3@3na ) r@33:rar 3)r<@;r<3;3@a -r<;@;<r (a>;r3@ >3 -a;3@ @9a,3<rara >;ar33 (nra >3 <9;3 @3n3@a 2a<ra:3a.

• @<n;3n9ara ;ra;a,n;993 @9 I;ra@<na?< @<n2<r, R-D

• r3n a @<n;r< ->; 1 9na.

"#$%RA BR%&'%()#*$%&ARA *++ ",&2$x

)&E#$%&-E *++

)%+-B-*E $E"A+"AE %+%A+E /+%* R.

3RA!"#RA +#B!A)-"A*A !%* 3E$#RA* R. /)%+-B-* )E %+ )A"%*%4-!55 -& A)) RE!E&"E )". !ARE +(A E3E!"#A" AR"R%)*A+"-E )AR"-A*A +%* R.

)R%"EARE

!%*E!"-E )*E#RA*A -& !A&"-"A"E $-!A !*%A%&A"A

A&E$-E !R%&-!A +-$)*A

#*!ER 4A+"R-! %)ERA" -& A))

"R%$B%A E&%A+A 3+ 3) ) )E R. "R%$B%A E&%A+A ") +- ) )E

+"4. RE)ER$EAB-*-A"E.

3

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1.07.11 08:0 :

5BC=* *10!"L L+,-#=.6 *10!"L M3)#=* '.% *10!"L Gran#=* .%*10!"L L+,-$=* $ M3)$=1. $ Gran$=* %8.1 $ HGB=* 10.8 (!)

RBC=* '.&1 10*10!"L HCT=* '/.' $ MCV=* 8 2L MCH='0.% -( MCHC=*

'1./ (!) R45CV=* 1& $ R45S4=&&. 2 PLT='8 *10!"L MPV=8.8 2L P45=16 $ PCT=0.'/ $ Ta:<9 >an(3n=PMN = %6 n>(,n;a;= /EO = 8BA =

L = 10MO = 4>@r3r n<r,<,3@r<@3; 3-<@r<,3 VSH 71=8& ,, VSH

7=1/ ,, ALAT=8 U!L ASAT=8 U!L Cra;3n3na=0.8 ,(!) F<>2a;a?aa@a3na='8 U!L GGT=0 U!L G3@,3=80 ,(!) Pr<;3n ;<;a=%. ,(!)

Ur=6 ,(!) 4;@;ara -r<;3n<r 7A=n( 4;@;ara 9@<@3;<r 7P=-<?3;3

4;@;ara 3)ra;3<r ) @ar:<n 7Z=n( S)3,n; 9r3nar=&'0 9@<@3; 3?<a; >3 3n

-a@ar) ' @ -3;3a -a; >3 r<;9n)!@ rara 2<ra :a@;r3ana

1.07.11 08:06 :

S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ M9@<3) A>-@; ,3@r<>@<-3@

C9 3n2a,a;<r33 10&!@a,- C9 -3;3a >@9a,<a>10&!@a,- F3:r3na -r?n; / @<@3 (ra, -<?3;33 >3 @<@3

(ra, n(a;33!@a,- rar 32 ,3@3nS@<r ) @a3;a; 1 S-9;aC9;3ar :a@;r33ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a Ea,n ,3@<<(3@=N9 >a9

)?<;a; 29n(3.

18.07.11 07:2 :

5BC=* '.& *10!"L L+,-#='.' *10!"L M3)#=* /.' *10!"L Gran#=* /.

*10!"L L+,-$=* 10.' $ M3)$=1'.1 $ Gran$=* %6.6 $ HGB=* .6 (!)

RBC=* '.% 10*10!"L HCT=* '1. $ MCV=* %.% 2L MCH=.' -( MCHC=* '0 (!) R45CV=* 1& $ R45S4=&'.& 2 PLT=/'' *10!"L

MPV=8.6 2L P45=1&. $ PCT=0.'% $ Ta:<9 >an(3n=PMN = %8$DEO =

10$DBA = L = 8$MO = /$.4>@r3r N<r,<@3; rar ,3@r<@3; 3-<@r<,3.H,a;33 3n23>3@9r3. VSH 71=10 ,, VSH 7=18 ,, ALAT=1' U!L ASAT=1&

U!L B33r9:3na ;<;aa=0.' ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=* &6 U!L

GGT=6 U!L G3@,3=%/ ,(!) L4H='%/ U!L Pr<;3n ;<;a=6.8 ,(!) Ur='6 ,(!)

RGF stand. PA-opacitate deintensitate costala, ralativ bine delimitata, placata la peretele toracic lateralsuperior drept, cu diam de apro'. 1cm., hili fibrozati, cu calcificari, cord moderat marit.%* toracic - Atasat copie

#%O toracic+ p'nctie biopsie #%O-,hidata- Atasat copie

Fibrobronhoscopie- Tra 3:ra -3n;n ;ra@a n<r,a. Ar:<r :r<n>3@ 3:r @9 a>-@;

:r<n>3;3@. U><ara @<,-r>39n ;r3n>@a a n39 -r;93 ,)3a a :r<n>33 -r3,3;3 >;an(373na:<r)a:3a -; :3<->3 2ara ,<)323@ar3 a a>-@;993 ,9@<a>3. U><ara 3-r,3 a ,9@<a>3

:r<n>33 LSS. LSS LIS 3:r @9 a>-@; :r<n>3;3@.

#P$%R$&A- !olnav in varsta de * ani, fumator, "A, cunoscut cu fractura de col femural dr. in A""recente apr. 11 pt. care s-a intervenit chirugical, ulcer gastric operat in A"", boala varicoasa mb.

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inferiore, T"( si (" stg. repermeabilizate , aflat sub tratament cu anticoagulante, se prezinta pentrumodificarea starii generale, tuse cu e'pectoratie muco-purulenta, dispnee la efort mic/mediu, astenie,subfebrilitati, inaptetenta, scadere ponderala, transpiratii predominent nocturne, dureri toracice si la niv.soldului dr., simptome e'acerbate in ultimele saptamani anterior internarii.7biectiv - la internare2 starea generala mediu modificata, tegumente palide, transpiratii nocturne8p'()onar 2 torace astenic, matitiate pulm. si )( abolit hemitorace dr. sup., raluri bronsice bazal dr.!iologic- sdr. inflamator marcat, sdr. anemic moderat, leucocitoza.&adiografia pulmonara -ridica suspiciunea de tumora pulm. LSS, dgn. confirmat prin ;T toracic.;T toracic- descrie o formatiun tumorala e'tinsa de la hil la pleura parietala si include e'tremitatea distalaa arterei pulmonare stangi8 formatiunea este anturata de un proces de condensare pulmonarapneumonica. )ultiple adenopatii mediastinale in #A", precarinale. ;olectie pleurala stanga micacloazonata. 0epatomegalie. ;olecist litiazic.#ibrobronhoscopia - descrie compresia e'trinseca a peretelui medial al bronsiei "S, inabordabila ptbiopsie, motiv pt. care se efectueaza punctie biopsie transtoracica, eco-ghidata in ('cr'"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

A urmat tratament antibiotic, antitermic, rehidratare, antialgic, vitamine, roborante, e'pectorant,bronhodilatator, protector gastric, a continuat trat. pe care il urma ambulator, cu evolutie favorabila dpdvclinic. A urmat si tratament anticoagulant, dar a fost sistat anterior efectuarii #! si a punctiei transtoracice.

Reco)andari-tratament cu 2 Sintrom 1/ tb/zi sub control saptamanl al 6=& ,5- 3

-revine dupa rezultatul histopatologic al biopsiei transtoracice.-prezentarea la 67;= pt. tratament de specialitate

-reevaluare cardiologica, continuarea tratamentului recomandat de catre medicul specialist-consult dermatologic

-control pneumologic peste o luna, cu bilet de trimitere de la medical de familie si dovada de asiguratcupon de pensie din ultimele 3 luni calendaristice

INSUFICIENTA RESPIRATORIE CRONICA ACUTIZATA.

SILICOZA PULMONARA.INSUFICIENTA TRICUSPI4IANA GR4 IV.

HIPERTENSIUNE PUMONARA SEVERA.

CIROZA HEPATICA VIRALA B.

FORMATIUNI NO4ULARE HEPATICE IN SEGMENTUL III SI VIII CU SUBSTRATHISTOLOGIC NEPRECIZAT 7 POSIBIL HEMANGIOAME HEPATICE.

HIPOPROTEINEMIE.


2.07.11 07:29 : Gran#=&. *10!"L Gran$=%8.% $ HCT=&./ $ HGB=1&.1 (!)

L+,-#=0. *10!"L L+,-$=1/.& $ MCH=6.& -( MCHC=8.8 (!) MCV=.' 2L M3)#=0./ *10!"L M3)$=6.8 $ MPV=.& 2L PCT=0.1 $

P45=16.1 $ PLT=106 *10!"L RBC=&.68 10*10!"L R45CV=1%. $ R45

S4=60 2 5BC=6.& *10!"L VSH 71=1 ,, VSH 7=' ,, ALAT=U!L ASAT=& U!L B33r9:3na ;<;aa=1.1 ,(!) Cra;3n3na=1.1 ,(!) F<>2a;a?a

a@a3na=16 U!L G3@,3=6& ,(!) L4H=/00 U!L Pr<;3n ;<;a=&. ,(!)

Tr3(3@r3)=& ,(!) Ur=6& ,(!)

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26.07.11 08:27 : 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(. 4;@;ara 9@<@3;<r 7P=n(.

4;@;ara -r<;3n<r 7A=-<?. S)3,n; 9r3nar=@a,- -3n ) ,a;33 @<<ra; >3

)@<<ra;D2r@n; 9r3

2.07.11 07:90 : 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(. 4;@;ara 9@<@3;<r 7P=n(.

4;@;ara -r<;3n<r 7A=-<?. S)3,n; 9r3nar='/ 9@<@3;[email protected]& ,a;33

@<<ra;!@.!oagulograma: T= 18D APTT= &.8D INR= 1.6D

Na= 1/% ,ED J= ' ,E

ASTRUP .0%.011 -CO= 6.&D -O= .%D Sa;O= &6.$. &.0%.011 -CO= %'.D -O= /&.D Sa;O= 80.$. 7 2ara <3(nD

&.0%.011 -CO= 61.%D -O= /%.D Sa;O= 8'./$.7 2ara <3(nD

.0%.011 -CO= &'.1D -O= &0.1D Sa;O= 8.6$. -= %./8

EJG R> AV= 80 :a;a3! ,3n9; a RS a '0 (ra) BR) ,aK<r >9:)n3ar ST 3n VV6

9n) T n(a;3 V'V6.

)3R/68871;2.07.2011 )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a >ra <:>;r9@;3a ,<)ra;a 3n

;<; ar:<r :r<n>3@. R)9@ra VEMS @9 &$.R(r ;<ra@3@a @<r) (<:a ,ar3;2a>@ - )3a2ra(,D 33 @<n(>;33D )>n 3n;r>;3;3a a@@n;9a;

:3a;ra. M9;3- <-a@3;a;3 n<)9ar >3 3nar )3>,3na; 3n a,:33 @a,-3 -9,<nar3.Pa3-9r3;a )r-;a.

E)-!R-A:

B<na 3n ar>;a ) & an3 29,a;<r a ->; 80 PA @9n<>@9; @9 an;@)n; -r><na

-a;<<(3@ -9,<nar7 S33@<?a @ar)3<a>@ar 7IT (r) IV HTP >ra >3 )3(>;3 7 C3r<?a

-a;3@a 3raa B >; -r9a; ) a C3n3@a M)3@aa III 9n) a 2<>; )3a(n<>;3@a; @9 E),

-9,<nar a@9; >3 In>23@3n;a r>-3ra;<r3 a@9;a -n;r9 @ar a 2<>; 3n;9:a; 233n) ;9:a; 3n )@9r>9a / <r. La -r9ara - >@;3a n<a>;ra -a@3n; a2:r3 -<3-n3@ @9 >;ar (n;raa 3n29n;a;aD

-r?n;a )3>-n @9 <r;<-n ;9> @9 -@;<ra;3 ,9@<-9r9n;aK9n(3 ;<ra@3@ -<>;r3<r

a>;n< a)3na,3 2a;3(a:33;a; >@a)ra ;<ran;3 a 2<r;D ), (a,:3r ,<)ra; :3a;ra.O:3@;3 a 3n;rnar >;ara (nraa 3n29n;a;a ;(9,n; @3an<;3@ 9>@a; >9:3@;r

>@ra K9(9ar ;r9r(>@n; @3,<? a n39 ,,:r<r >9-r3<ra -<>; -9n@;33 n<a>D

), (a,:3r ,<)ra; :3a;ra-9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3 r<n2an; >3 :3an; )3>,3na; 3n a,:3 @a,-3 -9,<nar3 ra9r3 @r-3;an; :a?a :3a;raD Sa; O= 80 $ 7 a

-9><3,;r9 2ara <3(nD TA= 100!60 ,,H(D AV= 10 :a;a3! ,3n9;D a:)<,n ,ar3; ) <9,

@9 ;3,-an3>,. B3<<(3@ >)r ) r;n;3 a?<;a;a 3-<-r<;3n,3. Sa 2@;9a; A>;r9-D a@3)<?a

r>-3ra;<r3 @9 3-r@a-n3 >3 3-<,3. In <9;3 >a 2@;9a; A>;r9- @9 <9;3 2a<ra:3a3-<,3a >3 3-r@a-n3a > a,3<ra?a 3ar Sa; O= 0$. Ra)3<(ra23a -9,<nara )>@r3

,9;3- <-a@3;a;3 n<)9ar >3 3nar )3>,3na; 3n a,:33 @a,-3 -9,<nar3D -a3-9r3;a )r-;a.

PFR )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a >ra <:>;r9@;3a ,<)ra;a 3n ;<; ar:<r :r<n>3@D r)9@ra VEMS @9 &$. P -ar@9r>9 3n;rnar33 >a 2@;9a; n;3a;3 ,@an3@a @9

-r>39n -<?3;3a 3n r(3, BIPAP @9 <9;3 @3n3@a 2a<ra:3aD >a r)9> 3-<,3a >3 >a

a,3<ra; Sa; O= 8$. A -r?n;a; >3 -3><a) ) )3ar @9 >@a9n a-<a>D )3ara a r,3> )9-a3n3;3ra ;ra-33 an;3)3ar3@.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@ 7C3-r3,< 1 2!?3 HHCan;33n2a,a;<r an;3;r,3@ an;3a(3@

-@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ an;3)3ar3@ 3;a,3n >3 )

6

7/24/2019 69625104-epicrize


r@33:rar @;r<3;3@a a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r -r@9, >3 n;3a;3a

,@an3@a @9 -r>39n -<?3;3a 3n r(3, BIPAPD @9 <9;3 2a<ra:3a.

S ;rna?a @9 r@<,an)ar3

r(3, a3,n;ar @33:ra; @a<r3@ @9 3;ara a3,n;<r -raK3; a29,a; >3 @<n)3,n;a;D

rn9n;ara a 29,a;D a@@3nar an;3(r3-aa an9aaD

;ra;a,n; @9 SERETI4E &0! &00 ,3@r<(ra, 1 -92!?3D

VENTOLIN 100 ,3@r<(ra, -929r3 a n<3rD @<n;3n9ara ;ra;a,n;993 @ar3<<(3@ >3 (a>;r<n;r<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>;D

@<n>9; (a>;r<n;r<<(3@

@<n>9; @ar)3<<(3@D

r3n a @<n;r< ->; < 9na @9 :3; ) ;r3,3;r ) a ,)3@9 ) 2a,33 >3 @9-<n ) -n>3D )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33D

> r@<,an)a <3(n<;ra-3 a )<,3@339 / 3;r3! ,3n9; 10 ,3n9; - <ra.

PNEUMONIE LI4.BOALA PULMONARA CRONICA OBSTRUCTIVA S4T II GOL4 IN EACERBARE.

FIBROZA PULMONARA LI4 SI LM4.

BRONSIECTAZII SUPRAINFECTATE.INSUFICIENTA RENALA CRONICA.

PIELONEFRITA ACUTA IN REMISIE.

ANEMIE SECUN4ARA.

4ISLIPI4EMIE.


2.07.11 07:22 :Gran#=.8 *10!"L Gran$=%6. $ HCT=.% $ HGB= (!) L+,-#=. *10!"L L+,-$=1% $ MCH='0.' -( MCHC='0.' (!)

MCV=100.1 2L M3)#=0.8 *10!"L M3)$=6.8 $ MPV=% 2L PCT=0.// $ P45=1&./ $ PLT=6 *10!"L RBC=.% 10*10!"L R45CV=1& $ R45

S4=&6.% 2 5BC=1.8 *10!"L VSH 71=%& ,, VSH 7=11 ,, ALAT=1'

U!L ASAT=16 U!L B33r9:3na ;<;aa=0.' ,(!) Cra;3n3na=1.8 ,(!) F<>2a;a?a

a@a3na=1& U!L G3@,3=16 ,(!) L4H=06 U!L Pr<;3n ;<;a=6.0 ,(!) Ur=8& ,(!)

2.07.11 10:29 : Ta:<9 >an(3n=PMN =a(80

EO = BA =

L = 16MO = 4>@r3r ,a;33 3n 23>3@9r3

26.07.11 08:0, : 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(. 4;@;ara 9@<@3;<r 7P=-<?.

4;@;ara -r<;3n<r 7A=-<?. S)3,n; 9r3nar=&'0 9@<@3;[email protected] ,a;33@<<ra;[email protected]<ra ,3@r<:3ana

A+"R#): -CO= '.8 PO= 8. Sa; O= 6.8$

R43 stand. )A 33 @<n(>;33 )>n 3n;r>;3;3a a@@n;9a; :3a;raD <-a@3;a; 3n<,<(na 29

7

7/24/2019 69625104-epicrize


)3,3;a;a <@a3?a;a 3n2ra3ar )r-;. S3,23?a @<>;<)3a2ra(,a;3@a.

E!4 RS A=&8 :a;a3! ,3n9; a RS a 0 (ra) 9n) T n(a;3 3n V1V6.

!" toracic /27.07.2011 dr 4uttman " A;a>a; @<-3Ea,3nara a 2<>; 2@;9a;a 3n 3n@3)n; a3a @<r<na >3 >a(3;a.

R?9;a; M<)323@ar3 3,-<r;an; ) 23:r<?a -9,<nara 3n LI4 >3 LM4 9n) > @<n>;a;a ;ra3@;

:r<n>3@;a;3@ ) ;ra@;39n 9n @9 >@r;33 3n;ra9,3na. R;<>;rna >;an( an;r3<r ) @<r) 3n3n(9a > @<n>;a;a < 2<r,a;39n ;3>9ara ) &.&/ @, @<,-a@;a a a,3nara na;3a :3n

)3,3;a;a @9 ;3<<(3 ,a3 )323@3 ) -r@3?a;. N9 3na)a?a -r3@ar)9 a)3a@n; >3 n3@3

>;r9@;9r3 -ar3;a -ara>;rna. N9 > @<n>;a;a ,<)323@ar3 ;9,<ra >a9 a)n<-a;3@ 3<-9,<nar.

N9 > @<n>;a;a a>-@; ) @<@;3 -9raa.

N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@3@.

F3@a;9 ar )3,n>39n3 >3 >;r9@;9ra n<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar >a9 -<r;aC<@3>;9 n9 >; <@93;.

Gan) SR ) a>-@; n<r,a

R3n3@33 :3a;ra a9 )3,n>39n3 >3 >;r9@;9ra n<r,a. In r3n3@39 )r-; @3>; @<r;3@a ) & ,,

)3a,;r9 >3 >;a?a -33@aa -r3n >)r ) K<n@;39n. C<n@9?3 F3:r<?a -9,<nara 3n LI4 >3 LM4 @9 ;a3@; :r<n>3@;a;3@. F<r,a;39n ;3>9ara

r;<>;rnaa >;an(a @9 ;3<<(3 (r9 ) -r@3?a;a.

)3R /6866;22.07.2011 )3>29n@;3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n;

@n;ra >3 >ra 3n -r32r3. R)9@ra VEMS @9 '%$.

E)-!R-A

B<na 3n ar>;a ) %0 an3 @9n<>@9; @9 an;@)n; -r><na -a;<<(3@ @3r9r(3@a 7>;<,a@

r?@a; -n;r9 U4 C<@3>;@;<,3 9r<<(3@ 7P3<n2r3;a a@9;a >3 ,;a:<3@ 743>3-3),3 > -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> >a@a )3>-n a 2<r; ,)39 @2a

a,;3 ;ran>-3ra;33a>;n3<a)3na,3 2a;3(a:33;a; 3na-;;n;a >@a)r -<n)raa >3,-;<,

a@r:a; 3n 9;3, >a-;a,an3 an;r3<r 3n;rnar33.O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; >3 ,9@<a> -a3) -9,<nar

;<ra@ a>;n3@ >9:,a;3;a; :a?a )r-; @9 MV )3,3n9a; a a@>; n3 ra9r3 @r-3;an; :a?a

:3a;ra >3 23n >3:3an; )3>,3na; 3n a,:33 @a,-3 -9,<nar3 Sa; O= %$D TA=100!%0,,H( AV= %0 :a;a3! ,3n9;D a:)<,3na >n>3:33;a; )9rr<a>a a -a-ara -r<29n)a 3n

;aK9 a:)<,3na 3n2r3<r.

B3<<(3@ >)r. 3n2a,a;<r 79@<@3;<?a VSH a@@ra; >)r an,3@ >)r ) r;n;3 a?<;a;a 9><ara@r>;r a (3@,33 :a?a 3-<-r<;3n,3. Ea,n9 >9,ar ) 9r3na 9@<@3;9r3 >3

-r<;3n9r3.

Ra)3<(ra23a -9,<nara 3)n;3a?a <-a@3;a; 3n<,<(na 29 )3,3;a;a <@a3?a;a 3n2ra3ar )r-;

@ar r3)3@a >9>-3@39n 9n93 -r<@> -r<32ra;3 a a@>; n3 ,<;3 -n;r9 @ar > 3n)3@a2@;9ara CT ;<ra@3@. CT ;<ra@3@ )>@r3 23:r<?a -9,<nara 3n LI4 >3 LM4 @9 ;a3@;

:r<n>3@;a;3@ >3 < 2<r,a;39n ;3>9ara r;<>;rnaa >;an(a @9 ;3<<(3 (r9 ) -r@3?a;a.

PFR )3>29n@;3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n; @n;ra >3 >ra 3n -r32r3 r)9@ra VEMS @9 '%$.

In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3

>9>.A 9r,a; ;ra;a,n; an;3:3<;3@7C3-r3n< 1 2!?3 HHC an;3;r,3@ an;3a(3@ -@;<ran;

:r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3n >3 ) r@33:rar

3)r<@;r<3;3@a @9 <9;3 2a<ra:3a.

8

7/24/2019 69625104-epicrize


r(3, a3,n;ar @33:ra; @a<r3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

a@@3nar an;3(r3-aa an9aaD ;ra;a,n; ,)3@a,n;<> @9D SPIRIVA 18 ,3@r<(ra, 1 @->!?3

VENTOLIN 100 ,3@r<(ran 929r3 a n<3D

BISEPTOL @-r!?3 7% ?3D reine la control peste o luna @9 :3; ) ;r3,3;r ) a ,)3@9 ) 2a,33 >3 @9-<n ) -n>3D

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

BR%&+-"A !R%&-!A +#)RA-&3E!"A"A !# <*EB+-E**A.

R'-&%3AR-&4-%$ -RA-A" +- !'-$-%"RA"A" -& A)) /1887

-ABE" A'ARA" "-) 2 &%&-&+#*-&%E)E&E&"

A&E$-E 3ER-)R-A

2.07.11 08:1 :

5BC=&.' *10!"L L+,-#=1.% *10!"L M3)#=0.& *10!"L Gran#='.1 *10!"L

L+,-$=' $ M3)$=.& $ Gran$=&8.& $ HGB=* 1. (!) RBC=/.&8

10*10!"L HCT=/1.% $ MCV=1. 2L MCH=8.1 -( MCHC=* '0. (!) R45CV=1'.8 $ R45S4=/%.1 2 PLT=%& *10!"L MPV=.1 2L P45=1&.%

$ PCT=0.& $ VSH 71=8 ,, VSH 7=& ,, ALAT=8 U!L ASAT=8

U!L B33r9:3na ;<;aa=0./ ,(!) C<>;r<=160 ,(!) Cra;3n3na=1.0 ,(!)

F3r=* 1 9(!) F<>2a;a?a a@a3na=6 U!L GGT=1 U!L G3@,3= ,(!) L4H=/' U!L Pr<;3n ;<;a=* 6./ ,(!) Tr3(3@r3)=1'% ,(!) Ur='1 ,(!)

26.07.11 12:96 :

An;3:3<(ra,a ar<:3=1. AMIJACIN 7P3ra,3S .CEFIIM 7E23@2 . AMPICILINA 7O,n3-rn P<3@33n R

'. IMIPENEM 7T3na, '. AMPICILINA SULBACTAM 7Una>+n

/. JANAMICINA 7Jana,+@3n /. AMOICILINA AC. CLAVULANIC7A9(,n;3n R &. LINEZOLI4

&. BISEPTOL 7Ta(r,3n R 6.

LINCOMICINA 7L3n@<@3n 6. COLISTIN 7C<3,+@3n S

%. MEROPENEM 7Mr<n, S %. CIPROFLOACIN 7C3-r3n<E9@3-r3nS8. NALI4IIC ACI4 7N(ra, 8. CLARITROMICINA 7Ja@3)

. NITROFURANTOIN 7Ma@r<)an;3n . CLORAMFENICOL 7Br3@;3n

R '0. NORFLOACIN 7N<3@3n10. CEFACLOR 7C@<r '1.

OFLOACINA 7Tar33) S 11.CEFOPERAZONASULBACTAM

7 S9-ra?<na '. OACILINA 7Pr<>;a-+n 1.CEFOTAIM7Ca2<ran R ''. PENICILINA 7Pn3@33na

G 1'.CEFTAZI4IM 7F<r;9, R

'/. PIPERACILINATAZOBACTAM 7Ta?<@3n R 1/.CEFTRIAON

7R<@-3n R '&. TETRACICLINA 7A@r<,3@3n

9

7/24/2019 69625104-epicrize


R 1&.CEFUROIM AETIL R

'6. TOBRAMICINA 7N:9@3n R 16.ERITROMICINA 7Er+;r<@3n

'%. TICARCILINACLAVULANIC 7T3,n;3n R 1%.GENTAMICINA7Gn;a,+@3n R '8. VANCOMICINA 7L3)3@3n

18.4OICICLINA '. MOIFLOACINA +

1.AZTREONAM/0. CLIN4AMICINA 0.CEFTIBUTEN

/1.CEFOITIN1.TICARCILINA /.LEVOFLOACINA

R?9;a; >9n; -r3,a; @a3;a;3 3n ,, ?<na ) 3n3:3;3 >a9 @an;3;a;3 CMI (! S= >n>3:3DI= 3n;r,a)3arD R= r?3>;n;D N=N3n;r-r;a:3D C<n;a,3na;D

A>-3ra; :r<n>3@ C9;9r3 ar<:=J:>3a >-- 7 ;9-3na -r<)9@a;<ar ) :;a a@;a,a? @9

>-@;r9 ;3n> A>-3r;a :r<n>3@ Ea,n ,3@<<(3@=Can)3)a a:3@an> 60 UFC!-a@a

A>-3ra; :r<n>3@ Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ M9@<-9r9n; A>-@;,3@r<>@<-3@ C9 3n2a,a;<r33 10&!@a,- ,a@r<2a(

C9 -3;3a >@9a,<a> >3 :r<n>3@ 10!@a,- F3:r3na

-r?n; /6 :a@33 (ra, n(a;33! @a,- 2r@n; 32 ,3@3nS@<r ) @a3;a; RGF stand. PA-desen interstitial accentuat infrahilar bilateral, hili fibrozati, cu calcificari.Fibrobronhoscopie - =721131/.<.11- #ormatiune tumorala bine vascularizata la nivelul mucoaseice proemina pe peretele posterior al faringelui. ;( mobile, trahee libera, pintene traheal normal. Aspectbronsitic difuz bilateral, secretii muco-seroase moderate cantitativ provenind de la nivelul ambilor arboribronsici, predominant cel stang. Aspirare secretii.Se recolteaza aspirat bronsic pentru citologie, flora,micologie.%ons'(t ne'rochir'r,ica(- atasat copiePFR- 5><</ .<.11- obstructie medie in periferie

#P$%R$&A- !olnav in varsta de 55 ani, fumator, "A?5, cunoscut cu rhinofaringiom radio-chimiotratat1**<, $@ tip sub trat. cu A$7, este trimis de urgenta de :": unde a fost investigat pentru un episodde lipotimie urmata de caderea de la acelasi nivel, dispnee severa, tuse cu e'pectoratie mucopurulenta.7biectiv la internare2 modificarea starii generale, tuse cu e'pectoratie muco-purulenta, dispnee la efortmic, disartrie, disfonie, astenie, inaptetenta. $ispneea, tusea cu e'pectoratie, inapetenta s-au e'acerbatin ultimele zile anterior internarii8 p'()onar 2 torace astenic, )( inasprit, raluri ronflante bazal bilateral sirare sibilante.!iologic- sdr. anemic, hipoproteinemie.%'. sputei evidentiaza lebsiella spp.&adiografia pulmonara - desen interstitial accentuat infrahilar bilateral, hili fibrozati, cu calcificari.#ibrobronhoscopia - a fost efectuata in scop de drena al secretiilor bronsice. "ostprocedural pacientulprezinta ameliorarea importanta a dispneei si tusei cu e'pectoratie muco-purulenta."e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

A urmat tratament antibiotic austat ulterior conform antibiogramei, antitermic, e'pectorant,bronhodilatator, antialgic, a continuat trat. pe care il urma ambulator antidiabetic cu evolutie favorabila.

Reco)andari-tratament cu 2 Avelo' 1 tb/zi 1 zile-consult neurologic, consult 7&L, diabetologic, hematologic sdr. anemic, tratament conform

recomadarilor-control pneumologic peste 3 luni, cu bilet de trimitere de la medical de familie si dovada de asiguratcupon de pensie din ultimele 3 luni calendaristice

S-a eliberat reteta compensate seria ;S!! nr. 3<<5

10

7/24/2019 69625104-epicrize


BR%&'%)&E#$%)A"-E !R%&-!A %B+"R#!"-A 3%R$A +EERA -&

E=A!ERBARE

'") +E!#&ARA $%ERA"A

'-)ER"E&+-#&E AR"ER-A*A E+E&"-A*A +" -- R-+! !AR-%A+!#*AR

-&A*".

!AR-%)A"-E -+!'E$-!A !R%&-!A:A&4-&A )E!"%RA*A +"AB-*-A"A$E-!A$E&"%+

-!! &>'A ---.

A&E$-E +E!#&ARA 3%R$A #+%ARA.

+"%$A! %)ERA".

AE&%$ E )R%+"A"A.

-+*-)-E$-E.

Analize de laborator:27.07.11 07:01 : Gran#=6. *10!"L Gran$=%'.' $ HCT='.8 $

HGB=1' (!) L+,-#=1.& *10!"L L+,-$=1%.& $ MCH=6.8 -( MCHC='.6 (!) MCV=8.' 2L M3)#=0.% *10!"L M3)$=. $ MPV=%.' 2L

PCT=0.1&& $ P45=1&.6 $ PLT=1' *10!"L RBC=/.8/ 10*10!"L R45CV=1/.8 $ R45S4=/'.6 2 5BC=8./ *10!"L VSH 71=' ,, VSH

7=&' ,, ALAT=8 U!L ASAT=11 U!L B33r9:3na ;<;aa=0.& ,(!) Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na=06 U!L G3@,3=0 ,(!) L4H='&1 U!L

Pr<;3n ;<;a=%./ ,(!) Ur='0 ,(!)

A+"R#) PH= %.'%D -O= 88. ,,( -CO= //.,,H(D Saa;O= 6./$ Na= 1/8 ,,<!D J= .8 ,,<!D Ca= 0.%' ,,<!.

)3R/91,,6: )3>29n@;3 n;3a;<r3 ,3;a >ra 3n ;<; ar:<r :r<n>3@. VEMS >9: 1 3;r9.

Rgr toracica: 33 @<n(>;33 @9 @a@323@ar3D )>n 3n;r>;33a a@@n;9a; :3a;raD S@3?9ra>9-3,n;ara<:9 n3 a?+(<>D 2ara ?39n3 a@;3 TBC -9r<-9,<nar.

E<4: R> AV= %& :a;a3! ,3n9;D a RS a 80 (ra) 2ara ,<)23@ar3 3>@,<?3<na.

E)-!R-A:

Pa@3n; 3n ar>;a ) % ) an3 2<>; 29,a;<r a '&PA @9n<>@9; @9 BPOC700& @ar)3<-a;3

3>@,3@a @r<n3@a700% 9@r )9<)na710 > 3n;rna?a @9 )3>-n a 2<r;9r3 ,3@3 ;9> @9

-@;<ra;3 ,9@<-9r9n;a 2r3><an ;ran>-3ra;33 a>;n<a)3na3 2a;3(a:33;a; >@a)ra;<ran;3 a 2<r; >3,-;<, a@r:a; 3n 9;3,a >a-;a,ana an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar -a@3n; a2:r3 @9 >;ar (nraa 3n29n;a;aD ;(9,n; >3 ,9@<a> -a3)D

-9,<nar MV 3n>-r3; @9 -3r -r9n(3; ra9r3 r<n2an; )3>,3na; 3n a,:3 @a,-3 -9,<nar3Dra9r3 @r-3;an; :a?a :3a;raD TA= 1'0!80,,H(D AV= %& :a;a3! ,3n9;.EJG R> AV=%&:!,3n

2ara ,<)323@ar3 3>@,3<?3<na.Ra)3<(ra23a >;an)ar) PA )>@r3 33 @<n(>;33 @9 @a@323@ar3D

)>n 3n;r>;33a a@@n;9a; :3a;raD >@3?9ra >9-3,n;ara<:9 n3 a?+(<>D 2ara ?39n3 a@;3

TBC -9r<-9,<nar. PFR )3>29n@;3 n;3a;<r3 ,3;a >ra 3n ;<; ar:<r :r<n>3@. VEMS>9: 1 3;r9.

In 9r,a ana,n?3 a a,n993 @3n3@ >3 -ara@3n3@7ra)3<<(3@ PRF >3 @<(ra23@ > >9>;3n

)3a(n<>;3@9 ) ,a3 >9>.P -ar@9r>9 3n;rnar33 a 9r,a; ;ra;a,n; an;3:3<;3@7A,<3 -9> 2!?3HHCan;33n2a,a;<r

an;3;r,3@ an;3a(3@ :r<n<)3a;a;<ar 293)323an; -r<;@;<r (a>;r3@ >3 -a;3@ 3;a,3n >3 )

r@33:rar 3)r<@;r<3;3@a a 9r,a; ;ra;a,n;9 @ar)3<<(3@ )3n a,:9a;<r @9 a,3<rara>;ar33 (nra >3 <9;3 @3n3@a 2a<ra:3a.

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S ;rna?a @9 9r,a;<ar r@<,an)ar3

• r(3, a3,n;ar @33:ra; @a<r3@D

• 3;ara 2r3(993 29,993 ) ;3(ara 3n2@;33<r 3n;,-r33<rD

• 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

• a@@3nar an;3(r3-aa an9aaD• ;ra;a,n; ,)3@a,n;<> S+,:3@<r; 160/.& ,3@r<(ra, *1-929r3!?3

• S-3r3a 18 ,3@r<(ra, 1@->!?3

• Vn;<3n a n<3 -n;r9 6 9n3D

• Taan3@ &00 ,( 1 @-r!?3 7% ?3D

• Er)<,) '00 ,( 1 @-r!?3 710 ?3

• @<n;3n9a ;ra;a,n;9 @ar)3<<(3@ -r>@r3> ) @ar ,)3@9 >-@3a3>;D

• r3n a @<n;r< ->; 6 9n3 3n a>n;a a@r:ar3<rD

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

BPO% *. $ A%*$&A*A$NF$%$#N*A R#P$RA*OR$# %RON$%A A%*$&A*A%AR$O#GA3$# 4$P#R*ROF$%A6%OR P3ONAR %RON$% %OP#NA**ABAG$ %RON$%Analize de laborator:

01.0.11 08:2, :

5BC=* 11 *10!"L L+,-#='.6 *10!"L M3)#=0.8 *10!"L Gran#=6.6

*10!"L L+,-$='./ $ M3)$=%. $ Gran$=&.% $ HGB=1&.% (!)

RBC=/.8 10*10!"L HCT=/6.8 $ MCV=* &.8 2L MCH='.1 -( MCHC=''.& (!) R45CV=1/.' $ R45S4=/8. 2 PLT=& *10!"L

MPV=8.8 2L P45=1&.& $ PCT=0.& $ VSH 71=' ,, VSH 7=% ,, ALAT=10 U!L ASAT=8 U!L B33r9:3na ;<;aa=0./ ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=1/ U!L GGT= U!L G3@,3=%1 ,(!) L4H=* 1' U!L

Pr<;3n ;<;a=%./ ,(!) Ur=' ,(!)

RGF stand. PA-opacitate de intensitate costala /supracostala infrahilar dr., desen interstitial accentuat bazalbilateral, cord moderat marit.

PFR NO: !"7"7- disfunctie mi'ta severa pe tot arborele bronsic mai accentuat in periferie. (%)S B 1l.&educerea ventilatiei cu C>+.

#P$%R$&A- !olnav in varsta de * ani, mare fumator "A?, cunoscut cu !"7; std 6( D7L$, aflat

sub tratament cu Seretide 5/5 puff/zi, 6pravent Epuff/zi, (entolin la nevoie, se prezinta de urgentacu stare generala alterata, dispnee la repaus si efort mic, tuse cu e'pectoratie muco-purulenta, cianozaperiorala, acrocianoza, astenie, fatigabilitate, simptome e'acerbate in urma cu cateva zile anteriorinternarii.Obiecti - la internare2 starea generala alterata, cianoza periorala, acrocianoza8 p'()onar 2 toracecifoscoliotic, )( diminuat pe ambii campi pulmonari, raluri bronsice diseminate pe ambii campi pulmonari,S7?<>+.Bio(o,ic- leucocitoza,Radio,ra8ia p'()onara - evidentiaza o opacitate cu caracte mai probabil sechelar, de intensitatesupracostala infrahilar dr, cord global marit, desen nterstitial accentuat bazal bilateral.

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PFR- releva disfunctie mi'ta severa si reducerea (%)S cu >+.Sat 7- initial <>+, sub tratament se amelioreaza, se mentine la val. de *-*5 +."e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

A urmat tratament antibiotic, bronhodilatator, e'pectorant, antialgic, o'igenoterpe, a continuat trat. pe careil urma ambulator, cu evolutie clinica favorabila. Se e'terneaza cu recomandarile2

Reco)andari-tratament cu 2 Seretide 5/5 '1 puff/zi 6pravent ' puff/zi Avelo' 1tb/zi inca 5 zile-o'igenoterapie la domiciliu-%ON3* %AR$O3OG$%

-renuntarea la fumat-control pneumologic peste o luna, cand se va reevalua oportunitatea efectuarii ;T toracic

S-a eliberat reteta compensate seria ;S!! nr. 3<<<1 Avelo'


BOALA PULMONARA CRONICA OBSTRUCTIVA STA4IUL III GOL4 IN EACERBARE.HIPERTENSIUNE ARTERIALA ESENTIALA STA4IUL I CU RISC CARIOVASCULAR

MO4ERAT.

CAR4IOPATIE ISCHEMICA NE4UREROASA.BR4 MAOR.

INSUFICIENTA VENOASA MEMBRE INFERIOARE BILATERAL.

STENOZA FEMURALA NESEMNIFICATIVA.

STENOZA CAROTI4IANA BILATERALA NESEMNIFICATIVA.SPON4ILOZA C4L CU RA4ICULALGII.

A4ENOM TOIC TIROI4IAN. HIPERTIROI4ISM SUBCLINIC.

)3R/68021;26.07.2011: )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;aD <:>;r9@;3a

,<)ra;a >(,n; @n;ra >3 >ra 3n 3n -r32r3. R)9@ra VEMS @9 '$.

Rgr toracica: 33 @<n(>;33D )>n 3n;r>;3;3a a@@n;9a; :3a;raD <-a@3;a; 3n<,<(na @9 ?<n) 3-r;ran>-arn;a :a?a )r-;.

E<4: R> AV= 100 :a;a3! ,3n9; a RS a 0 (ra) BR4 ,aK<r.

!" rtoracic /28.07.2011 dr 4uttman " In LI4 >9:-9ra > @<n>;a;a < :an)a )

@<n)n>ar -9,<nara 3n<,<(na @9 ;ra3@; ) :r<n<(ra,a @9 a>-@; -n9,<n3@ a;3-@. Un -r<@> >3,3ar )ar ,3@ > <:>ra >3 3n LIS 3n >an;9 @<>;<r;:ra. 2ara a>-@; :r<n>3@;a;3@.

I,a(3n3 (an(3<nar ,)3a>;3na >9: 1 @, )3a,;r9. P9ra ) @<n;a@; n9 >; 3n(r<>a;a. N9 >

@<n>;a;a a>-@; ) @<@;3 -9raa. N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@3@. N9 > @<n>;a;a,<)323@ar3 ;9,<ra ,)3a>;3n< -9,<nar. 23@a;9 ar )3,n>39n3 >3 >;r9@;9ra n<r,a. N9 >

@<n>;a;a ,<)32<@ar3 :33ar >a9 -<r;a., C<@3>;9 n9 >; <@93;. Gan) SR ) a>-@; nr,a.

C<n@9?3 C<n)n>ar -9,<nara -n9,<n3@a LI4 @9 a>-@; a;3-3@. Fara a>-@; :r<n>3@;a;3@.

E)-!R-A:

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Pa@3n; 3n ar>;a ) %1 an3 2<>; 29,a;<r a ->; 80PA @9n<>@9; @9 an;@)n; -9,<nar

7BPOC >;) III G<)a2a;a >9: ;ra;a,n; @9 S-3r3a 18 ,3@r<(ra, 1 @-> !?3 >3 Vn;<3n 100

,3@r<(ra, -929r3 a n<3 In>923@3n;a r>-3ra;<r3 @r<n3@a @ar)3<a>@9ar 7HTA BR4,aK<r. CI S;n<?a 2,9raa :3a;raa S;n<?a @ar<;3)3ana :3a;raa n>,n323@a;3a n)<@r3n

7 a)n<, ;3r<3)3an ;<3@ 3-r;3r<3)3>, >9:@3n3@ > 3n;rna?a -r3n ;ran>2r ) a C3n3@a B<3

In2@;3<a> 9n) a 2<>; )3a(n<>;3@a; @9 -n9,<n3 :a?aa )ra-;a r2ra@;ara a ;ra;a,n;. La -r9ara - >@;3a n<a>;ra -a@3n;9 -r?n;a )3>-n a 2<r;9r3 ,<)ra; ;9> @9 -@;<ra;3

,9@<-9r9n;a 2:ra 7'8. (ra) C 2r3><an ;ran>-3ra;33 @2a >@a)ra ;<ran;3 a 2<r;.

O:3@;3 a 3n;rnar >;ar (nraa 3n29n;a;a @3an<?a -r3<raa @<r)<an ar3@<a> a n39,,:r<r 3n2r3<ar :3a;raD -9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3 r<n2an; >3

>3:3an; )3>,3na; 3n a,:33 @a,-3 -9,<nar3 ra9r3 @r-3;an; :a?a :3a;ra ,a3 a@@n;9a;

:a?a )r-; Sa; O= /$ 7 a -9><3,;r9 >9: <3(nD @ar)3<a>@9ar ?(<,; @ar)3a@

r3;,3@ TA= 1'0!80,,H( AV= 8 :a;a3! ,3n9;.B3<9,<ra7ana3? r@<;a; 3n >r3@39 B<3 In2@;3<a> >)r 3n2a,a;<r 9><r. PFR )3>29n@;3

n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;aD <:>;r9@;3a ,<)ra;a >(,n; @n;ra >3 >ra 3n 3n

-r32r3 r)9@ra VEMS @9 '$. R(r ;<ra@3@a 3)n;3a?a 33 @<n(>;33D )>n 3n;r>;3;3a

a@@n;9a; :3a;raD <-a@3;a; 3n<,<(na @9 ?<n ) 3-r;ran>-arn;a :a?a )r-; @ r3)3@a>9>-3@39n -r?n;3 9n<r ;a3@; :r<n>3@;a;3@. S 3n)3@a 2@;9ara 9n93 CT ;<ra@3@. C;9

;<ra@3@ 3)n;3a?a -r<@> ) <@n)n>ar -9,<nara -n9,<n3@a LI4 @9 a>-@; a;3-3@. 2ara a3)n;3a a>-@; :r<n>3@;a;[email protected] BR4 ,aK<r.

In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a

>9>.P -ar@9r>9 3n;rnar33 a 9r,a; ;ra;a,n; an;3:3<;3@ 7C3-r3n< 12! ?3 :r<n<)3a;a;<r HHC

,3<233n an;33n2a,a;<r an;3;r,3@ ,9@<3;3@ -r<;@;<r (a>;r3@ >3 3;a,3n a 9r,a; ;ra;a,n;9

@ar)3<<(3@ >3 n)<@r3n<<(3@ )3n a,:9a;<r @9 <9;3 2a<ra:3a.

In <9;3 - -ar@9r>9 3n;rnar33 >9: ;ra;a,n; > <:>ra a,3<rara @3n3@a a>3,-;<,a;<<(33 )3>-na >3 ;9>a ,9; a,3ra;a.

S ;rna?a a,3<ra; @9 r@<,an)ar3

r(3, a3,n;ar @33:ra; @a<r3@ 3-<><)a;D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

3;ara @<n>9,993 ) ;<3@ 7 a@<<D ;ra;a,n; ,)3@a,n;<> @9 TAVANIC &00 ,( 1 @-r! ?3 7% ?3

Er)<,) '00 ,( 1 @-r ?3 710 ?3

S-3r3a 18 ,3@r<(ra, 1 @->! ?3Sr;3) &0! &0 ,3@r<(ra, 1 -92!?3

Vn;<3n 100 ,3@r<(ra, -929r3 a n<3

@<n;3n9ara ;ra;a,n;993 @ar)3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3;.

r3n a @<n;r< 3n 6 9n3 3n a:>n;a a@r:ar3<rD )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

BR%&+-"A !R%&-!A A!#"-A"A

"B! )#*$%&AR 3-BR%A" A)-!A* R.

A&E$-E !R. +-$)*A #+%ARA


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02.0.11 08:0 :

5BC=8.& *10!"L L+,-#=1. *10!"L M3)#=0.8 *10!"L Gran#=&.8 *10!"L L+,-$=. $ M3)$=.8 $ Gran$=68 $ HGB=* 1'. (!) RBC=* '.8

10*10!"L HCT=* /0. $ MCV=* 101. 2L MCH=''.1 -( MCHC='.8

(!) R45CV=1/.' $ R45S4=&1. 2 PLT=' *10!"L MPV=* %.& 2L P45=1&.' $ PCT=0. $ VSH 71=/ ,, VSH 7=&/ ,, ALAT=8 U!L

ASAT=8 U!L B33r9:3na ;<;aa=0. ,(!) Cra;3n3na=0.% ,(!) F<>2a;a?a

a@a3na=1%% U!L GGT=/ U!L G3@,3= ,(!) L4H='' U!L Pr<;3n;<;a=* &.% ,(!) Ur=11 ,(!)

RGF stand. PA-desen intersitial acentuat bazal bilateral, hipertransparenta difuza la niv. camplilorpulmonari bilateral, pahipleurita apicala dr., hil stg. fibrzata, ascensionat, cu calcifcari, calcificarenfrahilara stg.

PFR !"915/2.09.2011- valori normale

#P$%R$&A- !olnav in varsta de 3 ani, fost mare fumator "A?5, cunoscut cu T!; pulm. in A"",fibroza pulmonara post T!;F, bronsita cronica , se interneaza pentru alterarea starii generale, tuse cue'pectoratie muco-purulenta, dispnee la efort mediu, transpiratii profuze, astenie, inapetenta8 simptomee'acerbate in ultimele zile anterior internarii.Obiecti - la internare2 starea generala usor modificata, tegumente palide8 p'()onar 2 torace astenic,)( diminuat bilateral, raluri crepitante bazal bilateral.Bio(o,ic- hipoproteinemie, usoara anemie, sdr. inflamator.Radio,ra8ia p'()onara - evidentiaza sechele mai probabil post T!.PFR- cu valori normale."e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

A urmat tratament antibiotic, antialgic, e'pectorant, A6=S, bronhodilatator, cu evolutie clinica favorabila.

Reco)andari-tratament cu 2 (entolin puff la nevoie

-control pneumologic peste luni, cu bilet de trimitere de la medical de familie si dovada de asiguratcupon de pensie din ultimele 3 luni calendaristice

)*E#RE-E R. E E"-%*%4-E &E)RE!-A"A -& !A&"-"A"E $E-E;$ARE

!AR!-&%$ !# !E*#*E RE&A*E +#B"-) !# !E*. !*ARE %)ERA" -& A)) /2008

/R-&-!'- +"4.

%BE-"A"E 4R. ---

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0.0.11 08:17 :

5BC=8. *10!"L L+,-#=1.8 *10!"L M3)#=0.% *10!"L Gran#=&.% *10!"L L+,-$=1./ $ M3)$=.0 $ Gran$=6.6 $ HGB=1./ (!) RBC=/./

10*10!"L HCT='%./ $ MCV=88.' 2L MCH=. -( MCHC=''.1 (!)

R45CV=1'.& $ R45S4=/'.6 2 PLT='/' *10!"L MPV=.0 2L P45=1&.%$ PCT=0.'08 $ VSH 71='8 ,, VSH 7=68 ,,

0.0.11 08:,9 :

L. -9ra 2r<;39 Gra,=F3:r3na rar 9@<@3; ,a;33 L. -9ra Ea,n ,3@<<(3@=N9>a9 )?<;a; 29n(3.

0.0.11 08:,8 :

L3@3) -9ra Ea,n @3;<<(3@=PMN 10$ L+ &$ @9 ,?<;3a '8$. Fr@n;

,a;33. L3@3) -9n@;3 N9,. ,n;=1'00 L. -9ra Fr<;39 -;. )@rarBAAR=NEGATIV '6!0&.08.011

Ex. bioc?imie sange( n9 >a 2@;9a; a-ara; )2@;.

R43 stand. )A ( <-a@3;a; ,a>3a ) 3n;n>3;a; 3@3)3ana <@9-an) K9,a;a;a 3n2r3<ara a,3;<ra@93 )r-; ra;3 :3n )3,3;a;a 2a;a ) -arn@3,9 >9-raKa@n;D >@3?9r3;a <r3?<n;aa

>a9 >@3?9ra >9-ran9,raa 7 7<:9 n3 a?+(<> >9:@a3@9ar )r-;. A>-@;9 -)a?a -;.@<@;3 -9ra 3n @an;3;a; ,)3!,ar @ar -a;r9n) >3 a n3. >@3?9r33 .

E)-!R-A B<naa 3n ar>;a ) &' an3 2<>;a 29,a;<ar0 PA @9n<>@9;a @9 ;9,<ra rnaa

>;(. <-ra;a 3n 00 7@ar@3n<,a @9 @9 rna >9:;3-9 @9 @9 @ar TNM > -r?3n;a

) 9r(n;a -;. )3>-n -r<(r>3a ) 2<r; @9 ):9; 3n>3)3<> )ar a@r:a; 3n 9;3, ?3

an;r3<r 3n;rnar33. A><@3a; a@9?a rara ;9> @9 -;<ra;3 3n @an;. ,3n3,a a>;n3. ;ran>-3ra;33n<@;9rn.

O:3@;3 a 3n;rnar >;. (n. 9><r ,<)323@a;a >9-ra-<n)r pulmonar: ;<ra@ <9,3n<>

,a;3;a; a n3. 3n2r3<r )r. MV a:<3; a a@>; n3.B3<<(3@ >)r. 3n2a,a;<r

Ra)3<(ra23a -9,<nara r3)3@a >9>-3@39na ) @<@;3 -9raa 1! 3n2 )r.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )(n. ) >)r. -9ra >3 >a 2@;9a; -9n@;3 -9raa 3n >@<- )(n. >3 ;ra-9;3@ )ar >a r9>3; a@9ara )<ar a 00 ,. 3@3) >r<,<ra(3@

@9 @9ar3;a; 2<ar; :<(a;a.

A 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ AINS HHC @9 <9;3 2a<ra:3a )-)@3n3@.


@<n;3n9ara ;ra;. an;3:3<;3@ @9 A< 1;:!?3 3n@a 10 ?32@;9ara ;<ra@<>@<-33 3n >@<- )(n. >3 ;ra-9;3@ @<n2<r, -r<(ra,ar33

@<n;r< -n9,<<(3@ ->; < 9na.)&E#$%&-E -&"ER+"-"-A*A

B%A*A )#*$%&ARA !R%&-!A %B+"R#!"-A +" --- 4%* -& E=A!ERBARE

-&+#3-!-E&"A RE+)-RA"%R-E !R%&-!A E=A!ERBA"A

3-BR%A )#*$%&ARA --%)AR"-!A

'") +E!#&ARA

3-BR-*A"-E A"R-A*A )ER+-+"E&"A !# A -&A*"A

'-)ER"E&+-#&E AR"ER-A*A E+E&"-A*A +"A-#* --- !

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-&+#3-!-E&"A !AR-A!A !%&4E+"-A &>'A ---

'-)ER"R%3-E BE&-4&A E )R%+"A"A

A&E$-E #+%ARA


0,.0.11 07:,0 :

5BC=&.1 *10!"L L+,-#=* 0.8 *10!"L M3)#=0.& *10!"L Gran#='.8 *10!"L

L+,-$=* 1&.8 $ M3)$=10. $ Gran$=%/ $ HGB=* 11.8 (!) RBC=* /./

10*10!"L HCT=* '6.' $ MCV=8.6 2L MCH=* 6.8 -( MCHC='.& (!) R45CV=* 16.% $ R45S4=&1. 2 PLT=1 *10!"L MPV=8. 2L

P45=1&.8 $ PCT=0.188 $ Ta:<9 >an(3n=PMN = %EO = BA = L = MO =

/4>@r3r VSH 71=10 ,, VSH 7='/ ,, ALAT= U!L ASAT=% U!L

Cra;3n3na=1.0 ,(!) F<>2a;a?a a@a3na=* '/1 U!L G3@,3=* 118 ,(!) L4H=/10 U!L Pr<;3n ;<;a=%.0 ,(!) Ur=/8 ,(!)

RGF stand. PA-cord global marit flasc pe diafragm8 hili congestivi8 desen interstitial accentuat bilateral.)ultiple microopacitati nodulare infrahilar bilateral.

#%G- #iA cu A(?*b/min, e'trasistole ventriculare.PFR- =7 *>>32 disfunctie mi'ta medie segment central si severa in periferie. &educerea (%)S cu 5+.

#P$%R$&A- !olnav in varsta de <1 ani, fost fumator "A?, cunoscut cu !"7; stadiul 666 D7L$,

6nsuficienta respiratorie cronica, #iA, 0TA, 6;;, aflat sub tratament cu SGmbicort 1/.5 micrograme,(entolin 1 micrograme, !iseptol, se prezinta pentru modificarea starii generale, tuse cu e'pectoratiemuco-purulenta, dispnee severa cu ortopnee, astenie marcata, cianoza periorala simptome e'acerbate inultimele zile anterior internarii.7biectiv - la internare2 starea generala alterata, facies caracteristic Hblue blotterH8 p'()onar 2 toraceemfizematos, )( inasprit cu e'pir prelungit, raluri bronsice diseminate pe ambii campi pulmonari, raluricrepitante bazal bilateral, S7?*+.!iologic- anemie usoara, #A crescuta.&adiografia pulmonara -evidentiaza microopacitati nodulare infrahilar bilateral, aspect asemanator cu &E

toracica efectuata in cursul internarii din .11 cand ;T-ul toracic efectuat descrie aspect de alveolitae'sudativa cu condensare pneumonica si adenopatii paratraheale de pana la cm diametrul."#&- disfunctie mi'ta medie segment central si severa in periferie6n cursul zilei de >.>.11 prezinta dureri precordiale cu caracter anginos care cedeaza laadministrarea de nitrati. %D efectuat in criza releva #iA cu A( inalta si e'trasistole ventriculare."e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

A urmat tratament antibiotic, antialgic, bronhodilatator, protector hepatic, a continuat trat. pe care il urmaambulator, cu evolutie favorabila.Se e'terneaza cu recomandarile2

-regim alimentar hiposodat, hipolipidic-efort fizic in limita tolerabilitatii-tratament medicamentos cu SGmbicort 1/.5 micrograme E1puff/zi

(entolin 1 micrograme 3E1puff/zi-control cardiologic cu bilet de trimitere de la medicul de familie si continuarea tratamentului prescris decardiolog.-control pneumologic peste luni, in absenta e'acerbarilor, cu bilet de trimitere de la medicul de familie sidovada de asigurat cupon de pensie din ultimele 3 luni calendaristice-dispensarizare prin medicul de familie

17

7/24/2019 69625104-epicrize


&E% BR%&'%()#*$%&AR +"4 ",&2$=

)*E#RE-E +E!#&ARA -& !#R+ E %R4A&-ARE

)&E#$%&-E +"4

-&+#3-!-E&"A RE+)-RA"%R-E !R%&-!A A!#"-A"A

!%R )#*$%&AR !R%&-!


28.07.11 0: :

5BC=* 1/.% *10!"L L+,-#= *10!"L M3)#=0. *10!"L Gran#=* 11.8 *10!"L L+,-$=* 1'.' $ M3)$=6.% $ Gran$=* 80 $ HGB=* 1'./ (!) RBC=&.11

10*10!"L HCT=/1.& $ MCV=81./ 2L MCH=* 6. -( MCHC='. (!)

R45CV=* 1%.1 $ R45S4=&1. 2 PLT='/6 *10!"L MPV=8.' 2L

P45=1&.% $ PCT=0.8% $ VSH 71=& ,, VSH 7=%/ ,, ALAT=8 U!L ASAT=8 U!L B33r9:3na ;<;aa=0./ ,(!) C<>;r<=* '% ,(!) Cra;3n3na=0.%

,(!) F<>2a;a?a a@a3na='& U!L GGT=* 8' U!L G3@,3=* 10 ,(!) L4H=*

%61 U!L Pr<;3n ;<;a=%. ,(!) Tr3(3@r3)=* 18% ,(!) Ur=0 ,(!)

Rgf. pulm. stand. )A( <-a@323ra ,a>3a a ,3;<ra@93 >;(. @9 )-a>ara ,)3a>;3n993 >-r

>;(.

3ibrobron?oscopie( atasat copie

Bipsie endobronsica( @<n@9?3<na?a @a a?-@;9 -)a?a -n;r9 -n;r9 a)n<@ar@3n<, ,<)ra;

)32rn;3a;.

Epicriza( Pa@3n; 3n ar>;a ) &8 an3 ,ar 29,a;<r 7%0 PA @9n<>@9; @9 n< :r<n<-9,<nar

LSS 73an 011 )ar n@<n23r,a; 3>;<-a;<<(3@ BPOC >;. IV GOL4 CPC In>92. r>-3ra;<r3

@r<n3@a )ar 2ara 9n ;ra;. ) 2<n) > 3n;rna?a -;. a;rara >;ar33 (nra ;9> @9 -@;<ra;3,9@<-9r9n;a @9 >;r39r3 >an(3n<n; ;ran>-3ra;33 )9rr3 ) 3n;n>3;a; ,ar a n3.

,3;<ra@93 >;(. )3>-n a r-a9> >3 2<r; ,3n3, 2a;3(a:33;a; @3an<?a -r3<raa >3,-;<,

a@r:a; 3n 9;3, 3 an;r3<r 3n;ranr33.O: a 3n;rnar >;. (n. ,<)323@a;a @3an<?a -r3<raa a@r<@3an<?a )(; 3-<@ra;3@

pulmonar: ;<ra@ ,23?,a;<> MV a:<3; a n3. ,3;<ra@93 >;(. ra9r3 :r<n>3@ )r. >3 a-3@a

>;(.

B3<<(3@ >)r. 3n2a,a;<r 9><r >)r. an,3@ 9@<@3;<?a 3-r(3@,3 L4H a @r>@9;3-r@<>;r<,3.

R(2 3)n;3a?a ,3;<ra@ >;(. <-a@ > >9>-3@3<na?a -r?n;a -9r?33 >3 > ;n;a?a -9n@;3

-9raa @ar n9 a@9a?a 3@3) 7-9n@;3 a:a. S 2@;. @< ;<ra@3@ @ar 3)n;3a?a @<@;33n @9r> ) <r(an3?ar.

S 2@;9a?a FB @ar >9>;3n )(n. ) ;9 :r<n<-9,<nar a n3 :r.PS @9 ;3n)r >-r :r. LSS

>3 LIS. Bipsia endobronsica( @<n@9?3<na?a @a a?-@;9 -)a?a -n;r9 -n;r9 a)n<@ar@3n<,

,<)ra; )32rn;3a;.P :a?a )a;<r @3n3@ >3 -ara@3n3@ > >;a:3>; )(n. ) ,a3 >9>.

A 9r,a; ;ra;. an;3:3<;3@ r3)ra;ar 3;a,3n an;3a(3@ >3 -;. )9rra n9 a@)a; a a),3n3>;raraa@>;<ra >a a),3n3>;ra; an;3a(3@ ,aK<r 7,3a(3n. E<9;3a >; 2a<ra:3a )-) @3n3@ @3

a,3<rara >;ar33 (nra.


;ra;. @9 +@mbocort 160;, ug 2x1 puff;zi

18

7/24/2019 69625104-epicrize


+piria 1 cps;zi

;ra;. antialgic la neoie

@<n>9; @ar)3<<(3@-r?n;ar a C3n3@a Ra)3<<(3 On@<<(3@a -n;r9 3n;rnar.

BR%&'%)&E#$%)A"-E !R%&-!A %B+"R#!"-A +". --- 4%* A!#"-A"A

3-BR%A )#*$%&ARA -3#A-&+#3-!-E&"A RE+)-RA"%R-E !R%&-!A A!#"-A"A

'-)ER"E&+-#&E )#*$%&ARA +EERA

'-)ER"E&+-#&E AR"ER-A*A E+E&"-A*A +". -- !

-&+#3-!-E&"A !AR-A!A !%&4E+"-A &>'A ---;-

-&+#3-!-E&"A "R-!#+)--A&A 4RA#* -;--

!-R%A 'E)A"-!A )%+" -&3E!"-E !# -R#+ 'E)A"-"-! ! !*A+A !'-* A


02.0.11 07:,6 :

5BC=6.1 *10!"L L+,-#=* 1./ *10!"L M3)#=0.6 *10!"L Gran#=/.1 *10!"L L+,-$='.& $ M3)$=10. $ Gran$=66.' $ HGB=1&.& (!) RBC=/./&

10*10!"L HCT=* /8./ $ MCV=* 108. 2L MCH=* '/.8 -( MCHC='

(!) R45CV=* 1&. $ R45S4=* 61.& 2 PLT=* 11% *10!"L MPV=8.82L P45=16.1 $ PCT=0.10 $ Ta:<9 >an(3n=PMN = 66EO = 6BA = L = /MO

= /4>@r3r! VSH 71=& ,, VSH 7=1& ,, ALAT=11 U!L ASAT=6 U!L

B33r9:3na )3r@;a=* 1.6 ,(!) B33r9:3na ;<;aa=* 1.8 ,(!) Cra;3n3na=1.0 ,(!)

F<>2a;a?a a@a3na='0 U!L GGT=* /8 U!L G3@,3=' ,(!) L4H=* /%% U!L Pr<;3n ;<;a=%./ ,(!) Ur=1% ,(!)

02.0.11 10:29 :

S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ M9@<-9r9n; A>-@; ,3@r<>@<-3@ C93n2a,a;<r33 10&!@a,- ,a@r<2a(. C9 -3;3a >@9a,<a> 10!@a,- F3:r3na

-r?n; 2<ra :a@;r3ana -<3,<r2a rar 32 ,3@3n S@<r ) @a3;a; S-9;a

C9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a Ea,n,3@<<(3@=N9 >a9 )?<;a; 29n(3.

R43 stand. )A <-a@3;a;3 r;3@9<n<)9ar ) 3n;n>3;a; @<>;aa )3>,3na; :3a;ra 9n @9

;n)3n;a a @<n29arD 33 ,ar3;3 23:r<?a;3D ,)3a>;3n ar(3;.

E!%("%RA!E: Ea,3nar 3n @<n)3;33 >9-ra-9nr3<r ar3@ ,9;3-. F3@a; @9 @<(n3;a;>@a?9; ) )3,n>39n3 n<r,a. C<@3>; 3:r @9 -r;3 3n(r<>a;3 2ara 3,a(3n3 ) @a@93. A,:33

r3n3@3 @<(ra23@ n<r,a3 2ara 3,a(3n3 ) @a@93 2ara )3a;ar3 -3<@a3@a.

E!4( RS. AV=106:!,3n. In@ar@ar V4.

!" toracic A;a>a; @<-3

3ibrobron?oscopie ( NO 110!0/.08.011 CV ,<:3 ;ra 3:ra -3n;n ;raa n<r,a.

A>-@; :r<n>3;3@ )329? :3a;ra >@r;33 ,9@<>r<a> ,<)ra; @an;3;a;3 -r<n3n) ) a n39

a,:3<r ar:<r3 :r<n>3@3 -r)<,3nan; @ )r-;. Fara >,n )3r@; >a9 3n)3r@; ) -r<@> -r<32ra;3. Br<n<a>-3ra;3.

)3R NO68'6 )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 >ra >(,n; @n;ra >3 [email protected])9@ra VEMS @9 &/$.

E)-!R-A B<naa 3n ar>;a ) 6 an3 n29,a;<ar @9n<>@9;a @9 -a;<<(3 r>-3ra;<r3

7F3:r<?a -9,<nara BPOC>;). III GOL4 In>923@3n;a r>-3ra;<r3 @r<n3@a HTP >ra@ar)3a@a 7HTAE >;). II r3>@ @ar)3<a>@9ar 3na; In>923@3n;a ;r3@9>-3)3ana (ra) I!II In>923@3n;a

19

7/24/2019 69625104-epicrize


@ar)3a@a NHA III!IV >3 C3r<?a -a;3@a -<>; 3n2@;3 @9 3r9> -a;3;3@ C a2a;a >9: ;ra;a,n;

@9 Cn3 K; 1-922!?3 I-ran; -922!?3 Vra-a,3 80,( 111;:!?3 439r &0,( 11

0;:!?3 F9r<>,3) /0,( 010;:!?3 A>-n;r %&,( 010;:!?3 O,ran 0,( 101;:!?3 > -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra )3>-n >ra @9 <r;<-n ;9> @9 -@;<ra;3

,9@<-9r9n;a a>;n3 3na-;;n;a 2a;3(a:33;a; @3an<?a -r3<raa a@r<@3an<?a ),

(a,:3r :3a;ra >3,-;<, a@r:a; 3n 9;3, ?3 an;r3<r 3n;rnar33.O:3@;3 a 3n;rnar >;ara (nraa >r ,<)323@a;a @3an<?a -r3<raa >3 a@r<@3an<?aD 2a@3>

) Q3@<ana :3?an;3naQD -9,<nar ;<ra@ a>;n3@ MV )3,3n9a; - a,:33 @a,-3 -9,<nar3

>9:,a;3;a; :3a;ra ra9r3 :r<n>3@ )3>,3na; a n39 3n;r(33 ar33 -9,<nar.B3<<(3@ :33r9:3na ;<;aa >3 )3r@;a @r>@9; L4H @r>@9;.

Ra)3<(ra23a -9,<nara )>@r3 <-a@3;a;3 r;3@9<n<)9ar ) 3n;n>3;a; @<>;aa )3>,3na; :3a;ra

9n @9 ;n)3n;a a @<n29arD 33 ,ar3;3 23:r<?a;3D ,)3a>;3n ar(3;.

F3:r<:r<n<>@<-3a a 2<>; 2@;9a;a 3n >@<- ;ra-9;3@. Sa 2@;9a; :r<n<a>-3ra;3a >@r;33<r,9@<>r<a>. E<9;3a -<>;-r<@)9ra >; 2a<ra:3a @9 >@a)ra @an;3;a;33 -@;<ra;33.

PFR ra )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 >ra >(,n; @n;ra >3 -r32r3@. R)9@ra

VEMS @9 &/$.

In @9r>9 3n;rnar33 -a@3n;a a@9?a )9rr3 <,:ar >;an(3 @9 @ara@;r @<3@a;3 @ar @)a?a aa),3n3>;rara ) an;3a(3@ >3 an;3>-a>;3@. ECO a:)<,3naa 2@;9a;a 3n @r3?a n9 ra )3a;ar3

-3<@a3@a >a9 3,a(3n3 ) @a@93. Z3 9r,a;<ar )9rra >; ) 3n;n>3;a; >@a?9;a @9@ara@;r ,@an3@ >3 >; @9-a;a ) a),3n3>;rara an;3a(3@<r.

A><@3a; -a@3n;a -r?3n;a a@@n;9ara ),<r (a,:3r :3a;ra 3n @<n)3;33 3n @ar a >;<-a;

a),3n3>;rara ) 29r<>,3) ;3,- ) ' ?3 @<n2<r, 3n)3@a;33<r @ar)3<<(993. S r3n;r<)9@F9r<>,3)9 3n >@,a ;ra-9;3@a 439r?a!/=1&00, @9 r,3>3a -r<(r>3a a ),<r.


A 9r,a; ;ra;a,n; an;3:3<;3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r ar<>< 7@9 HHC &,( >3

M3<233n 2 ?3n3@D a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 9><r 2a<ra:3a.S ;rna?a @9 r@<,an)ar3

&egim alimentar hiposodat, hipolipidic, moderat hipoproteic.%vitarea e'punerii la no'e respiratorii si intemperii, hepatoto'icelor si nefroto'icelor.Tratament promt al infectiilor respiratorii.%fort fizic in limita tolerabilitatii.-tratament cu2 6pravent Epuff/zi ;lenil et E1puff/zi-reevaluare cardiologica si continuarea tratamentului recomandat de catre mediculspecialist.-control pneumologic peste 3 luni, cu bilet de trimitere de la medical de familie si dovadade asigurat cupon de pensie din ultimele 3 luni calendaristice.

)&E#$%&-E BAA*A REA)"A

BR%&+-"A !R%&-!A %B+"R#!"-A !# E=A!ERBARE

3-BR%A )#*$%&ARA )%+""B!

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!AR-%)A"-E -+!'E$-!A !R%&-!A +-*E&"-%A+A

'-)ER"E&+-#&E AR"ER-A*A E+E&"-A*A +" --B

20

7/24/2019 69625104-epicrize


+"%$A! REE!A"


16.0.11 08:01 :

Gran#=&./ *10!"L Gran$=6'. $ HCT=/'. $ HGB=1/.' (!) L+,-#=.'

*10!"L L+,-$=6. $ MCH=' -( MCHC=''.1 (!) MCV=% 2L M3)#=0.8 *10!"L M3)$=. $ MPV=8.& 2L PCT=0./ $ P45=1&.6 $

PLT=8' *10!"L RBC=/./6 10*10!"L R45CV=1/ $ R45S4=/8. 2

5BC=8.& *10!"L VSH 71= ,, VSH 7=6 ,, ALAT=1 U!L ASAT=1%U!L B33r9:3na ;<;aa=0.%1 ,(!) Cra;3n3na=1 ,(!) F<>2a;a?a a@a3na='18 U!L

GGT=1 U!L G3@,3=/ ,(!) L4H='6 U!L Pr<;3n ;<;a=%. ,(!)

Ur='6 ,(!)

Rx )A,8,2 ,8,9;12.0.2011C<r) r;3@a3?a;D :9;<n a<r;3@ -r3,a;. In;r>;3;39 -ara3ar a@@n;9a; @9 @a@323r3

a>@9arD <-a@3;a;3 3nar )3>,3na; 3n 1!' ,)3 >3 3n2r3<ara a ,3;<ra@93 >;an(.)3R/980;12.0.2011 43>29n@;3 n;3a;<r3 <:>;r9@;3a 9><ara 3n -r32r3.

Pa@3n; 3n ar>;a ) &6 an3 29,a;<r71&PA @9n<>@9; @9 :r<n>3;a @r<n3@a @<r) -9,<nar @r<n3@ @ar)3<-a;3

3>@,3@a @r<n3@a >3n;3<a>a 3-r;n>39n ar;r3aa >n;3aa >;) IIB 9@r )9<)na @r<n3@ @9 >;n<?a -3<r3@a

<-ra; 3n 00 > -r?3n;a a C3n3@a ) Pn9,<<(3 a@9?an) ;9> @9 -@;<ra;3 ,9@<-9r9n;a 3n @an;3;a;,3n3,a )3>-n a 2<r;9r3 ,<)ra; K9n(3 ;<ra@3@ -<>;r3<r a ar29 <,<-a;993 >;an( >@a)ra ;<ran;3 a

2<r; >3,-;<, @ar >a9 3n>;aa; @9 a-r<3,a;3 ' ?3 an;r3<r 3n;rnar33.Examenul obiecti(la internare >;ar (nraa=,<)ra; a;ra;aD 2a@3> n@ara@;r3>;3@ ;(9,n; >3 ,9@<a> 9><r

-a3) 9>@a;D a n39 a-ara;993 r>-3ra;<r > )@a?a MV 3na>-r3; @9 ra9r3 @r-3;an; :a?a :3a;ra ,a3a@@n;9a; a :a?a ,3;<ra@93 >;an( SaO=8$ a -9><3,;r9D Car)3a@ TA=1&0!8&,,H( AV=6:!,3nD

?(<,<; @ar)3a@ r3;,3@ :3n :a;9; >3n@r<n @9 -9>9 -r32r3@ 2ara >929r3 >9-raa)a9(a;.Biologic: >3n)r<, ) @<>;a?a.9><ara an,3 ,a@r<@3;ara.E<4 R> AV=100:!,3nD aa RS n<r,aaD HV4 R a,-9;a; V1 V'D P -9,<nar Ta3@ar)3 >3n9>aa.Rx )A,8,2 ,8,9;12.0.2011 3)n;3a?a C<r) r;3@a3?a;D :9;<n a<r;3@ -r3,a;. In;r>;3;39 -ara3ar a@@n;9a; @9

@a@323r3 a>@9arD <-a@3;a;3 3nar )3>,3na; 3n 1!' ,)3 >3 3n2r3<ara a ,3;<ra@93 >;an(.)3R/980;12.0.2011 43>29n@;3 n;3a;<r3 <:>;r9@;3a 9><ara 3n -r32r3.

P :a?a a,n993 @3n3@ ra)3<<(3@ >3 ) a:<ra;<r > >9>;3n )3a(n<>;3@9 ) ,a3 >9>.P -ar@9r>9 3n;rnar33 -a@3n;a a 9r,a; ;ra;a,n; -@;<ran; an;3;9>3 3n3:3;<r3 ) -<,-a ) -r<;<n3

an;332a,a;<r an;3,3@<;3@ @9 a,3<rara >;ar33 (nra >3 <9;3 @3n3@a 2a<ra:3a.

• r(3, a3,n;ar 3-<><)a; 3-<3-3)3@D

• )<?ara a@;33;a;33 23?3@ 3n 29n@;3 ) ;<ran;a a 2<r;D

• 3;ara -9nr33 a n< ar3a;33 ;r,3@ ,ar3 @<n;a@;993 3n2@;3<> 29,a;993 >3 @<n>9,993 ) a@<<D

• ;ra;a,n; ,)3@a,n;<> @9 S-3r3a 1@->!?3 6 9n3D

• ra9ar @3n3@<:3<<(3@a ->; 6 9n3 3n a:>n;a a@r:ar3<r.

• PNEUMONIE LI4.

• ASTM BRONSIC PERSISTENT PARTIAL CONTROLAT.•


• 11.0.11 08:12 : Gran#=6 *10!"L Gran$=6% $ HCT='8.% $ HGB=1.8

(!) L+,-#=./ *10!"L L+,-$=6. $ MCH= -( MCHC='' (!) MCV=88 2L M3)#=0.6 *10!"L M3)$=6.8 $ MPV=8 2L PCT=0.6 $

P45=1&./ $ PLT='& *10!"L RBC=/./ 10*10!"L R45CV=1'.%

$ R45S4=/&. 2 5BC= *10!"L VSH 71=1% ,, VSH 7=&1

21

7/24/2019 69625104-epicrize


,, ALAT=1 U!L ASAT=1 U!L B33r9:3na ;<;aa=0./' ,(!)

Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=1'% U!L G3@,3=10 ,(!)

L4H=1%/ U!L Pr<;3n ;<;a=6.% ,(!) Ur=1 ,(!)

• )3R /6788;10.0.2011: )3>29n@;3 n;3a;<r3 <:>;r9@;3a >ra 3n -r32r3.

• Rgr toracica /11199;10.0.2011: ,9;3- <-a@3;a;3 n)9ar >3 3nar ) 3n;n>3;a;

@<>;aa 9n @9 ?<n ) 3-r;ran>-arn;a <@a3?a; LI4.• !" toracic /12.0.2011 dr 4uttman ".A;a>a; @<-3

• Ea,3nara a 2<>; 2@;9a;a 3n 3n@3)n; a3a @<r<na >3 >a(3;a.

• R?9;a; In LI4 -r32r3@ >9:-9ra 3>;a 9n -r<@> ) @<n)n>ar -n9,<n3@a )

11,, a;n9a; ,3n3, ) a<3;a 9)a;a. In r>; ara;3a -9,<nara >; -a>;ra;a

:3a;ra.N9 > @<n>;a;a ,<)323@ar3 ;9,<ra >a9 a)n<-a;3@ 3<-9,<nar. N9 >@<n>;a;a a>-@; ) @<@;3 -9raa. N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@[email protected]@a;9

ar )3,n>39n3 >3 >;r9@;9ra n<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar >a9 -<r;a.

C<@3>;9 n9 >; <@93;. Gan) SR ) a>-@; n<r,a. R3n3@33 :3a;ra a9)3,n>39n3 >3 >;r9@;9ra n<r,a.

• C<n@9?3 Pr<@> ) @<n)n>ar -n9,<n3@a 3n LI4. Fara a; ,<)323@ar3 >,n323@a;3.

•

• E)-!R-A Pa@3n;a 3n ar>;a ) &' an3 2<>;a 29,a;<ar a 10PA @9n<>@9;a 3n

an;@)n; @9 A>;, :r<n>3@ a2a; >9: ;ra;a,n; @9 S+,:3@<r; 160!D/.& ,3@r<(ra, 1 -92! ?3 @9 >9-3,n;ara )<?3 3n @a? ) n<3 > -r?3n;a -n;r9 ;9> >a@a )3>-n a

2<r; ,)39 a>;n3 a)3na,3 2a;3(a:33;a; >@a)ra ;3ran;3 a 2<r;>3,-;<,

a@r:a; 3n 9;3,a >a-;a,ana an;r3<r 3n;rnar33.

• O:3@;3 a 3n;rnar -a@3n;a a2:r3a @9 >;ar (nraa ,)39 ,<)323@a;aD -9,<nar

;<ra@ n<r,a @<n2<r,a; MV 3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;ra

>3 23n ra9r3 >3:3an; Ta= 1'0!80 ,,H( AV= %6 :a;a3! ,3n9;.

• B3<<(3@ >)r. 3n2a,a;<r7VSH 9><r a@@ra; 9><ar @r>;r a L4H. PFR )3>29n@;3

n;3a;<r3 <:>;r9@;3a >ra 3n -r32r3.• Ra)3<(ra23a -9,<nara 3)n;3a?a ,9;3- <-a@3;a;3 n)9ar >3 3nar ) 3n;n>3;a;

@<>;aa 9n @9 ?<n ) 3-r;ran>-arn;a <@a3?a; LI4@ r3)3@a >9>-3@39na 9n93

-r<@> 3n<@93;<r ) >-a;39 ,<;3 -n;r9 @ar > 3n)3@a 2@;9ara 9n93 CT ;<ra@3@. CT 9;<ra@3@ )>@r3 9n -r<@> ) @<n)n>ar -n9,<n3@a 3n LI4 2ara a 3)n;3a >,n ) T9

BP.

• In 9r,a a,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 )

,a3 >9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r @9 )9ra;a

>@9r;a >3 9n(a ) a@;39n -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3

9r,a a,:9a;<r @9 <9;3 2a<ra:3a.

• S ;rna?a @9 r@<,an)ar3

•

•

• r(3, a3,n;ar 3-<(9@3)3@D

• 3;ara 2a@;<r3<r ar(n3D

• 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

• ;ra;a,n; ,)3@a,n;<> @9 Taan3@ &00 1 @-r!?3 7% ?3 >a 3:ra; R- @<,-n>a;a.

22

7/24/2019 69625104-epicrize


• Er)<,) '00 ,( 1 @-r !?3 >a 3:ra; R- @<,-n>a;a

• @<n;3n9ara ;ra;a,n;993 @9 SMBICORT 160! /.& ,3@r<(ra, 1 -92! ?3 >3

>9-3,n;ara )<?3 3n @a? ) n<3D

• r3n a @<n;r< ->; 6 9n3 3n a:>n;a a@r:ar3<rD

• >a 3:ra; CM - -r3<a)a 3n;rnar33 >3 % ?3 a ;rnar >r3a CCMA4 nr 0111&8.

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.• BOALA PULMONARA CRONICA OBSTRUCTIVA MO4ERATA IN EACERBARE.

• PNEUMONIE LI4.

• FIBROZA PULMNARA 4IFUZA BILATERALA.

• INSUFICIENTA CAR4IACA CONGESTIVA CLASA NHA III.

• CAR4IOMIOPATIE 4ILATATIVA MITA 7 TOICA SI ISCHEMICA.

• CAR4IOPATIE ISCHEMICA IN SERVATIE.

• HIPERTENSIUNE ARTERIALA ESENTIALA ST4. II CU RISC CAR4IOVASCULAR

INALT.

• 4IABET ZAHARAT TIP II NOU 4EPISTAT CONTROLAT PRIN 4IETA.

• STEATOZA HEPATICA.

• SPON4ILOZA C4L CU RA4CULALGII.

• GONARTROZA BILATERALA.

• COARTROZA BILATERALA.

• AVC IN ANTECE4ENTE.

• OBEZITATE GRA4UL II•


• 11.0.11 10:16 : Gran#='.6 *10!"L Gran$=&.% $ HCT=//.' $ HGB=1/.6

(!) L+,-#= *10!"L L+,-$=''.& $ MCH='0.& -( MCHC='.

(!) MCV=.8 2L M3)#=0./ *10!"L M3)$=6.8 $ MPV=.' 2L PCT=0.1%' $ P45=1&.% $ PLT=18% *10!"L RBC=/.%8 10*10!"L

R45CV=1'.8 $ R45S4=/8.1 2 5BC=6 *10!"L VSH 71=6 ,, VSH 7=% ,, ALAT=%& U!L ASAT=&/ U!L B33r9:3na ;<;aa=0.8% ,(!)

Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=0/ U!L GGT=101 U!L

G3@,3=%& ,(!) L4H=806 U!L Pr<;3n ;<;a=6. ,(!) Ur= ,(!)

• R43 stand. )A @<r) <:a ,ar3; ,a3 a@@n;9a; VS 2a>@ - )3a2ra(,D 33 @<n(>;33D )>n

3n;r>;3;3a a@@n;9a; :3a;ra ,a3 a@@n;9a; a n39 @a,-993 -9,nar )r-;. M9;3-

,3@r<<-a@3;a;3 3nrar ) n;>3;a; @<>;aa 3n n3;<ra@ )r-;,a3 a@@n;9a; a :a?a.

• )3R )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n;

@n;ra >3 ,a3 a@@n;9a;a 3n -r32r3. R)9@ra VEMS @9 /0$.

• E!4 RS AV= 60:a;a3! ,3n9; a RS 3n;r,)3ar n@r<?a 3nr3<ara @.

•

• !" toracic/11.0.2011 dr 4uttman ". A;a>a; @<-3


• R?9;a; F3:r<?a -9,<nara )329?a :3a;raa -r)<,3nan; :a?a >@ara @9 @a;a

;ra3@; :r<n>3@;a;3@ ) ;ra@;39n. N9 > @<n>;a;a ,<)323@ar3

;9,<ra >a9 a)n<-a;3@ 3<-9,<nar.N9 > @<n>;a;a a>-@; ) @<@;3 -9raa.N9

23

7/24/2019 69625104-epicrize


> @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@3@. F3@a;9 ar )3,n>39n3 >3 >;r9@;9ra n<r,a. N9

> @<n>;a;a ,<)323@ar3 :33ar >a9 -<r;a. C<@3>;9 n9 >; <@93;. Gan) SR ) a>-@;

n<r,a. R3n3@33 :3a;ra a9 )3,n>39n3 >3 >;r9@;9ra n<r,a.

• C<n@9?3 F3:r<?a -9,nara )329?a :3a;raa. 2ara a>-@; TU BP. S;a;<?a -a;3@a.

• 3ibrobron?oscopie /16;02.0.2011 dr. +imon $ a;a>a; @<-3

•

• CV ,<:3. Traa -r?3n;a an;r3<r 3n -<r;39na )3 @<n)r<a, - a-r<3,a;3 /

3n ;raa @ar;3a(3,<a>. P3n;n ;raa n<r,a. Ar:<r :r<n>3@ >;( 3:r @9,)323@ar3 ) :r<n>3;a @r<n3@a >; III. C<n(>;3 ), >@r;33 ,9@9r9n; 3n ar:<r

:r<n>3@ )r-;. A>-@; ) :r<n>3;a ,9@<-9r9n;a.

•

• E)-!R-A:

• B<na 3n ar>;a ) 60 an3 29,a;<r a ->; /0 PA @9n<>@9; @9 an;@)n; -r><na

-a;<<(3@ -9,<nar 7 BPOC a2a; >9: ;ra;a,n; @9 S-3r3a 18 ,3@r<(ra, 1 @->! ?3 >3

Vn;<3n 100 ,@r<(ra, -929r3 a n<3 @ar)3<a>@9ar 7ICC CM4,3;a HTA

CIC AVC <>;<ar;3@9ar 7 C<ar;r<?a >3 (<nar;r<?a :3a;raa S-<n)3<?a C4 >3,;a:<3@ 7 O:?3;a; > -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> @9

-@;<ra;3 ,9@<a>a )3>-n a 2<r; ,)39 >@a)ra ;<ran;3 a 2<r; a>;n3

a)3,a,3 2a;3(a:33;a; >3,-;<, a@r:a; 3n 9;3,a >a-;a,ana an;r3<r 3n;rnar33.

• O:3@;3 a 3n;rnar -a@3n; >9-ra-<n)ra a2:r3 @9 >;ara (nraa ,)39

,<)323@a;aD -9,<nar ;<ra@ ,23?,a;<> MV 3na>-r3; @9 -3r -r9n(3; ra9r3

@r-3;an; :a?a :3a;ra ,a3 a@@n;9a; 3n :a?a )ra-;aD TA= 1/0!0,H( AV= 6/ :a;a3!

,3n9;.

• B3<<(3@ VSH 9><r a@@ra; ASAT ALAT GGT >3 L4H @r>@9; (3@,3 :a?aa

@r>@9;a. PFR )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a

>(,n; @n;ra >3 ,a3 a@@n;9a;a 3n -r32r3.

•Ra)3<(ra23a -9,<nara 3)n;3a?a ,9;3- ,3@r<<-a@3;a;3 3nrar ) n;>3;a; @<>;aa3n n3;<ra@ )r-;,a3 a@@n;9a; a :a?a @ar r3)3@a >9>-3@39na 9n<r :r<n>3@;a?33

,<;3 -n;r9 @ar > 3n)3@a 2@;9ra 9n93 CT ;<ra@3@ >3 a 23:r<:r<n<>@<-33. CT 9

;<ra@3@ )>@3D F3:r<?a -9,nara )329?a :3a;raa @9 @a;a ;ra3@; :r<n>3@;a;3@ );ra@;39n 2ara a 3)n;3a a>-@; TU BP 3ar 23:r<:r<n<>@<-3a 3)n;3a?a a n9

ar:<r93 :r<n>3@ )r-; a>-@; ) :r<n>3;a ,9@<-9r9n;a.

• In 9r,a ana,n?3 a a,n993 @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> '1 2!?3 an;33n2a,a;<r an;3a(3@ -@;<ran;

:r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ )39r;3@ a @<n;3n9a; ;ra;. - @ar 3

9r,a a,:9a;<r @9 <9;3 2a<ra:3a.


•

• r(3, a3,n;ar -<><)a; 3-<3-3)3@ 3-<(9@3)3@

• >@a)r -<n)raaD

• ;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->! ?3

• VENTOLIN 100 ,3@r<(ra, -929r3 a n<3

• >a 3:ra; R-. -; < 9na >r3a CSBB nr '%/%&/.

• 9r,a?a ;ra;a,n;9 @ar)3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>;D

24

7/24/2019 69625104-epicrize


• @<n>9; @ar)3<<(3@ -r3<)3@D

consult diabetologic la !linica de iabet si boli de nutritie

• ( r3n a @<n;r< >; 6 9n3 3n a:>n;a a@r:ar3<rD

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

• INSUFCIENTA RESPIRATORIE CRONICA ACUTIZATA

• COR4 PULMONAR CRONIC 4ECOMPENSAT

• NEO COLON 4ESCEN4ENT CHIMIOTRATAT

• POLIPOZA SIGMOI4IANA SPORA4ICA

• STEATOZA HEPATICA

• A4ENOM 4E PROSTATA

• CAR4IOPATIE ISCHEMICA CRONICA NE4UREROASA

• HTAE ST4 II CU RISC CAR4IOVASCULAR INAL.

• HEPATITA CRONICA VIRALA C.•

•


•

16.0.11 12:2 :

• Gran#=6.1 *10!"L Gran$=61.1 $ HCT='/. $ HGB=11. (!)

L+,-#='.1 *10!"L L+,-$='1.% $ MCH=.' -( MCHC='.% (!)

MCV=8.% 2L M3)#=0.% *10!"L M3)$=%. $ MPV=8.8 2L PCT=0.00

$ P45=1&./ $ PLT=8 *10!"L RBC='.8 10*10!"L R45

CV=1&. $ R45S4=&/.1 2 5BC=. *10!"L VSH 71=8 ,, VSH7=60 ,, ALAT=% U!L ASAT=/ U!L B33r9:3na ;<;aa=0.88 ,(!)

Cra;3n3na=0. ,(!) F3r=/1 9(!) F<>2a;a?a a@a3na=16& U!L GGT=&/ U!L

G3@,3=& ,(!) Pr<;3n ;<;a=& ,(!) Ur=/ ,(!)16.0.11 12:90 :

• S-9;a Ea,n ,3@<<(3@ 7A>-r(39>=A>-r(39> n(a;3. S-9;a Fr<;39

Gra,=A>-@; ,a@r<>@<-3@ Sa3ar

• A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 10&!@a,-

• C9 -3;3a >@9a,<a> &!@a,-

• F3:r3na -r?n; & @<@3 (ra, -<?3;33!@a,- 3n

(ra,?3 / @<@3 (ra, n(a;33 >3 :a@33 (ra, n(a;33!@a,- 9r3

• S@<r ) @a3;a; 0

16.0.11 12:99 :

• S-9;a Fr<;39 BAAR A=NEGATIV '%1!1%.08.011

16.0.11 12:97 :

• Ta:<9 >an(3n=PMN =66

• EO =

• BA =

• L = '0

• MO =

25

7/24/2019 69625104-epicrize


• 4>@r3r

17.0.11 11:27 :

• S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana.

1.0.11 11:21 :

• S-9;a Fr<;39 BAAR B=NEGATIV S-9;a Fr<;39 BAAR C=NEGATIV

2,.0.11 12:2 :

• S-9;a Ea,n ,3@<<(3@=Can)3)a >--. '& UFC!;9:.

•

• Bioumoral an,3 >@9n)ara 3n2a,a;<r3 ,3@r<@3;ara 3-<@r<,a >3n)r<, 3n2a,a;<r

a@@ra;.

• E<4 R> AV=100:!,3nD;ra>3>;< n;r3@9ar.

• Rx )A

•

• Pa@3n; 3n ar>;a ) &8 ) an3 n29,a;<r @9n<>@9; @9 an;@)n; ) -a;3;a @r<n3@a

3raa @9 3r9> C > -r?3n;a a C3n3@a ) Pn9,<<(3 233n) ;r3,3> -r3n UPU I a@9?an))3>-n a 2<r;9r3 ,3@3 ;9> >a@a @3n93;<ar >@a)ra ;<ran;3 a 2<r; a>;n<

a)3na,3 ;ran>-3ra;33 -r)<,3nan; >-ra 3na-;n;a )9rr3 a:)<,3na )329?

>3,-;<, @ a9 ):9;a; :r9>@ @9 < ?3 3na3n;a 3n;rnar33.

• Examenul obiecti(la internare >;ar (nraa 3n29n;a;aD 2a@3> an3<>D ;(9,n; >3

,9@<a> -a3)D -r?3n;a ), -r3,a<ar :3a;raD @3@a;r3@ -ara,)3ana >;an(a

-<>; <-ra;<r3 -n;r9 n< ) @<<nD 3,:a >a:9ra:aD 2anr @9 ,<)323@ar3 ;r<23@D ;>9;

@<nK9n@;3<a)3-<> :3n r-r?n;a;D ;<ra@ @32<;3@ @9 MV 3na>-r3; -3r -r9n(3; ra9r3@r-3;an; :a?a :3a;raD TA=110!%0,,H( AV=0:!,3nD )3(>;3 2<r,a;39n ;9,<raa

) '!'@, - @3@a;r3@a -<>;<-ra;<r3 ) @<n>3>;n;a ,<a r)9@;3:3a.

• Bioumoral: an,3 >@9n)ara 3n2a,a;<r3 ,3@r<@3;ara 3-<@r<,a >3n)r<, 3n2a,a;<r

a@@ra;.• E<4 R> AV=100:!,3nD;ra>3>;< n;r3@9ar.

• Rx )A In;r>;3;39 a@@n;9a; :3a;raD 3-r;ran>-arn;a @9 -r; -r<-r39 >9:@a3@9ar

>;an(D 33 @<n(>;33.

• P :a?a a,n993 @3n3@ ra)3<<(3@ >3 ) a:<ra;<r > >9>;3n )3a(n<>;3@9 ) ,a3 >9>.

• P -ar@9r>9 3n;rnar33 -a@3n;9 a a )?<;a; 9n -3><) ) )9rr3 -r@<r)3a )3>-n )

r-a9> ;ran>-3ra;33 (r;9r3. Sa 2@;9a; EJG 3n 9r(n;a >3 a>-@;9 -)a -n;r9 9n

3n2ar@; ,3<@ar)3@ a@9; ,<;3 -n;r9 @ar >a9 a),3n3>;ra; ;: ) n3;r<(3@r3na > >3 1 23

) A(<@a,3nD >a ><3@3;a; >r3@39 ) 9r(n;a @ar a r@<,an)a; -r9ara -a@3n;993 - 9n >r3@39 ) @ar)3<<(3 -n;r9 3n>;3(a;33 >9-3,n;ar >3 ;ra-3 ) >-@3a3;a;. In

;3,-9 3n;rnar33 3n >@;3a n<a>;ra -a@3;9 a 9r,a; ;ra;a,n; an;3:3<;3@7C3-r<2<a@3na

Gn;a,3@3na an;3;9>3 )39r;3@ -r<;@;<ar (a>;r3@ >3 -a;3@ 3;a,3n7B1 B6 @9a,3<rara >;ar33 (nra >3 <9;3 @3n3@a 2a<ra:3a.

•

• -r9ara -a@3n;993 ) @a;r >r3@39 ) @ar)3<<(3 @<n2<r, r@<,an)ar3<r ,)3@3<r

><3@3;a;3 -n;r9 @<n>9;9 ) 9r(n;a.

• PNEUMONIE LS4.

26

7/24/2019 69625104-epicrize


• HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULAR

INALT.

• ANEMIE SECUN4ARA.

• HEPATOPATIE 4E ETIOLOGIE NEPRECIZATA.

• OBEZITATE GR4 II.•

•


• 11.0.11 07:10 : Gran#='. *10!"L Gran$=6. $ HCT='6.6 $ HGB=1.1

(!) L+,-#=1.6 *10!"L L+,-$='1. $ MCH=8 -( MCHC='' (!)

MCV=8& 2L M3)#=0.' *10!"L M3)$=&. $ MPV=10.1 2L PCT=0.1%1

$ P45=16 $ PLT=1%0 *10!"L RBC=/.'1 10*10!"L R45CV=1'.$ R45S4=/. 2 5BC=&.1 *10!"L VSH 71=8' ,, VSH 7=11%

,, ALAT=1%% U!L ASAT=%6 U!L B33r9:3na ;<;aa=0.8/ ,(!)

• 11.0.11 07:11 : C<>;r<=18 ,(!) Cra;3n3na=1.' ,(!) F<>2a;a?a

a@a3na='6% U!L GGT='66 U!L G3@,3=10/ ,(!) L4H=/80 U!L

Pr<;3n ;<;a=6. ,(!) Ur=%& ,(!)

• 1.0.11 07:6 : VSH 71=8 ,, VSH 7=106 ,,

• E<4: RS AV= 100 :a;a3! ,3n9;D a RS 3n;r,)3arD HAS 9n) T 3na; V V6.

• )3R/70086;1.0.2011: ra;33 n<r,a.

• Rgr toracica: @<r) ,<)ra; ,ar3;D 33 @<n(>;33D <-a@3;a; 3n<,<(na LS4 :3n

)3,3;a;a 3n2r3<r ) >@3?9ra <r3?<n;aa 3ar >9-r3<r 29 )3,3;a;a 2a;a ) -arn@3,9

>9-ra3a@n;.

• !" toracic /11.0.2011 dr 4uttman ": a;a>a; @<-3.


• R?9;a; In LS4 -32r3@ 3>;a 9:n -r<@> ) a<3;a 9)a;3a -n9,<n3@a.

I,a(3n3 (an(3<nar ,)3a>;3na >9: 1 @,. N9 > @<n>;a;a,<)323@ar3 ;9,<ra >a9 a)n<-a;3@ 3<-9,<nar. N9 > @<n>;a;a a>-@; ) @<@;3 -9raa.N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@[email protected]@a;9 ar )3,n>39n3 >3 >;r9@;9ra

n<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar >a9 -<r;a. C<@3>;9 n9 >; <@93;. Gan)

SR ) a>-@; n<r,a. R3n3@33 :3a;ra a9 )3,n>39n3 >3 >;r9@;9ra n<r,a

• C<n@9?3 Pr<@> ) a<3;a 9)a;3a -n9,<n3@a LS4. Fara a>-@; T9 BP.

•

• E)-!R-A B<na 3n ar>;a ) %0 an3 n29,a;<r @9n<>@9; @9 an;@))n;

@ar)3<a>@9ar 7 HTA > -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> @9

-@;<ra;3 ,9@<a>a )3>-n a 2<r; ,)39 a>;n32:ra 2r3><an ;ran>-3ra;33

2a;3(a:33;a; >3,-;<, a@r:a; 3n 9;3, ?3 an;r3<r 3n;rnar33.• O:3@;3 a 3n;rnar -a@3n; a2:3 >9-ra-<n)raa @9 >;ara (nraa ,)39

,<)323@a;a ;(9,n; -a3)D -9,<nar MV 3na>-r3; ra9r3 @r-3;an; :a?a :3a;ra >3

rar >3:3an; TA= 1/0!80 ,,H(D AV= 0 :a;a3! ,3n9;.

• B3<<(3@ >)r. 3n2a,a;<r 7 VSH ,9; a@@ra; @ar 3n <9;3 r,3; 9><r >)r an,3@

>)r ) -a;<@3;<<?a L4H 9><r @r>@9; 9><ara 3-<-r<;3,n3.PFR ra;33 n<r,a.

Ra)3<(ra23a -9,<nara 3)n;3a?a <-a@3;a; 3n<,<(na LS4 :3n )3,3;a;a 3n2r3<r )>@3?9ra <r3?<n;aa 3ar >9-r3<r 29 )3,3;a;a 2a;a ) -arn@3,9 >9-ra3a@n; r3)3@an)9

27

7/24/2019 69625104-epicrize


> >9>-3@39na 9n3 -r@> 3n<@93;<r ) >-a;39 a a@>; n3 ,<;3 -n;r9 @ar > 3n)3@a

2@;9ara 9n93 CT ;<ra@3@. CT9 ;<ra@3@ )>@r3 9n -r<@> ) a<3;a 9)a;3a

-n9,<n3@a LS4 2ara a )>@r3 a>-@; ) T9 BP.

• In 9r,a ana,n?3 a a,n993 @3n3@ >3 a -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3

>9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> 2a@<an!?3 >3 Gn;a,3@3na 1 2!?3an;3;r,3@ an;3a(3@ an;33n2a,a;<r -@;<ran; -r<;@;<r -a;3@ -r<;@;<r (a>;r3@3;a,3n )39r;3@ >3 ) r@33:rar )r<@;r<3;3@aD a @<n;3n9a; ;ra;. - @ar 3 9r,a

a,:9a;<r @9 <9;3 2a<ra:3a.


•

•

•

• r(3, a3,n;ar 3-<><)a; 3-<(9@3)3@D

• 2<r; 23?3@ 3n 3,;a ;<ra:33;a;33D

•

;ra;a,n; ,)3@a,n;<> @9 TAVANIC &00 ,( 1 @-r! ?3 7% ?3D• ER4OME4 '00 ,( 1 @-r!?3 7% ?3D

• >a 3:ra; R- >r3a CSB4 nr 1//'%0'D

• ( consult gastroenterologic -n;r9 9@3)ara @a9?3 -a;<-a;33.

• r3n a @<n;r< ->; >a-;a,an3D

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.•

BR%&'%)&E#$%&-E

B)%! +" --- !# E=A!ERBARE

+AR!%-%A +"A-#* --

•

A&E$-E +E!#&ARA•


•

11.0.11 08:1, :

• Gran#=8. *10!"L Gran$=%.' $ HCT=/'./ $ HGB=1/./ (!)

L+,-#=1.' *10!"L L+,-$=11.% $ MCH='.% -( MCHC=''.1 (!)

MCV=8.8 2L M3)#=1 *10!"L M3)$= $ MPV=8.' 2L PCT=0./6 $

P45=1&./ $ PLT=% *10!"L RBC=/./ 10*10!"L R45CV=1'.1

$ R45S4=/8. 2 5BC=11. *10!"L VSH 71=/ ,, VSH 7=8,, ALAT=6 U!L ASAT='1 U!L B33r9:3na ;<;aa=0.0 ,(!)

Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na=0 U!L G3@,3=' ,(!) L4H='/1 U!L Pr<;3n ;<;a=6 ,(!) Ur='0 ,(!)

12.0.11 0:9 :

• S-aa;9ra :r<n>3@a Fr<;39 BAAR A=NEGATIV '%6%!1.08.011 S-aa;9ra

:r<n>3@a Fr<;39 BAAR B=NEGATIV S-aa;9ra :r<n>3@a Fr<;39 BAAR

C=NEGATIV

12.0.11 0:97 :

28

7/24/2019 69625104-epicrize


• S-aa;9ra :r<n>3@a C9;9r3 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana.

S-aa;9ra :r<n>3@a E.,3@<<(3@=Can)3)a >-- /0 UFC!-a@a S-aa;9ra :r<n>3@a

Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ M9@<-9r9n;

• A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,- ,a@r<2a(

• C9 -3;3a >@9a,<a> 10&!@a,-

• F3:r3na -r?n; 2<ra :a@;r3ana -<3,<r2a rar 9r3• S@<r ) @a3;a;

17.0.11 11:08 :

• LaaK :r<n<a<ar C9;9r3 ar<:=Rar @<<n33 ) (r,n3 )3n ,3@r<:3<@n<?a

<r< 2ar3n(3ana LaaK :r<n<a<ar Ea,n ,3@<(3@=N9 >a9 )?<;a;

29n(3. LaaK :r<n<a<ar Fr<;39 Gra,=A>-@; ,a@r<>@<-3@

• A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 !

• C9 -3;3a >@9a,<a> >3 :r<n>3@ 10!@a,-

• F3:r3na a:>n;

• S@<r ) @a3;a; !

17.0.11 11:10 :• LaaK :r<n<a<ar Fr<;39 -;. )@rar BAAR=NEGATIV '80%!18.08.011

LaaK :r<n>3<<a<ar E. @3;<<(3@=N9,ar ;<;a ) @9 0. 1000000. Fr<;39 @9@9ar3;a; r)9>a @<n>;3;93;a -r)<,3nan; )3n @9 -3;3a :r<n>3@ >3 rar

,a@r<2a(. N3n;r-r;a:3 -r<@n;9a.

•

• Pa@3n; 3n ar>;a ) &6 ) an3 n29,a;<r 2ara an;@)n; -r><na -a;<<(3@ >

-r?3n;a a C3n3@a ) Pn9,<<(3 a@9?an) ;9> @9 -@;<ra;3 ,9@<-9r9n;a

)3>-n a 2<r;9r3 ,<)ra; >@a)ra ;<ran;3 a 2<r; >@a)r -<n)raa a>;n3

2a;3(a:33;a; >3,-;<, 3n>;aa; @9 a-r<3,a;3 ' ?3 an;r3<r 3n;rnar33.

•

Examenul obiecti(la internareD >;ar (nraa ,<)ra;a;ra;aD ;<ra@ @9 ><n<r3;a; -9,<nara @9 ,9r,9r ?3@9ar -r?n; 2ara ra9r3D TA= 10!60,,H( AV=%&:!,3n.

• Biologic 9@<@3;<?a an,3 ,a@r<@3;ara n<r,<@r<,a.

• E<4 R> AV=8&:!,3nD aa RS n<r,aaD 2ara ,<)323@ar3 3>@,<?3<na.

• R= )A C<r) (<:a ,ar3; ) <9, ,a3 a@@n;9a; VS. B9;<n a<r;3@ -r3,a;. 4>n

3n;r>;3;3a a@@n;9a; :3a;ra ,9;3- <-a@3;a;3 n<)9ar >3 3nar -ara3ar :3a;ra

@a@323r3 3arD3,a(3n3 ,33ara)n<-a;33 -<3@3@3@ -ara;raa :3a;ra >3 ,9;3-

,3@r<<-a@3;a;3 n<)9ar >3 3nar -r)<,3nan; :3a;ra @9 ;n)3n;a a @<n29ar @ r3)3@a

>9>-3@39na 9n3 -<>3:3 >ar@<3)<?.

• Aan) 3n )r @r3;r33 )@a; a ra)<(ra23 > r@<,an)a 2@;9ara 9n93 !"

toracic @ar 3)n;3a?a ,9;3- a>-@; ) @<n)>ar -9,<nar 3n 2@ar ) -ana a '

@, )3a,;r9 @ -)a?a -n;r9 < >ar@<)<?a. E3>;a ,9;3- a)n<-a;33 ,)3a>;3na ) -ana a ,, )3a,. A)n<-a;33 3ar :3a;ra ) -ana a & ,, )3a,. C<n@9?3Sar@<3)<?a >;a)39 II 2ara a @9) < a;a ;3<<(3.

• S 2@;9a?a bron?oscopie 3n )ra ra3?ar33 9n93 aaK :r<n<a<arD a

:r<n<>@<-3 3-ra>@9ar3?a;3 a :r<n33 -r3,3;3 :3a;ra. S@r;33 ,9@<-9r9n;a:9n)n;. S9>-@; :r<n>3@;a?33 :r. LSS a ,r(n;a >3 @9,3naa. A>-@; >9(>;3 )

>ar@<3)<?a 2ara a @9) 9n -<>3:3 -r<@> ;9,<ra.

29

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• *aaul bron?oaleolar )@a?a 2r<;39 @9 @9ar3;a; r)9>a @<n>;3;93; )3n @9

-3;3a ,a@r<2a(.

• Biopsia 3)n;3a?a r)9>a :r<n>3;a @r<n3@aD 2ara ?39n3 (ran9<,a;<a> 2<@ar )

n@r<?a @a?<a>a >a9 ,n; ) ,a3(n3;a; 3n ,a;r3a9 a,3na;.

• )3R = 43>29n@; n;3a;<r3 ,3;a. R>;r3@;3a ,<)ra;a. O:>;r9@;3a ,<)ra;a >(,n;

@n;ra >ra 3n -r32r3. r)9@ra VEMS @9 /%$.• P :a?a a,n993 @3n3@ ra)3<<(3@ :r<n<>@<-3@ CT T<ra@3@ >3 ) a:<ra;<r > >9>;3n

)3a(n<>;3@9 ) ,a3 >9>.

• P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7C3-r3n< 3;a,3n7B1 B6

an;39>3 -r<;@;<r (a>;r3@ -@;<ran; an;3a(3@ @9 a,3<rara >;ar3 (nra >3

<9;3 @3n3@a 2a<ra:3a.

•

•

•

• 3;ara 3n2@;33<rD

•

)<?ara 2<r;993 23?3@ 3n 29@n;3 ) ;<ran;a a 2<r;D ;ra;a,n; ,)3@a,n;<> @9 "aanic 1tb;zi zile.

• Erdomed 900mg 2x1tb;zi 7 zile.

• )3>-n>ar3?ar -rn ,)3@9 ) 2a,33D

• r3n a @<n;r< ->; 6 9n3 3n a:>n;a a@r:ar3<r @9 :3; ) ;r3,3;r ) a ,)3@9

) 2a,33 >3 a)r3n;a ) >aar3a;.

• BOALA PULMONARA CRONICA OBSTRUCTIVA SEVERA ACUTIZATA.

• INSUFICIENTA RESPIRATORIE CRONICA.

• TBC PULMONAR SECUN4AR BAAR NEGATIV CULTURI IN LUCRU.•

•


• 12.0.11 08: : Gran#='. *10!"L Gran$=&/.1 $ HCT=/1./ $ HGB=1'.&

(!) L+,-#=. *10!"L L+,-$='8.1 $ MCH='0.% -( MCHC='.6(!) MCV=/.& 2L M3)#=0.& *10!"L M3)$=%.8 $ MPV=8.8 2L

PCT=0.0 $ P45=1&.% $ PLT='8 *10!"L RBC=/.' 10*10!"L

R45CV=1/.& $ R45S4=&0.' 2 5BC=&. *10!"L VSH 71='0

,, VSH 7=6 ,,

• 16.0.11 08:0/9777;16.0.2011 :S-9;a Fr<;39 BAAR A=NEGATIV

• S-9;a Fr<;39 BAAR B=NEGATIV

• S-9;a Fr<;39 BAAR C=NEGATIV

• 18.0.11 0:0, : ALAT=1 U!L ASAT=0 U!L B33r9:3na ;<;aa=0.% ,(!) C<>;r<=16 ,(!) Cra;3n3na=1.& ,(!) F<>2a;a?a a@a3na=16% U!L GGT=/ U!L G3@,3=%& ,(!) L4H=&06 U!L Pr<;3n ;<;a=8.' ,(!)

Ur=/ ,(!)

• E<4: RS AV= 60 :a;a3! ,3n9; a RS a 0 (ra) 9n) T 3na;.

Rgr toracica /,091 ,092; 12.0.2011: ,9;3- <-a@3;a;3 n<)9ar 3n23;ra;3 LSS @9

?<n ) 3-r;ran>-arn;a @ ;ra@;3<na?a ;raa @<r)9 >3 a>@n>3<na?a 39 >;an(.

O-a@3;a;3 n<)9ar >3 3nar 3n2ra3ar )r-;.

30

7/24/2019 69625104-epicrize


• )3R/6887;10.0.2011: )3>29n@;3 n;3a;<r3 ,3;a >ra - ;<; ar:<r :r<n>3@.

VEMS 1 3;r9. R)9@ra n;3a;33 ,a3, @9 % $.

•

E)-!R-A:

• Pa@3n; 3n ar>;a ) /8 an3 2<>; 29,a;<r a ->; & PA @9n<>@9; @9 an;@)n; -r><na

-a;<<(3@ -9,<nar7 TBC -9,<nar >@9n)ar LSS 3n 010 > -r?3n;a -n;r9 ;9>>a@a -r>3>;n;a )3>-n a 2<r;9r3 ,3@3! ,<)ra; >@a)ra ;<ran;3 a 2<r; a>;n<

a)3na,3 2a;3(a:33;a; >3,-;<,a;<<(3 a@@n;9a;a 3n 9;3,a >a-;a,ana an;r3<r3n;rnar33.

• O:3@;3 a 3n;rnar -a@3n; a2:r3 @9 >;ar (nra ,)39 3n29n;a;aD -9,<nar MV

3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;raD TA= 1'0!80,,H( AV= %8 :a;a3! ,3n9;.

• B3<9,<ra >)r 3n2a,a;<r 9><r 9><r >)r an,3@ @ra;3n3na >3 L4H 9><r @r>@9;.

Ea,n9 >-9;3 -n;r9 BJ >; BARR n(a;3 a ,3@r<>@<-3 @9;9r3 233n) 3n 9@r9.

R(r ;<ra@3@a 3)n;3a?a ,9;3- <-a@3;a;3 n<)9ar 3n23;ra;3 LSS @9 ?<n )3-r;ran>-arn;a @ ;ra@;3<na?a ;raa @<r)9 >3 a>@n>3<na?a 39 >;an(D <-a@3;a;3

n<)9ar >3 3nar 3n2ra3ar )r-;. PFR )3>29n@;3 n;3a;<r3 ,3;a >ra - ;<;

ar:<r :r<n>3@D VEMS 1 3;r9D r)9@ra n;3a;33 ,a3, @9 % $.

• In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ > >;a:3>; )3a(n<>;3@9

) ,a3 >9>.

• P -ar@9r>9 3n;rnar33 a 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> 2! ?3 an;33n2a,;<r

an;3a(3@ an;3;r,3@ :r<n<)3a;a;<r @9 )9ra;a >@9r;a >3 9n(a ) a@;39n an;3;9>3 HHC

-r<;@;<r (a>;r3@ >3 -a;3@ 3;a,3n >3 ) r@33:rar 3)r<@;r<3;3@a @9 <9;32a<ra:3a )3>-n >3 ;9>a >a9 a,3<ra;.

• S ;rna?a a,3<ra; @9 r@<,an)ar3

• •

• r(3, a3,n;ar @33:ra; @a<r3@D

• 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33 @9 @r>;ra ;<ran;3 a 2<r; -r3n r@3;33 9><arD

• ;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->! ?3

• CLENIL ET 100 ,3@r<(ra, -92 !?3D

• >a 3:ra; R- -n;r9 < 9na >r3a CSB4 nr. 1//'%06D

• r3n )9-a r?9;a;9 @9;9r3<r -n;r9 BJ a2a; 3n 9@r9D

• <3(n<;ra-3 a )<,3@339 / 3;r3! ,3n9; 10 <r !?3D

• r3n a @<n;r< ->; ' 9n3 3n a:>n;a a@r:ar3<rD

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.• BOALA PULMONARA CRONICA OBSTRUCTIVA ST4 II GLO4 IN

EACERBARE.

• TBC PULMONAR SECUN4AR FIBRONO4ULAR LS BAAR NEGATIV LA

MICROSCOPIE CULTURI IN LUCRU.

• ANEMIE SECUN4ARA•

•

31

7/24/2019 69625104-epicrize



•

17.0.11 07:99 :

• Gran#=/.% *10!"L Gran$=6&.6 $ HCT='.1 $ HGB=1.8 (!)

L+,-#=1.8 *10!"L L+,-$=&.' $ MCH=. -( MCHC='.% (!)

MCV=8./ 2L M3)#=0.6 *10!"L M3)$=.1 $ MPV=.' 2L PCT=0.1&$ P45=1&.% $ PLT=' *10!"L RBC=/.'8 10*10!"L R45

CV=1/. $ R45S4=/8.1 2 5BC=%.1 *10!"L VSH 71=1 ,, VSH7=/0 ,, ALAT=/ U!L ASAT='% U!L B33r9:3na ;<;aa=0.'8 ,(!)

Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na=1& U!L GGT=10 U!L G3@,3=88

,(!) L4H=&6% U!L Pr<;3n ;<;a=6.& ,(!) Ur=61 ,(!)

•

• E)-!R-A Pa@3n; 3n ar>;a ) &% an3 29,a;<r a '0PA @9n<>@9; @9 an;@)n;

-r><na -a;<<(3@ -9,<nar 7BPOC TBC -,<nar >@. S9-9ra;3 @r<n3@a LIS >3

<>;<ra;3@9ar 7Pr<;?a @<<2,9raa )ra-;a> 3n;rna?a -n;r9 ;9> @9 -@;<ra;3,9@<-9r9n;a )3>-n a 2<r;9r3 ,<)ra; a>;n<a)3,an3 2a;3(a:33;a; >@a)ra

;<rn;3 a 2<r; 3na-;n;a >@a)r -<n)raa ;ran>-3ra;33 -r)<,3nan; n<@;9rn

>3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r 3n;rnar33.

• %biecti la internare >;ara (nraa ,)39 ,<)323@a;a ;(9,n; ;ran>-3ra;D

-9,<nar ;<ra@ a>;n3@ MV 3na>-r3; @9 -3r -r9n(3; ra9r3 r<n2an; )3>,3na; 3n

a,:33 @a,-3 -9,<nar3 ra9r3 @r-3;an; :a?a :3a;raD TA= 1'0!80,,H(D AV= %0

:a;a3! ,3n9;.

• Bioumoral >)r. 3n2a,a;<r7VSH a@@ra; >)r an,3@D 9><ara r;n;3 a?<;a;a.

• )3R 43>29n@;3 n;3a;<r3 ,3;aD r>;r3@;3a ,<)ra;a <:>;r9@;3a ,<)ra;a >(,n;

@n;ra >3 >ra 3n -r32r3D r)9@ra VEMS @9 &&$.

• Radiografia pulmonara 3)n;3?a <-a@3;a;3 3nar ) 3n;n>3;a; @<>;aa -r)<,3nan;

3n2ra3ar >;an(D• In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 )

,a3 >9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@7A,<3-9> 1 ( a 1HHC an;33n2a,a;<r an;3a(3@

-@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3n >3 )r@33:rar 3)r<@;r<3;3@a @9 <9;3 2a<ra:3a.

• r(3, a3,n;ar @33:ra; @a<r3@D

• rn9n;ara a 29,a;D

• a@@3nar an;3(r3-aa an9aaD

• ;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->!?3D

•

SERETI4E &0!&0 ,3@r<(ra, 1 -92! ?3D• VENTOLIN 100 ,3@r<(ra, 1-922!?3 >3 a n<3.


• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

• BOALA PULMONARA CRONICA OBSTRUCTIVA ST4 II GLO4 IN

EACERBARE.

• TBC PULMONAR SECUN4AR FIBRONO4ULAR LS BAAR NEGATIV LA


32

7/24/2019 69625104-epicrize


• ANEMIE SECUN4ARA•

•


•

17.0.11 07:99 :• Gran#=/.% *10!"L Gran$=6&.6 $ HCT='.1 $ HGB=1.8 (!)

L+,-#=1.8 *10!"L L+,-$=&.' $ MCH=. -( MCHC='.% (!) MCV=8./ 2L M3)#=0.6 *10!"L M3)$=.1 $ MPV=.' 2L PCT=0.1&

$ P45=1&.% $ PLT=' *10!"L RBC=/.'8 10*10!"L R45

CV=1/. $ R45S4=/8.1 2 5BC=%.1 *10!"L VSH 71=1 ,, VSH7=/0 ,, ALAT=/ U!L ASAT='% U!L B33r9:3na ;<;aa=0.'8 ,(!)

Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na=1& U!L GGT=10 U!L G3@,3=88

,(!) L4H=&6% U!L Pr<;3n ;<;a=6.& ,(!) Ur=61 ,(!)

•

• E)-!R-A Pa@3n; 3n ar>;a ) &% an3 29,a;<r a '0PA @9n<>@9; @9 an;@)n;

-r><na -a;<<(3@ -9,<nar 7BPOC TBC -,<nar >@. S9-9ra;3 @r<n3@a LIS >3

<>;<ra;3@9ar 7Pr<;?a @<<2,9raa )ra-;a> 3n;rna?a -n;r9 ;9> @9 -@;<ra;3,9@<-9r9n;a )3>-n a 2<r;9r3 ,<)ra; a>;n<a)3,an3 2a;3(a:33;a; >@a)ra

;<rn;3 a 2<r; 3na-;n;a >@a)r -<n)raa ;ran>-3ra;33 -r)<,3nan; n<@;9rn

>3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r 3n;rnar33.

• %biecti la internare >;ara (nraa ,)39 ,<)323@a;a ;(9,n; ;ran>-3ra;D

-9,<nar ;<ra@ a>;n3@ MV 3na>-r3; @9 -3r -r9n(3; ra9r3 r<n2an; )3>,3na; 3na,:33 @a,-3 -9,<nar3 ra9r3 @r-3;an; :a?a :3a;raD TA= 1'0!80,,H(D AV= %0

:a;a3! ,3n9;.

• Bioumoral >)r. 3n2a,a;<r7VSH a@@ra; >)r an,3@D 9><ara r;n;3 a?<;a;a.

•

)3R 43>29n@;3 n;3a;<r3 ,3;aD r>;r3@;3a ,<)ra;a <:>;r9@;3a ,<)ra;a >(,n;@n;ra >3 >ra 3n -r32r3D r)9@ra VEMS @9 &&$.

• Radiografia pulmonara 3)n;3?a <-a@3;a;3 3nar ) 3n;n>3;a; @<>;aa -r)<,3nan;

3n2ra3ar >;an(D

• In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 )

,a3 >9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@7A,<3-9> 1 ( a 1HHC an;33n2a,a;<r an;3a(3@

-@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3n >3 )r@33:rar 3)r<@;r<3;3@a @9 <9;3 2a<ra:3a.

• r(3, a3,n;ar @33:ra; @a<r3@D

• rn9n;ara a 29,a;D


• ;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->!?3D

• SERETI4E &0!&0 ,3@r<(ra, 1 -92! ?3D

• VENTOLIN 100 ,3@r<(ra, 1-922!?3 >3 a n<3.


• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

"#$%RA BR%&'%)#*$%&ARA *++

33

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B)%! +" -- 4%* !# E=A!ERBARE

• %BE-"A"E•


• 16.0.11 08:19 : Gran#=&.' *10!"L Gran$=66. $ HCT=/.6 $

HGB=1/.' (!) L+,-#= *10!"L L+,-$=&.& $ MCH=.6 -( MCHC=''.& (!) MCV=88.' 2L M3)#=0.% *10!"L M3)$=8.' $ MPV=8./ 2L PCT=0.1& $ P45=1&.8 $ PLT='' *10!"L RBC=/.8'

10*10!"L R45CV=1'.& $ R45S4=/&. 2 5BC=8 *10!"L

ALAT=1 U!L ASAT=18 U!L B33r9:3na ;<;aa=0.6 ,(!) Cra;3n3na=0.,(!) F3r=%6 9(!) F<>2a;a?a a@a3na=1' U!L GGT=0 U!L

G3@,3=1/0 ,(!) L4H='' U!L Pr<;3n ;<;a=% ,(!) Ur='1 ,(!)

• 18.0.11 0:0 : VSH 71=1/ ,, VSH 7=' ,, G3@,3=160 ,(!)

•

• Rx )A O-a@3;a; n<)9ara ) a-r<3,a;3 / @,)3a,;r9 <@a3?a;a 3n LSS @9

a;@;a?3 ) LSS.

• E<4 R> AV=8:!,3nD ?39n3 3>@,3@ )329?.

• )3R:70062=43>29n@;3 n;3a;<r3 ,3;a. r>;r3@;3a ,<)ra;a. O:>;r9@;3a 9><ara

>(,n; @n;ra ,<)ra;a 3n -r32r3. r)9@ra VEMS @9 '%$

•

•

• Pa@3n; 3n ar>;a ) 6/ an3 2<>; 29,a;<r780PA @9n<>@9; @9 BPOC a2a; >9: ;ra;a,n;

@9 S-3r3a 18,3@r<(ra,!?3 S+,:3@<r; 160!/&,3@r<(ra, 1-922!?3 > -r?3n;aa@9?an) )3>-n a 2<r;9r3 ,3@3!,<)ra; ;9> @9 -@;<ra;3 ,9@<-9r9n;a a>;n<

a)3na,3 2a;3(a:33;a; >3,-;<, @ >a9 3n>;aa; @9 ' ?3 an;r3<r 3n;rnar33.

• Examenul obiecti(la internare >;ar (nraa 3n29n;a;aD >9-ra-<n)raD 2a@3>

an3<>D ;(9,n; ;an(3@;a?33 2a@3a ?39n3 r3;,a;<a> -r9r3(3n<a> a n39;<ra@93 an;r3<rD 3,:a >a:9raaD ;<ra@ ,23?,a;<> ><n<r3;a; -9,<nara @9 MV

3na>-r3; @9 -3r -r9n(3; ra9r3 >3:3a,n; a n39 @a,-993 -9,<nar >;an(D

SaO=/$.TA=1'0!80,,H(D AV=6/:!,3n.

• Bioumoral: 3-r(3@,3.


a;@;a?3 ) LSS.

• E<4 R> AV=8:!,3nD ?39n3 3>@,3@ )329?.

•

•

•

• 4a;<r3;a a>-@;993 )@a; a ra)3<<(3 >a r@<,an)a; 2@;9ara 9n93 !" toracic @ar

3)n;3a?a -r<@> -r<32ra;3 <@a3?a; 3n LSS @9 3n@9)ra AP>;an(a. M)3a>;3n

r;ra@;a;a >-r >;an(a 2ara a)n<-a;33. C<n@9?3 TU BLSS T/N0M0

• 7>a a;a>a; @<-3 r<.

• Pn;r9 >;a:33ra )3a(n<>;3@993 ) @r;3;9)3n > 2@;9a?a bron?oscopie @ar )@a?a

<:>;r9@;3 :r. -r3,3;3a >;an(a 3n2r3<r -r3n 2<r,a;39n (;an;a ,<:3a a ;9> >3

r>-3ra;3 @9 -9n@; ) -@ar :r. LSS >3 -3n;n 3n;r<:ar >;an(. Sa 2@;9a; :3<->3.

34

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• Examenul ?istopatologic 3)n;3a?a Car@3n<, >@9a,<> nra;3n3?a; ,3@r<3na?3 3n

,a;r3a9 a,3na;.

• )3R =43>29n@;3 n;3a;<r3 ,3;a. r>;r3@;3a ,<)ra;a. O:>;r9@;3a 9><ara >(,n;

@n;ra ,<)ra;a 3n -r32r3. r)9@ra VEMS @9 '%$

• P :a?a a,n993 @3n3@ ra)3<<(3@ C; ;<ra@3@ B >3 ) a:<ra;<r > >9>;3n

)3a(n<>;3@9 ) ,a3 >9>.• P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7C3-r3n<@<r;3?<n3@

:r<n<)3a;a;<r 3;a,3n7B1 B6 an;3;9>3 ,<>;a;3@ an;3-3r;3@ >3 an;3a(3@ @9a,3<rara >;ar33 (nra >3 <9;3 @3n3@a 2a<ra:3a.

•

•

• 3;ara 3n2@;33<rD

• )<?ara a@;33;a;33 23?3@ 3n 29n@;3 ) ;<ran;a a 2<r;D

@<n;3n9ara ;ra;a,n;993 @9 +piria 1micrograme 1cps;zi dimineataC6 luniC

• +@mbicort 160;, micrograme 2x1puff;zi 6 luni.

•

@<n>9; a I.O.C.N.• PNEUMONIE LS4.

• ANEMIE SECUN4ARA.

• IMAGINI GANGLIONARE INFLAMATORII ME4IASTINALE.•


• 12.0.11 07:1 : Gran#=.% *10!"L Gran$=/% $ HCT='6.1 $ HGB=1

(!) L+,-#=.8 *10!"L L+,-$=/%.% $ MCH=.6 -( MCHC=''.

(!) MCV=8. 2L M3)#=0.' *10!"L M3)$=&.' $ MPV=8.& 2L

PCT=0.'6 $ P45=1&.6 $ PLT=/6% *10!"L RBC=/.0& 10*10!"L R45CV=1/.& $ R45S4=/8. 2 5BC=&.8 *10!"L VSH 71=6'

,, VSH 7=11 ,, ALAT=1& U!L ASAT=% U!L B33r9:3na;<;aa=0./ ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=& U!L GGT=18U!L G3@,3=8' ,(!) L4H=/' U!L Pr<;3n ;<;a=6.% ,(!)

Ur=/ ,(!)

• R43 stand. PA)>n 3n;r>;3;3a a@@n;9a; :a?a :3a;ra 33 23:r<?a;3 a>@n>3<na;3 @9

@a@323@ar3.

• E!4 RS AV= 60 :a;a3! ,3n9;D a RS a 0 (ra) 9n) T 3na; 3n V V&.

• )3R/11.0.2011: ra;33 nr,a.

•

• E)-!R-A

• Pa@3n; 3n ar>;a ) & an3 29,a;<r a /PA ;rna; 3n 9na 393 )3n @3n3@a na>;ra @9)3a(n<>;3@9 ) Pn9,<n3)ra-;a >3 I,a(3n3 (an(3<nar 3n2a,a;<r33 ,)3a>;3na >

-r?3n;a -n;r9 ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r; ,)39 a>;n<

a)3na,3 2a;3(a:33;a; >@a)ra ;<rn;3 a 2<r; K9n(3 ;<ra@3@ -<>;r3<r >3,-;<,a@r:a; 3n 9;3,a >a-;a,ana an;r3<r 3n;rnar33.

• %biecti la internare -a@3n; a2:r3 @9 >;ar (nraa 9><r 3n29n;a;a ;(9,n; >3

,9@<a> -a3) -9,<nar ;<ra@ ,23?,a;<> MV 3na>-r3; @9 -3r -r9n(3; ra9r3

@r-3;an; :a?a :3a;raD TA= 1'0!80,,H( AV= &8 :a;a3! ,3n9;.

35

7/24/2019 69625104-epicrize


• E<4: Rs AD60b;minC axa R+ normala.

• Biologic >)r. 3n2a,a;<r 7VSH a@@ra; >)r an,3@ FA >3 L4H 9><r @r>@9;. PFR

>9n; 3n 3,3; n<r,a.

• Radiografia pulmonara <-a@3;a; 29 )3,3;a;a 3n,<(na >3;9a;a 3n;r@3<)<3ar

)r-;. @a@323r3 3ar :3a;raa.

• In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ),a3 >9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> 2! ?3 HHC an;33n2a,a;<r an;3;r,3@

an;3a(3@ -@;<ran; :r<n<)3a;a;<r @9 )9ra;a >@9r;a ) a@;39n -r<;@;<r -a;3@

-r<;@;<r (a>;r3@ 3;a,3n >3 ) r@33:rar 3)<@;r<3;3@a @9 <9;3 2a<ra:3a.•

• r(3, a3,n;ar @33:ra; @a<r3@D

• 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

• a@@3nar an;3(r3-a an9aaD

• ;ra;a,n; ,)3@a,n;<> @9 VENTOLIN 100 ,3@r<(ra, -929r3 a n<3.

• r3n a @<n;r< ->; < 9na @9 :3; ) ;r3,3;r ) a ,)3@9 ) 2a,33 >3 )<a)a@a3;a;33 ) a>3(9ra;D

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

• PNEUMONIE LI4.

• BOALA PULMONARA CRONICA OBSTRUCTIVA ST4 III GOL4 IN

EACERBARE.

• INSUFICIENTA RESPIRATORIE CRONICA ACUTIZATA.

• COLECTIE PLEURALA 4REAPTA .

• STENOZA AORTICA ME4IE.

• INSUFICIENTA CAR4IACA CONGESTIVA CLASA NHA II.

•

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 III CU RISCCAR4IOVASCULAR INALT.

• CAR4IOPATIE ISCHEMICA ANGINA PECTORALA 4E EFEORT.

• PURTATOR 4E PACEMAJER.


•


• 11.0.11 10:1 :Gran#=6.0 *10!"L Gran$=%8. $ HCT=/.' $ HGB=1'.6

(!) L+,-#=1.0 *10!"L L+,-$=1'.8 $ MCH=8.' -( MCHC='.1(!) MCV=88.' 2L M3)#=0.& *10!"L M3)$=%.' $ MPV=8./ 2L

PCT=0. $ P45=1&.6 $ PLT=6& *10!"L RBC=/.80 10*10!"L R45CV=1&.& $ R45S4=/%./ 2 5BC=%.& *10!"L VSH 71=18

,, VSH 7=/8 ,, ALAT= U!L ASAT=% U!L B33r9:3na;<;aa=0.8& ,(!) Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na=18' U!L GGT=%0

U!L G3@,3=110 ,(!) L4H=/'0 U!L Pr<;3n ;<;a=6. ,(!)

Ur=& ,(!)

• 12.0.11 10:16/9778;16.0.2011 : L. -9ra Fr<;39 -;. )@rar BAAR=NEGATIV

36

7/24/2019 69625104-epicrize


• 12.0.11 10:17 : L. -9ra @9;3ar :a@;r33 ar<:=N9 >a9 )?<;a; (r,n3. L.

-9ra @9;9r3 anar<:=N9 >a9 )?<;a; (r,n3. L. -9ra Ea,n

,3@<<(3@=N9 >a9 )?<;a; 29n(3. L. -9ra 2r<;39 Gra,=F3:r3na rar 9@<@3;rar ,a;33.

• 12.0.11 10:1 : L3@3) -9ra Ea,n @3;<<(3@=PMN = / $ E< = / $ L+ = % $

@9 ,?<;3a =1' $ rar ,a;33 L3@3) -9ra G9@<?a=11 ,(!) L3@3) -9ra L4H=16 U!L L3@3) -9ra Pr<;3n=1.6 (!)

)3R/11.0.2011: )3>29n@;3 n;3a;<r3 ,3;a >ra 3n ;<; ar:<r :r<n>3@. VEMS

13;r9. R)9@ra n;3a;33 ,3, @9 60$.

• Rgr toracica /,8,0 ,8,1;12.0.2011: @ar)3<>;3,9a;<rD @<r) (<:a ,ar3;D 33

@<n(>;33D )>n 3n;r>;3;3a a@@n;9a; :3a;ra. <-a@3;a; :a?aa )ra-;a @ <@9-a 1!'3n2r3<ra a ,3;<ra@93 )r-;.

• EJG r3;, ) CAE AV= 100 :a;a3! ,3n9;.

•

• E)-!R-A: Pa@3n; 3n ar>;a ) %% an3 n29,a;<r -9r;a;<r ) -a@,ar @9n<>@9; @9

an;@)n; -9,<nar7In>923@3n;a r>-3ra;<r3 @r<n3@a BPOC a2a; >9: ;ra;a,n; @9Sr;3) &0!&00 1 -92!?3 Vn;<3n -929r3 a n<3. @ar)3<a>@9ar 7HTA CI

S;n<?a a<r;3@a ,)3 CPC -9r;a;<r ) -a@,ar > 3n;rna?a -n;r9 )3>-n )

r-a9> @9 <r;<-n ;9> @9 -@;<ra;3 ,9@<-9r9n;aa>;n< a)3na,3 2a;3(a:33;a;>@a)ra ;<an;3 a 2<r; a,;3 ), (a,:3r ,<)ra; ;ran>-3ra;33 >3,-;<,

a@r:a; 3n 9;3, ?3 an;r3<r 3n;rnar33.

• O:3@;3 a 3n;rnar -a@3n; >9-ra-<n)ra a2:r3 @9 >;ar (nraa 3n29n;a;a ),

(a,:3r ,<)ra; :3a;ra -9,<nar ,a;3;a; 3n 1!' 3n2r3<ara a ,3;<ra@93 )r-; @9MV a:<3; a a@>; n3D ra9r3 @r-3;an; :a?a >;an( >3 ra9r3 r<n2an; )3>,3na; 3n 1!

>9-r3<ara a a,:3<r @a,-3 -9,<nar3 >3 23n ra9r3 >3:3an; )3>,3na; 3n a,:33 @a,-3

-9,<nar3D TA= 1/0!8& ,,H(D AV= 8 :a;a3! ,3n9;.

•

B3<<(3@ >)r. 3n2a,a;<r 7VSH a@@ra; @r>;ra 9><ara a GGT >3 a L4H >)r )r;n;3 a?<;a;a 9><ara 3-<-r<;3n,3.. Ea,n9 3@3)993 -9ra -n;r9 BJ >;

n(a;3 @9;9r3 233n) 3n 9@r9. PFR )3>29n@;3 n;3a;<r3 ,3;a >ra 3n ;<; ar:<r :r<n>3@. VEMS 13;r9D r)9@ra n;3a;33 ,3, @9 60$. Ra)3<(ra23a -9,<nara

)>@r3 <-a@3;a; :a?aa )ra-;a <,<(na @ <@9-a 1!' 3n2r3<ra a ,3;<ra@93 )r-;.

P -ar@9r>9 3n;rnar33 >a 2@;9a;a; ;<ra@n;?a )3a(n<>;3@a >3 ;ra-9;3@a @9 a@9ara a

a-r<3,a;3 &000 , 3@3) -9ra >r<@3;r3n 7>a9 2@;9a; ' -9n@;33 -9raa@9a;<r33 @9 @ara@;r ) ;ran>9)a;.

• In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 )

,a3 >9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r @9 )9ra;a

>@9r;a ) a@;39n >3 @9 )9ra;a 9n(a ) a@;39n )39r;3@ -r<;@;<r -a;3@ -r<;@;<r(a>;r3@ a @<n;3n9a; ;ra;a,n;9 @ar)3<<(3@ - @ar 3 9r,a a,:9a;<r @9 <9;3

2a<ra:3a. S ;rna?a @9 r@<,an)ar3

• r(3, a3,n;ar 3-<><)a;D

• 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

• ;ra;a,n; ,)3@a,n;<> SERETI4E &0!&00 ,3@r<(ra, 1 -92!?3D

• VENTOLIN 100 ,3@r<(ra, -929r3 a n<3

37

7/24/2019 69625104-epicrize


• AVELO /00 ,( 1 @-r!?3 7% ?3D >a 3:ra; R- @<,->a;a

>r3a CSB4 nr 1//'%0

• ER4OME4 '00 ,( 1 @r!?3 7% ?3 >a 3:ra; R-

@<,->a;a >r3a CSB4 nr 1//'%0

• -n;r9 r)9@ra ),<r > 3n)3@a F9r<>,3) /0 ,( 1 ;a:;a a ?3 >3

S-3r;<n<a@;<na &0 ,( 1@-r!?3D• 9r,a?a ;ra;a,n;9 @ar)3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>;D

• ( consult cardiologicC


• ,<n3;<r3?ar -r3n ,)3@9 ) 2a,33.•

• PNEUMONIE LS4.

• HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULAR

INALT.

• CAR4IOPATIE ISCHEMICA ANGINA PECTORALA 4E EFORT.

•INSUFICIENTA TRICUSPI4IANA GR I! II.

• 4ISLIPI4EMIE MITA.

• SPON4ILOZA C4L CU RA4ICULAGII.•


•

18.0.11 0:09 :

• Gran#=&./ *10!"L Gran$=6.8 $ HCT=/0. $ HGB=1'.& (!)

L+,-#=.% *10!"L L+,-$='.' $ MCH=%.8 -( MCHC='' (!)

MCV=8/.6 2L M3)#=0./ *10!"L M3)$=/. $ MPV=. 2L PCT=0.'11

$ P45=16.1 $ PLT='1& *10!"L RBC=/.8/ 10*10!"L R45CV=1/./ $ R45S4=/&./ 2 5BC=8.& *10!"L VSH 71=/ ,, VSH

7=0 ,, ALAT=6 U!L ASAT=1 U!L B33r9:3na ;<;aa=0.6 ,(!)

C<>;r<=1% ,(!) Cra;3n3na=1 ,(!) F3r=8/ 9(!) F<>2a;a?aa@a3na=111 U!L GGT=' U!L G3@,3=8' ,(!) L4H=%1 U!L

Pr<;3n ;<;a=%.1 ,(!) Ur=1 ,(!)

• 18.0.11 12:99 /9,2;22.0.2011 : A>-3ra; :r<n>3@ Fr<;39 BAAR A=NEGATIV

•

E)-!R-A:

• Pa@3n; 3n ar>;a ) &6 an3 2<>; 29,a;<r7'0PA @9n<>@9; @9 HTA >;) III 3n>923@3n;a

;r3@9>-3)3ana (r) I!II an(3na -@;<raa ) 2<r; 3n>923@3n;a n;r3@9ara NHA II

BPOC > -r?3n;a a C3n3@a ) Pn9,<<(3 a@9?an) ;9> >a@a 3n;r,3;n;a )9rrr;r<>;rnaa )3>-n a 2<r;9r3 ,<)ra; ;ran>-3ra;33 a:9n)n; >@a)ra ;<ran;3 a

2<r; K9n(3 ;<ra@3@ -<>;r3<r a>;n<a)3na,3.

• %biecti(la internare >;ar (nraa ,<)ra;a;ra;aD ;an(3@;a?33 2a@3aD ;<ra@

n<r,a @<n2<r,a; ><n<r3;a; -9,<nara @9 MV 3na>-r3; @9 -3r -r9n(3; ra9r3@r-3;an; :a?a :3a;ra. TA=10!60,,H( AV=%6:!,3nD

• E<4: R> AV=6&!,3nD a>-@; ) BRS ,3n<rD 2ara ,<)323@ar3 3>@,3<?3<na.

38

7/24/2019 69625104-epicrize


• Rx )AD T<ra@ ,23?,a;<> @<a>; r;3@a3?a; @<r) ,ar3; ) <9, 3n;r>;3;39

a@@n;9a;. B9;<n9 a<r;3@ a,-rn;a?a >3 3,-3n( )3>@r; ;raa. O-a@3;a; 3n2ra3ar

)r-; 3n<,<(na.

• Biologic n<r,a.

• )3R = 43>29n@;3 n;3a;<r3 ,3;a ,)3 - ;<; ar:<r :r<n>3@. r)9@ra VEMS @9

'$.• !" pulmonar 2@;9a; an;r3<r 3n;rnar33 3)n;3a?a r)9@ra <9,993 -9,<nar

a-@a >;an(D 3n(r<>ara -9raa >;an(a >3 3n -<r;39na >9-r3<ara a >@3?9r33 <:3@ >;an(3D3,a(3n n<)9ara 2<r,a nr(9a;a a-3@a >;an( 3n @<n;a@; @9 -9ra ,)3a>;3naa

a)n<-a;3 ,)3a>;3naa @n;3,;r3@ FAPD >9-rarna @9 a>-@; n<r,a.

• !t cranian: 2ara ?3n3 ;r<)n> >9-ra >3 3n2ra;n;<r3a ?<na ) <>;<>@r<?a a

n39 r;9937U;3,a >@;39n.

• Aan) 3n )r @r3;r33 )@a; a ra)3<(ra23 >3 C; -9,<nar >3 @ran3an > r@<,an)a

2@;9ara 9n3 :r<n<>@<-33 @ar 3)n;3a?a Br. -r3,3;3a >;an(a LIS L3n(9a >(,n;

n;ra @9,n 3:r. S;n<?a @9 a>-@; @3@a;r3@3a :r. @9,3naa >(,;n a-3@<)<r>a @9>9-9ra;3 >@. M9@<a>a ) a>-@; :r<>n3;a @r<n3@a. Sa 2@;9a; a>-3ra; B @ar a 2<>;

9;r<r n(a;3.

• P :a?a a,n993 @3n3@ ra)3<<(3@ @<r<:<ra; @9 )a; )@a; a C; -9,<nar >3

@ran3an @9 )a; ) a:<ra;<r > >9>;3n )3a(n<>;3@9 ) ,a3 >9>.• P -ar@9r9> 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7A,<3 -9> (9@<?a

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• 3;ara 2r3(993 3n2@;33<r 3n;,-r3<rD

• )<?ara a@;33;a;33 23?3@ 3n 29n@;3 ) ;<ran;a a 2<r;D

• ;ra;a,n; ,)3@a,n;<> @9 TAVANIC &00 ,( 1 !?3D

• Er)<,) '00 ,( 1 @-r!?3

>a 3:ra; R- @<,-n>a;a >r3a CSB) nr 1//'%18 @<n;3n9ara ;ra;a,n;993 r@<,an)a; ) @ar)3<<(D r3n a @<n;r< ->; < 9na 3n a:>n;a a@r:ar3<rD

PNEUMONIE BAZALA STANGATUMORA BRONHOPULMONARA CENTROHILARA STANGA

PLEUREZIE PARANEOPLAZICA

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 III!CSTOMAC OPERAT


17.0.11 07:,8 :

VSH 71=11& ,, VSH 7=1 ,, ALAT=% U!L ASAT=' U!L B33r9:3na

;<;aa=0.&' ,(!) Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na='&' U!L GGT=1/ U!L G3@,3=81 ,(!) L4H=&0 U!L Pr<;3n ;<;a=8. ,(!) Ur=&0 ,(!)

1.0.11 08:11 :

Gran#=&./ *10!"L Gran$=6' $ HCT='%. $ HGB=1. (!) L+,-#=./*10!"L L+,-$=8.6 $ MCH=./ -( MCHC='.% (!) MCV=0 2L

39

7/24/2019 69625104-epicrize


M3)#=0.% *10!"L M3)$=8./ $ MPV=%.1 2L PCT=0./'8 $ P45=1&./ $

PLT=61% *10!"L RBC=/.1/ 10*10!"L R45CV=1'.6 $ R45S4=/6.% 2

5BC=8.& *10!"L

29.0.11 19:20 :

L. -9ra Fr<;39 -;. )@rar BAAR=NEGATIV '8%!/.08.011

29.0.11 19:22 : L. -9ra Ea,n ,3@<<(3@=N9 >a9 )?<;a; 29n(3. L. -9ra 2r<;39 Gra,=F3:r3na

29.0.11 19:29 :

L3@3) -9ra G9@<?a=// ,(!) L3@3) -9ra L4H=868 U!L L3@3) -9ra Pr<;3n=' (!)

E)-!R-A:

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<,<-a;993 >;an( )3>-n a 2<r;9r3 ,<)ra; >@a)ra ;<ran;3 a 2<r; a>;n<a)3na,3

2a;3(a:33;a; 3na-;n;a ;9> >a@a 3n;r,3;n;a >3,-;<, @ >a9 3>n;aa; 3n 9r,a @9

a-r<3,a;3 < 9na @ >a9 a(raa; 3n 9;3,3 ?3.Ea,n9 <:3@;3a 3n;rnar >;ar (nraa ,<)ra;a;ra;aD 2a@3> an3<>D ;(9,n;

n<r,a @<<ra; ;an(3@;a?33 @a23a @3@a;r3@ a:)<,3naa ,)3ana -<>; <-ra;3 -n;r9>;<,a@ 3,:a >a:9raaD ;<ra@ @9 >9:,a;3;a; :a?a >;an( @9 MV ,9; )3,3n9a; a a@>; n3.

MV 3na>-r3; @9 -3r -r9n(3; a n39 ,3;<ra@93 )r-; ra9r3 @r-3;an; :a?a )r-; SaO

=&$. TA=10!60,,H( AV= 6!,3n.EJG R> A=100:!,3nD aa RS n<r,aaD 2ara ,<)323@ar3 3>@,3<?3<na.

R PA O-a@3;a; 3n 1!' 3n2r3<ara a ,3;<ra@93 >;an( ra;3 <,<(na >3 29 )3,3;a;a

>@ -9ra :a?a >3 >@9?3ra >;an(aD @<@;3 -9raa 3n@3>;a;a.

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- :r<n>3a 3n(9a.

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VEMS @9 '8$.

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3;a,3n7B1 B6 -a;<-r<;@;<ar an;33n2a,a;<r33 an;3-3r;3@ an;3a(3@ IECA an;3;9>3

@9 a,3<rara >;ar33 (nra >3 <9;3 @3n@3a 2a<ra:3a.

• > 3n)3@a 3n;rn;3 @3r9r(3@aa >3 > r@<,an)a ;ran>2r9 - >@;3a ) @3r9r(3

;<ra@3@a.

)&E#$%&-E -&"ER+"-"-A*A

-&+#3-!-E&"A RE+)-RA"%R-E !R%&-!A A!#"-A"A

B)%! +" --- !# E=A!ERBARE

-&+#3-!-E&"A !AR-A!A !%&4E+"-A &>'A ---

'-)ER"E&+-#&E AR"ER-A*A E+E&"-A*A +" ---;!

• !%R )#*$%&AR !R%&-!•


40

7/24/2019 69625104-epicrize


•

2,.0.11 07:6 :

• 5BC=* 1&.& *10!"L L+,-#='.1 *10!"L M3)#=0.8 *10!"L Gran#=*

11.6 *10!"L L+,-$=1.% $ M3)$=&.& $ Gran$=%/.8 $ HGB=*1'.& (!) RBC=/.%1 10*10!"L HCT=/1./ $ MCV=88.1 2L MCH=8.6

-( MCHC='.6 (!) R45CV=* 1&.' $ R45S4=&0.6 2 PLT='/*10!"L MPV=* %.% 2L P45=1&. $ PCT=0.6' $ VSH 71=6,, VSH 7=10' ,, ALAT=/ U!L ASAT=' U!L B33r9:3na

;<;aa=0.6 ,(!) C<>;r<=1%0 ,(!) Cra;3n3na=* 1.8 ,(!) F<>2a;a?a

a@a3na=1%' U!L GGT=6 U!L G3@,3=* 6/ ,(!) L4H='&8 U!L Pr<;3n ;<;a=% ,(!) Tr3(3@r3)=118 ,(!) Ur=* &8 ,(!)

•

• Bioumoral=9@<@3;<?a ,<)ra;aD 9><ara r;n;3 a?<;a;a.

• E<4 R> AV=0:!,3nD ,<)323@ar3 3>@,3@ )329?.

• Rx )A In;r>;3;39 -9,<nar a@@n;9a; :3a;ra. O-a@3;a;3 n<)9ar >3 3nar 3n23;ra;3

3n 1!' 3n2r3<ara a a,:3<r @a,-3 -9,<nar3.•

• Pa@3n; 3n ar>;a ) %& ) an3 @9n><@9; @9 BPOC >;) III 3n>923@3n;a r>-3ra;<r3 @r<n3@a

@ar)3<-a;3 3>@,3@a an(3na -@;<raa ) 2<r; ICC NHA III BR4 ,aK<r HTAE >;)III!C CPC 3n2ar@; ,3<@ar)3@ @3 > -r?3n;a a@9?an) )3>-n a 2<r;9r3 ,3@3 ;9> @9

-@;<ra;3 ,9@<-9r9n;a 3na-;n;a ;ran>-3ra;33 2r3><an >@a)ra ;<ran;3 a 2<r;

a>;n<a)3na,3 2a;3(a:33;a; )9rr -r@<r)3aa @9 @ara@;r ) a-a>ar >3,-;<, @ >

a9 3n>;aa; 3n 9r,a @9 ?3. Pa@3n;9 >a -r?n;a; 3n >r3@39 UPU 9n) a 2<>; a9a;>3 @33:ra; 233n) 9;r3<r ;r3,3> a C3n3@a ) Pn9,<<(3 3n )ra >;a:33r33 ;ra-33

) >-@3a3;a;.

• Examenul obiecti(la internare: a2:r3 (r9 @<<-ran;D >;ar (nraa=3n29n;a;aD

>9-ra-<n)raD 2a@3> an3<>D ;(9,n; 9>@a; @9 ,<)323@ar3 3-r;r<23@ a n39(a,:3. T<ra@ ,23?,a;<> ><n<r3;a; -9,<nara @9 MV 3n>-r3; @9 -3r -r9n(3;

ra9r3 r<n2an; )3>,3na; 3n a,:33 @a,-3 -9,<nar3 ra9r3 @r-3;an; :a?a :3a;ra.

TA=1&0!0,,H( AV=8:!,3n.

• Bioumoral=9@<@3;<?a ,<)ra;aD 9><ara r;n;3 a?<;a;a.

• E<4 R> AV=0:!,3nD ,<)323@ar3 3>@,3@ )329?.

• Rx )A In;r>;3;39 -9,<nar a@@n;9a; :3a;ra. O-a@3;a;3 n<)9ar >3 3nar 3n23;ra;3

3n 1!' 3n2r3<ara a a,:3<r @a,-3 -9,<nar3.


• P -ar@9r>9 3n;rnar33 -a@3n;9 a )?<;a; -3><a) >9@@>3 ) 3-r;n>39n -n;r9

@ar >a a),3n3>;ra; )39r;3@7F9r<>,3) S-3r<n<a@;<na IECA7Ca-;<-r3 @r3? >r

) )3>-n -3ra;<r3 @9 ?3n( >3 ;ran>-3ra;33 -r<29? @a) 3-r3n2a;37>aa),3n3>;ra; ;ra;a,n; @<r;3?<n3@ :r<n<)3a;a;<r @9 a,3<rara n;a a >;ar33 (nra >3

<9;3 @3n3@a 2a<ra:3a.

• 3;ara 2r3(993 3n2@;33<r 3n;,-r33<rD

• )<?ara a@;33;a;33 23?3@ 3n 29n@;3 ) ;<ran;a a 2<r;D

;ra;a,n; ,)3@a,n;<> @9 +eretide 0;00 2x1 puff;zi 6 luniC

"enox mg 2x1tb;ziC

41

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• entolin 100micrograme 2x1 puff;zi la neoie.

• @<n>9; @ar)3<<(3@ 3n )ra >;a:33r33 >@,3 ) ;ra;a,n;D

• -r?n;ar a @<n;r< ->; 6 9n3 3n a:>n;a a@r:ar3<r @9 :3; ) ;r3,3;r ) a

,)3@9 ) 2a,33 >3 @9-<n ) -n>3.

• BPOC >;) III G<) 3n a@r:ar

• Pn9,<n3 <:ara )ra-;a

• HTAE >;) II r3>@ @ar)3<a>@9ar 3na;

• B<aa Ba>)<.

• O:?3;a; (r) II.

• An,3 >@9n)ara.•


• 22.0.11 08:7 : Gran#=8.6 *10!"L Gran$=6 $ HCT='%./ $ HGB=1.&

(!) L+,-#=.8 *10!"L L+,-$= $ MCH=. -( MCHC=''./

(!) MCV=8.% 2L M3)#=1.1 *10!"L M3)$= $ MPV=8. 2L PCT=0.18 $ P45=1&.& $ PLT=0 *10!"L RBC=/.18 10*10!"L

R45CV=1'.% $ R45S4=/6. 2 5BC=1.& *10!"L VSH 71='0 ,, VSH 7=%0 ,, ALAT=/ U!L ASAT=1 U!L B33r9:3na ;<;aa=1. ,(!)

C<>;r<=16 ,(!) Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na=1&/ U!L

GGT=/6 U!L G3@,3=%0 ,(!) L4H=/% U!L Pr<;3n ;<;a=6.%,(!) Ur='/ ,(!)

• 22.0.11 19:11 : B33r9:3na )3r@;a=0.6& ,(!)

• 2.0.2011: ASPRUP -C<= /0. ,,H( PO =1',,H( Sa; O= 8.% $ 7 >9:

<3(nD

• Na= 1'% ,,<!D J= /.6 ,,<!D Ca= 0./ ,,<!

• E<4: RS A %& :!,3n A RS /& (r)7 HBAS >9:)n3ar ST ) 0& @, V'V6

• )3R )3>29n@;3 n;3a;<r3 r>-3ra;<r3 ,3;a >ra 3n ;<; ar:<r :r<n>3@. VEMS >9:

1 3;r9.

• Radiograf pulmonara: )>n 3n;r>;3;3a a@@n;9a; :a?a :3a;r ,9;3- <-a@3;a;3

3nar >3 n<)9ar @9 ;n)3n;a a @<n29ar :a?a )ra-;a 33 @<n(>;33 @<r) (<:a,ar3;

•

• E)-!R-A

• B<na 3n ar>;a ) 61 an3 29,a;<r a ->; /0PA @9n<>@9; @9 an;@)n; -9,<nar

7BPOC >;) III a2a; >9: ;ra;a,n; @9 S-3r3a 18 ,3@r<(ra, 1 @->! ?3 >3 Vn;<3n a

n<3 @ar)3<a>@9ar 7 HTA F3A @<nr;3;a a R> >3n9>a >3 n)<@r3n 7 B<aaBa>)< > -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> >a@a -r>3>;n;a )3>-n a2<r; ,)39 >@a)ra ;<ran;3 a 2<r; a>;n3 a)3na,3 ), (a,:3r :3a;ra

>3,-;<, a@r:a; 3n 9;3,a ?3 an;r3<r 3n;rnar33.

• O:3@;3 a 3n;rnar -a@3; >9-ra-<n)ra a2:r3 @9 >;ar (nraa ,)39 ,<)323@a;a

;(9,n; -a3) ), :3a;ra a ,,:r 3n2r3<ar -9,<nar ;<ra@,23?,a;<> MV 3na>-r3; @9 -3r -r9n(3; :a;ra ra9r3 @r-3;an; :a?a :3a;ra >3

ra9r3 r<n2an; )3>,3na; 3n a,:33 @a,-3 -9,<nar3.

42

7/24/2019 69625104-epicrize


• B3<<(3@ >)r. 3n2a,a;<r ,<)ra;79@<@3;<?a VSH a@@ra; >3n)r<, an,3@ 9><r .

PFR )3>29n@;3 n;3a;<r3 r>-3ra;<r3 ,3;a >ra 3n ;<; ar:<r :r<n>3@ VEMS >9: 1

3;r9.

• Ra)3<(ra23a -9,<nara 3)n;3a?a )>n 3n;r>;3;3a a@@n;9a; :a?a :3a;r ,9;3-

<-a@3;a;3 3nar >3 n<)9ar @9 ;n)3n;a a @<n29ar :a?a )ra-;a 33 @<n(>;33 @<r)

(<:a ,ar3;.• P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@7C3-r3n< 1 2!?3 HHC an;33n2a,a;<r an;3;r,3@

an;3a(3@ -@;<ran; :r<n<)3a;a;<r @9 )9ra;a >@9r;a ) a@;39n >3 9n(a ) a@;39n

-r<;@;<r -a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;.@ar)3<<(3@ >3 n)<@r3n<<(3@

an;r3<r @9 <9;3 2a<ra:3a. S ;rna?a a,3<ra; @9 r@<,an)ar3

• r(3, a3,n;ar 3-<><)a; 3-<3-3)3@ >3 3-<(9@3)3@D

• 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

• 3;ara 3r3;an;3<r r>-3ra;<r3

• a@@3nar an9aa an;3(r3-aa

•

@<n;3n9ara ;ra-33 @ar)3<<(3@ @9 ra9ar -r3<)3@a• @<n;3n9ara ;ra-33 >3 ,<n3;<r3?ara 29n@;33 ;3r<3)3n

TRATAMENT ,)3@a,n;<> @9 +piria 10 ug 1cps;zi

+@mbicort 160;,. micrograme 2x1 puf; ziC

entolin 100 micrograme 2 pufuri la neoie.

"aanic 00 mg 1 cpr;zi /7 zileC

• Er)<,) '00 ,( 1 @-r!?3 7% ?3

• >a 3:ra; R- @<,-n>a;a >r3a CSB4 nr1//'%1' 7 -; an;3:3<;3@ >3 >r3a CSB4 nr

1//'%1/ 7-n;r9 :r<<)3a;a;<rD


• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

B)%! +" --- conform 4%* cu exacerbare

'-)ER"E&+-#&E AR"ER-A*A E+E&"-A*A 4RA#* --- !# R-+!

!AR-%A+!#*AR 3%AR"E -&A*"

!AR%)A"-E -+!'E$-!A &E#RER%A+A

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-ABE" A'ARA" "-) 2 &%# E)-+"A".

-+*-)-E$-E $-="A.

A*ER4-E *A )E&-!-*-&A +- *-+-&%)R-*.

• %BE-"A"E 4R --.

•

•

•


• 1.0.11 07:1 :Gran#=8. *10!"L Gran$=%&.% $ HCT='%. $ HGB=1.'

(!) L+,-#=1.6 *10!"L L+,-$=1'.8 $ MCH=8. -( MCHC=''

(!) MCV=8&.% 2L M3)#=1. *10!"L M3)$=10.& $ MPV=8.& 2L

PCT=0.1%% $ P45=1&.6 $ PLT=0 *10!"L RBC=/.'& 10*10!"L

43

7/24/2019 69625104-epicrize


R45CV=1/./ $ R45S4=/&. 2 5BC=11.% *10!"L VSH 71=' ,,

VSH 7=11& ,, ALAT=' U!L ASAT=/0 U!L B33r9:3na ;<;aa=1.1

,(!) C<>;r<=18 ,(!) Cra;3n3na=0. ,(!) F3r=&% 9(!) F<>2a;a?aa@a3na=% U!L GGT='& U!L G3@,3=/1 ,(!) Pr<;3n ;<;a=&./

,(!) Ur=/1 ,(!)

•1.0.11 10:,6 : B33r9:3na )3r@;a=1.& ,(!)

• 1.0.11 11:90 :Ta:<9 >an(3n=PMN = %8

• EO =

• BA =

• L = 18

• MO =

22.0.11 07:10 :

• G3@,3 1=06 ,(!) G3@,3 =%& ,(!) G3@,3 '=&/ ,(!)

G3@,3 /=61 ,(!) G3@,3 &=08 ,(!) G3@,3 6=06 ,(!)

• !onsult diabetologic/2,.0.2011 4(. 43a:; ?aara; ;3- n<9 )-3>;a;

• Pa@3n;a r29?a ,<,n;an 3n>93n<;ra-3a. S r@<,an)a Siofor 850mg, 1-0-1 )9-a,a>aD L9ar 3n 3)n;a a ;rnar -r3n a,:9a;<r7@9 :3; ) ;r3,3;r ) a ,)3@9 )2a,33. 74r. Ian@9 S33a

•

• E)-!R-A:

• Pa@3n;a 3n ar>;a ) 6' ) an3 2<>; 29,a;<ar760PA @9n<>@9;a @9 3-r;n>39n

ar;r3aa >n;3aa (r) IIIC @ar)3<-a;3 3>@,3@a @r<n3@a 3n>923@3n;a @ar)3a@a

@<n(>;3a NHAIII )3a:; ?aara; ;3- n@<n;r<a; > -r?3n;a a C3n3@a )

Pn9,<(3 -r3n UPU I a@9?an) 2:ra7'8/8C 2r3><an ;ran>-3ra;33 )3>-n a 2<r;9r3,3@3 ;9> @9 -@;<ra;3 ,9@<-9r9n;a a>;n<a)3na,3 2a;3(a:33;a; (r>;9r3 3n><;3;

) ar>a;9r3 a3,n;ar @2a a,;3 >3,-;<, 3n>;aa; 3n 9r,a @9 < >a-;a,ana @

>a9 a@r:a; 3n 9;3,3 ?3.

• %biecti(la internareD >;ar (nraaD ,<)ra;a;ra;aD >9-ra-<n)raa 2a@3> an3<>D

@3an<?a -r3<raaD ;<ra@ ,23?,a;<> >n<r3;a; -9,nara @9 ,9r,9r ?3@9ar 3na>-r3;@9 -r -r9n(3; ra9r3 r<n2an; >3 >3:3an; )3>,3na; 3n a,:3 @a,-3 -9,<nar3 ra9r3

@r-3;an; :a?a :3a;ra. La n39 a-ara;993 @ar)3<a>@9ar > )@a?a

TA=1&0!80,,H( AV=8:!,3n.

• Biologic >3n)r<, 3n2a,a;<r a@@ra;D -a;<@3;<3?a ,<)ra;aD >3n)r<, ) @<>;a?aD

3-r(3@,3D 3-<-r<;3n,3.

• E<4 R> AV= 11&,3nD ;a3@ar)3 >3n9>aaD P -9,<nar.2ara ,<)323@ar3 3>@,3<

?3<na.

•

Rx )A A@@n;9ara )>n993 -9,<nar 3n;r>;3;3a ) a>-@; r;3@9<,3@r<n<)9ar. Fara -n,<-r3;<n9. Fara n3 3)r<ar3@. S3n9>9r3 @<>;<)3a2ra(,a;3@ >9n; 3:r.

• Ecografia abdominala 2@;9a;a 3n UPU )@a?a C<@3>; 2ara @a@93 an> @9

-r3>;a;3>, -a>;ra;D 2ara 3@3) 3:r 3n @a3;a;a -r3;<naa.

• Aan) 3n )r a<r3 (3@,3@ @r>@9; >a r@<,an)a; 2@;9ara 9n93 -r<23

(@,3@D <ra 1'=06,(!)D <ra 1&=%&,(!)D <ra 18=&/,(!)D <ra 1=61,(!)D <ra

'=08,(!)D <ra %=06,(!).

44

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• )3R = 43>29n@;3 n;3a;<r3 ,3;a. R>;r3@;3a ,<)ra;a. O:>;r9@;3a ,<)ra;a >(,n;

@n;ra >ra 3n -r32r3. R)9@ra VEMS @9 /6$.

• !onsult diabetologic -a@3n;a r29?a ,<,n;an 3n>93n<;ra-3a. S r@<,an)a S3<2<r

8&0,( 101 )9-a ,a>aD L9ar 3n 3)n;a a ;rnar -r3n a,:9a;<r7@9 :3; );r3,3;r ) a ,)3@9 ) 2a,33. 74r. Ian@9 S33a

• P :a?a a,n99 @3n3@ ra)3<<(3@ >3 ) a:<ra;<r > >9>;3n )3a(n<>;3@9 ) ,a3 >9>.• P -ar@9r>9 3n;rnar33 -a@3n;a a 9r,a; ;ra;a,n; an;3:3<;3@7C3-r<2<a@3na

an;33n2a,a;<r an;3-3r;3@ an;3a(3@ -r<;@;<r (a>;r3@ )39r;3@ @9 <9;3 @3n3@a2a<ra:3a.

•

• 3;ara 2r3(993 3n2@;33<rD

• )<?ara a@;33;a;33 23?3@ 3n 29n@;3 ) ;<ran;a a 2<r;D

;ra;a,n; ,)3@a,n;<> @9 +piria 1micrograme 1cps;ziC 6 luniC

+eretide 0;20 2x1puff;zi 6 luniC

• entolin 100micrograme 2x1puff;zi la neoie.

• "aanic 00 mg 1 cpr;zi /7 zileC

• Erdomed 900 mg 2x1 cpr;zi /7 zile

• >a 3:ra; R- @<,-n>a;a Sr3a CSB4 nr 1//'%167 -n;r9 an;3:3<;3@ >3 >r3a CSB4 nr

1//'%16 7 -; :r<n<)3a;a;<r

• ;ra;a,n; @9 S3<2<r 8&0,( 101D

• @<n;3n9ara ;ra;a,n;993 r@<,an)a; ) @ar)3<<(.

• @<n>9; @ar)3<<(3@D

• consult diabetologic @<n2<r, -r<(ra,ar33D

• ra9ar a @n3@a ) )3a:;<<(3 @9 -r<(ra,ar >3 :3; ) ;r3,3;r ) a ,)3@9 )

2a,33.

•

r3n a @<n;r< ->; 6 9n3 3n a:>n;a a@r:ar3<r @9 :3; ) ;r3,3;r ) a ,)3@9) 2a,33 >3 @9-<n ) -n>3.

• PNEUMONIE INTERSTITIALA

•


•

17.0.11 08:18 :

• Gran#='.8 *10!"L Gran$=/%./ $ HCT='8 $ HGB=1 (!)

L+,-#='.% *10!"L L+,-$=/6./ $ MCH=% -( MCHC='1.& (!)

MCV=8&.8 2L M3)#=0.& *10!"L M3)$=6. $ MPV=8. 2L PCT=0.88$ P45=1&.% $ PLT='& *10!"L RBC=/./' 10*10!"L R45

CV=1/. $ R45S4=/'.6 2 5BC=8 *10!"L VSH 71= ,, VSH7=6 ,, ALAT=1' U!L ASAT=1 U!L B33r9:3na ;<;aa=0.&% ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=168 U!L GGT=1' U!L G3@,3='

,(!) L4H='6' U!L Pr<;3n ;<;a=% ,(!) Ur='1 ,(!)

•

• )3R 17.0.2011;9 :n<r,a

• E<4: r> a RS /& (r) AV 60 :!,3n

45

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• Radiogr toracica )>n 3n;r>;3;3a a@@n;9a :a?a :3a;ra 33 @<n(>;33 2ara ?39n3

a@;3 -9r<-9,<nar

•

• E)-!R-A:

• Pa@3n;a ) 6/ ) an3 2ara APP >,n323@a;3 -r?3n;a ) a-r< & ?3 ;9> @9

-@;<ra;3 ,9@<-9r9n;a ;ran>-3ra;33 >9:2:r33;a; )3>-n ) ,<)ra;a ) 2<r; >@a)ra ;<ran;3 a 2<r; a>;n3 a)3na,3 2a;3(a:33;a; @9 a(raar ;r-;a;a. E

<:3@;3 ;(9,n; n<r,a @<<ra; ;<ra@ n<r,a @<n2<r,a; MV 23?3<<(3@ 2ara ra9r3>9-rara)a9(a;.D TA 1'0!80 ,,H(

• B3<<(3@ >3n)r<, 3n2a,a;<r ,<)ra;.

• Ea,3nara ra)3<<(3@a 3)n;3a?a a@@n;9ara 3n;r>;3;3993 -9,<nar :a?a :3a;ra

33 @<n(>;33.

• In a@>; @<n;; @3n3@ :3<<(3@ >3 3,a(3>;3@ >9>;3n, )3a(n<>;3@9 ) ,a3 >9>.

• P -ar@9r>9 3n;rnar33 a 9r,a; ;ra;a,n; an;3:3<;3@ 7C3-r3,< 1 2!?3 an;3;r,3@

an;3a(3@ -r<;@;<r (a>;r3@ >3 -a;3@ 3;a,3n >3 ) r@33:rar 3)r<@;r<3;3@a @9

<9;3 2a<ra:3a.• S ;rna?a a,3<ra; @9 r@<,an)ar3

•

•

• 3;ara 3r3;an;3<r r>-3ra;<r3

• a@@3nar an9aa an;3(r3-aa

• "RA"A$E&": Taan3@ &00 ,( 100 7% ?3

• Er)<,) '00 MG 101 710 ?3

• F9@<3, &0 MG 100 7% ?3

• >a 3:ra; R- @<,-n>a;a >r3a CSB4 nr 1//'%1&D

•

r3n a @<n;r< ->; 9n3 @9 :3; ) ;r3,3;r ) a ,)3@9 ) 2a,33 >3 @9-<n ) -n>3D

• )3>-n>ar3?ar -r3n MF >3 ra9ar -n9,<<(3@a a 9n3

•

•

• Pn9,<n3 LS4

• HIPERTENSINE ARTERIALA ESENTIALA ST4 II C RISC

CAR4IOVASCULAR MO4RAT

• CAR4IOPATIE ISCHEMICA CRONICA.•

Analize de laborator:•

18.0.11 11:29 :

• S-9;a Fr<;39 BAAR A=NEGATIV '8/%!.08.011 S-9;a Fr<;39 BAAR

B=NEGATIV S-9;a Fr<;39 BAAR C=NEGATIV

18.0.11 11:2, :

46

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• S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a

Ea,n ,3@<<(3@=Can)3)a >--. 'UFC!-a@a S-9;a Fr<;39 Gra,=A>-@;

,a@r<>@<-3@ Sa3arA>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,-

• C9 -3;3a >@9a,<a> &!@a,-

• F3:r3na a:>n; 2<ra ,3@r<:3ana -<3,<r2a 9r3.• S@<r ) @a3;a; 0

22.0.11 07:16 :

• Gran#='.& *10!"L Gran$=60.8 $ HCT=/.8 $ HGB=1'.& (!)

L+,-#=1.8 *10!"L L+,-$='1. $ MCH=%.8 -( MCHC='1.& (!)

MCV=88./ 2L M3)#=0.& *10!"L M3)$=8 $ MPV=./ 2L PCT=0.1'' $

P45=16 $ PLT=1/ *10!"L RBC=/.8& 10*10!"L R45CV=1/.% $ R45S4=/%.6 2 5BC=&.8 *10!"L VSH 71=& ,, VSH 7=1 ,,

ALAT=& U!L ASAT='0 U!L B33r9:3na ;<;aa=0.6 ,(!) F<>2a;a?a

a@a3na=1%8 U!L GGT=%0 U!L G3@,3=%0 ,(!) L4H='' U!L Pr<;3n ;<;a=6.1 ,(!)

22.0.11 07:17 :

• Ur='6 ,(!)

• )3R: <:>;r9@;3 ,)3 3n -r32r

• Radiogr toracica ,9;3- <-a@3;a;3 3nar >3 n<)9ar @9 ;n)3n;a a @<n29ar a?a

)ra-;aD 33 @<n(>;33 D @<r) (<:a ,ar3;

•

E)-!R-A

•

• Pa@3n; ) 81 ) an3 @9 an;@)n; :a@3ar > -r?3n;a -n;r9 a;rara >;ar33 (nra

;9> @9 -@;<ra;3 ,9@<-9rn;a @an; ,<)ra;a K9n(3 ;<ra@3@ )r-; >9:2:r33;a;7 '%

6 )3>-n ,<)ra;a ) r-a9> a>;n3 a)3na,3. O:3@;3 a 3n;rnar >;ara (nraa

,)39 a;ra;a ;(9,n; -a3) ;ran>-3ra; >9:2:r3 ;<ra@ ,23?,a;<> M 3na>-r3;

:a?a :3a;ra rar ra9r3 @r-3;an; :a?a )ra-;a. S r3)3@a >9-3@39na 9n3 ra@;3ar3 :a@3ar 3n23r,a;a -r3n a,3nara ,3@r<>@<-3@a. C99r3 3n 9@r9

• PFR <:>;r9@;3 ,)3 3n -r32r

• Ra)3<(r ;<ra@3@a ,9;3- <-a@3;a;3 3nar >3 n<)9ar @9 ;n)3n;a a @<n29ar :a?a

)ra-;aD 33 @<n(>;33 D @<r) (<:a ,ar3; .

• In a@>; @<n;; @3n3@ >3 -ara@3n3@ >;a:33, )3a(n<>;3@9 ) ,a3 >9>. In @9r>9 3n;rnar33 a

9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ -r<;@;<r (a>;r3@ >3 @ar)3<<(3@ an;r3<r

@9 <9;3 2a<ra:3a

•R@<,an)ar3

• 3;ara 3r3;an;3<r r>-3ra;<r3

• r(3, 3-<><)a;

• @<n;3n9ara ;ra-33 @ar)3<<(3@ >3 ra9ar -r3<)3@a

• TRATAMENT

• Taan3@ &00 ,( 100 % ?3

• Er)<,) 101 10 ?3

47

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•

• M<n3;<r3?ar -r3n M2

• Ra9ara -n9,<<(3@a a 9n37 )9-a ><>3ra r?9;a;993 @9;9r3<r•

• BOALA PULMONARA CRONCA OBSTRUCTVA SEVERA IN EACERBARE.

• INSUFICIENTA REPIRATORIE CRONICA ACUTIZATA.

• FIBROZA PUMNARA POST TBC.

• COR4 PULMONAR CRONIC

• S4R HIPOANABOLIC.

• ANEMIE SECUN4ARA.•


• 22.0.11 07:12 :5BC=* /.1 *10!"L L+,-#=* 1.' *10!"L M3)#=0./ *10!"L

Gran#=./ *10!"L L+,-$='.6 $ M3)$= $ Gran$=&8./ $

HGB=* 11.% (!) RBC=* /.'6 10*10!"L HCT=* '.1 $ MCV=8.8 2L

MCH=* 6.8 -( MCHC=* . (!) R45CV=* 16.1 $ R45S4=&.1 2 PLT=0 *10!"L MPV=.1 2L P45=16 $ PCT=0.18' $ Ta:<9>an(3n=PMN =6/ EO = /BA = L = '0MO = 4>@r3r,a;33 3n 23>3@9r3. VSH

71=& ,, VSH 7=&6 ,, ALAT= U!L ASAT=1% U!L B33r9:3na

;<;aa=0.& ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=00 U!L GGT=* U!L G3@,3=* 68 ,(!) L4H=1/ U!L Pr<;3n ;<;a=* 6. ,(!)

Ur=1 ,(!)

• Rx)A: 4>n 3n;r>;3;a a@@n;9a; :3a;ra @9 ,9;3- <-a@3;a;3 n<)9ar >3 3nar

)3>,3na; 3n a,:33 @a,-3 -9,nar3 -r)<,3nan; :a?aD <-a@3;a;3 n<)9ar -ara3arar(3r ,)3a>;3naa. P<>3:3 :9 ,23?,a;<a>.

• E<4 R> A=%&:!,3nD aa RS n<r,aaD 2ara ,<)323@ar3 3>@,3<?3<na.

• Biologic >3n)r<, 3n2a,a;<r a@@ra;7VSH 100!1/0. 9@<@3;<?a an,3 3n2a,a;<r33-<@r<,a 3-<-r<;3n,3.

• )3R/7006;17.0.2011: 43>29n@;3 n;3a;<r3 ,3;a. r>;r3@;3a >ra. O:>;r9@;3a

>ra >(,n; @n;ra ,a3 a@@n;9a; 3n -r32r3. R)9@ra VEMS @9 %6$. VEMS >9:

1.

• !" "%RA!-!/22.0.2011 dr 4uttman ": ,<)323@ar3 3,-<r;an; ) ,23?, :9<>

:3a;ra 3n )ra-;a :9 ) ,23?, >9:-9ra ) -ana a 6',, )3a, 3n >;an(a ) -ana

a 1&080,,a>-@; ) -a,an )>;ra,a;. In >(,n;9 @n;ra a LS4 3>;a 9n a>-@;

) n(r<>ar -9raa -<>;r3<ara >3 @<n)n>ar -9,<nara a)3a@n;a >@ara 23:r<;3@a @9

r;ra@;3 ,)3a>;3naa.C<n@9?3 F3:r<?a -9,<nara @9 ,<)323@ar3 3,-<r;an; ),23?, :9<> :3a;ra. C<@;3 -9raa )r. ,3@a. Fara a>-@; ) T9 BP.

• E)-!R-A:

• Pa@3n; 3n ar>;a ) && an3 2<>; 29,a;<r7/0PA @9 an;@)n; ) TBC -9,<nar

>@ar 7186 > -r?3n;a a C3n3@a ) Pn9,<<(3 a@9?an) )3>-n a 2<r;9r3 ,3@3>@a)ra ;<ran;3 a 2<r; ;9> @9 -@;<ra;3 ,<)ra;a >@a)r -<n)raa &6 ( 3n

9n3 2a;3(a:33;a; >3,-;<, 3n>;aa; @9 a-r< ' 9n3 an;r3<r 3n;rnar33 @ >a9

a@r:a; 3n 9;3,3 ?3.

48

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• Examenul obeicti(la internareD >;ar (nraa ,<)ra;a;ra;aD ;(9,n; >3 ,9@<a>

-a3) )>3)ra;a; ;>9; @<nK9n@;3<a)3-<> >a: r-r?n;a;D ;<ra@ n<r,a @<n2<r,a;

@9 ><n<r3;a; -9,<nara @9 MV )3,3n9a; a n39 ,3;<ra@93 >;an(.

• Biologic >3n)r<, 3n2a,a;<r a@@ra;7VSH 100!1/0. 9@<@3;<?a an,3 3n2a,a;<r3

3-<@r<,a 3-<-r<;3n,3.

• E<4 R> A=%&:!,3nD aa RS n<r,aaD 2ara ,<)323@ar3 3>@,3<?3<na.• Rx)A 4>n 3n;r>;3;a a@@n;9a; :3a;ra @9 ,9;- <-a@3;a;3 n<)9ar >3 3nar

)3>,3na; 3n a,:33 @a,-3 -9,nar3 -r)<,3nan; :a?aD <-a@3;a;3 n<)9ar -ara3arar(3r ,)3a>;3naa. P<>3:3 :9 ,23?,a;<a>.

• !" "%RA!-!= ,<)323@ar3 3,-<r;an; ) ,23?, :9<> :3a;ra 3n )ra-;a :9 )

,23?, >9:-9ra ) -ana a 6',, )3a, 3n >;an(a ) -ana a 1&080,,a>-@; ) -a,an )>;ra,a;. In >(,n;9 @n;ra a LS4 3>;a 9n a>-@; ) n(r<>ar -9raa

-<>;r3<ara >3 @<n)n>ar -9,<nara a)3a@n;a >@ara 23:r<;3@a @9 r;ra@;3

,)3a>;3naa.C<n@9?3 F3:r<?a -9,<nara @9 ,<)323@ar3 3,-<r;an; ) ,23?, :9<> :3a;ra. C<@;3 -9raa )r. ,3@a. Fara a>-@; ) T9 BP.

• )3R =43>29n@;3 n;3a;<r3 ,3;a. r>;r3@;3a >ra. O:>;r9@;3a >ra >(,n;

@n;ra ,a3 a@@n;9a; 3n -r32r3. R)9@ra VEMS @9 %6$. VEMS >9: 1.

• P :a?a a,n993 @3n3@ ra)3<<(3@ CT ;<ra@3@ >3 ) a:<ra;<r > >9>;3n )3a(n<>;3@9

) a:<ra;<r.

• P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7C2<r; 3;a,3n7B1B6

@<r;3?<n3@ (9@<?a an;3;9>3 -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ an;33n2a,a;<r33 >3

an3a(3@ @9 a,3<rara >;ar33 (nra >3 <9;3 @3n3@a 2a<ra:3a.•

• 3;ara 2r3(993 3n2@;33<rD

• )<?ara a@;33;a;33 23?3@ 3n 29n@;3 ) ;<ran;a a 2<r;D

• a@@3nar an;3(r3-aa an;3(r3-aa an9aaD

• ;ra;a,n; ,)3@a,n;<> @9 SERETI4E &0! &0 ,3@r<(ra, 1 -92!?3D• SPIRVA 18 ,3@r<(ra, 1 @->!?3D

• VENTOLIN 100 ,3@r(ra, ' -929r3!?3

• TAVANIC &00 ,( 1 @->!?3D

• ER4OME4 '00 ,( 1 @-r!?3

• >a 3:ra; R- @<,-n>a;a >r3a CSB4 nr 1//'%' 7-; an;3:3<;3@ >3 >r3a CSB4 nr

1//'%' 7 -n;r9 :r<<)3a;a;<rD

• > n)3@a 3(;r-3 a ),3@339 /6 3;r3! ,3n 1 <r! ?3.

• R3n a @<n;r< )9-a 6 9n3 3n a:>n;a a@r:ar3<rD

• )3>-n>ar3?ar -r3n ,)3@9 )a 2a,33.

BOALA PULMONRA CRONICA OBSTRUCTIVA MO4ERATA IN EACERBARE.

HIPERCOLESTEROLEMIE.


1.0.11 08:11 :

49

7/24/2019 69625104-epicrize


5BC=6.1 *10!"L L+,-#=1.8 *10!"L M3)#=0.6 *10!"L Gran#='.% *10!"L

L+,-$='0 $ M3)$=10.1 $ Gran$=&. $ HGB=1/. (!) RBC=* /.11

10*10!"L HCT=/'.1 $ MCV=* 10/. 2L MCH=* '/.& -( MCHC='.(!) R45CV=* 1& $ R45S4=* &%.% 2 PLT='%6 *10!"L MPV=* %.' 2L

P45=1&.& $ PCT=0.%/ $ Ta:<9 >an(3n=PMN =66 EO = BA = L = 8MO =

/ VSH 71=/ ,, VSH 7=1& ,, ALAT=1' U!L ASAT=0 U!L B33r9:3na ;<;aa=0.&% ,(!) C<>;r<=* /% ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a

a@a3na=1 U!L GGT=1 U!L G3@,3=* 118 ,(!) L4H='/ U!L Pr<;3n

;<;a=6.6 ,(!) Ur=/ ,(!)

Biologic: 9><ara an,3 ,a@r<@3;ara 3-r@r<,a 3-r@<>;r<,3 3-r(3@,3.

E<4: R> A=6%:!,3nD 9n) T ) a,-3;9)3n @r>@9;a.

)3R = )3>29n@;3 n;3a;<r3 <:>;r9@;3a 9><ara 3n >(,n;9 -r32r3@.

Rx)A <-a@3;a;3 r;3@9<n<)9ar ) 3n;n>3;a; @<>;aa >3 >9-ra@<>;aa )3>,3na; 3n a,:33

@a,-3 -9,<nar3D @a@323r3 3ar :3a;ra.

Pa@3n; 3n ar>;a ) &8 ) an3 2<>; 29,a;<r70PA @9n<>@9; @9 an;@)n; ) TBC -9,<nar7001 > -r?3n;a a C3n3@a ) Pn9,<(3 a@9?an) ;9> @9 -@;<ra;3 ,9@<

-9r9n;a 9n<r3 @9 >;r39r3 >an(3n<n; )3>-n a 2<r;9r3 ,<)ra; >@a)ra ;<ran;3 a

2<r; a>;n<a)3na,3 >3,;-<, @ >a9 3n>;aa; @9 a-r<3,a;3 ' ?3 an;r3<r 3n;rnar33.

Examenul obiecti(la internare: >;ar (nraa ,)ra;a;ra;aD ;<ra@ n<r,a @<n2<r,a; MV

23?3<<(3@ @9 ra9r3 @r-3;an; :a?a :3a;raD SaO=%$ a -9><3,;r9.TA=1'0!80,,H(

AV=%6!,3n.

Biologic 9><ara an,3 ,a@r<@3;ara 3-r@r<,a 3-r@<>;r<,3 3-r(3@,3.

E<4: R> A=6%:!,3nD 9n) T ) a,-3;9)3n @r>@9;a.

Rx)A <-a@3;a;3 r;3@9<n<)9ar ) 3n;n>3;a; @<>;aa >3 >9-ra@<>;aa )3>,3na; 3n a,:33

@a,-3 -9,<nar3D @a@323r3 3ar :3a;ra.

)3R = )3>29n@;3 n;3a;<r3 <:>;r9@;3a 9><ara 3n >(,n;9 -r32r3@.

P :a?a a,n993 @3n3@ ra)3<<(3@ >3 ) a:<ra;<r > >9>;3n )3a(n<>;3@9 ) ,a3 >9>.

P -ar@9r>9 3n;nar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7A,<3-9> an;33n2a,a;<r-@;<ran; an;3;9>3 @<r;3?<n3@ -r<;@;<r (a>;r3@ >3 -a;3@ 3;a,3n @9 a,3<ara >;ar33

(nra >3 <9;3 @3n3@a 2a<ra:3a.

• 3;ara 2r3(993 3n2@;33<r 3n;,-r33<rD

• )<?ara 2<r;993 23?3@ 3n 29n@;3 ) ;<ran;aD

• ;ra;a,n; ,)3@a,n;<> @9

•TU BRONHOPULMONAR LIS 7CARCINON SCUAMOS NEJERATINIZAT.

• PNEUMONIE INTERSTITIALA.

• HEPATITA CRONICA VIRALA C.•


• 22.0.11 08:28 : 5BC=6./ *10!"L L+,-#=.1 *10!"L M3)#=0.6 *10!"L

Gran#='.% *10!"L L+,-$=''.& $ M3)$=10 $ Gran$=&6.& $

HGB=1/. (!) RBC=& 10*10!"L HCT=/6.1 $ MCV=. 2L

50

7/24/2019 69625104-epicrize


MCH=.8 -( MCHC='.' (!) R45CV=1'.6 $ R45S4=/6.1 2

PLT='' *10!"L MPV=8. 2L P45=1&.6 $ PCT=0.& $ Ta:<9

>an(3n=PMN =6 EO = BA = L = '/MO = 4>@r3r VSH 71='0 ,, VSH 7=% ,,

• E<4 R> AV=110:!,3nD aa RS n<r,aaD

• Rx )A O-a@3;a; 3n<,<(na ) )3,n>39n3 ) a-r< 1 ,, <@a3?a;a 3n 39 -9,<nar >;an( @9 @<n;9r nr(9a;. C<r) (<:a ,ar3; ,a3 a@@n;9a; VS. Lar(3r,)3a>;3naa.

• !" "%RA!-!/16.0.2011 dr. +tanescu 4.: 2;9a; an;r3<r 3n;rnar33 3)n;3a?a

a-3@a )r-; 9n n<)9 @a@ar ) @@a 1!11,,. 3n 3,)3a;a @3na;a; a a@>;93a a-ar 9nn<)9 ,<a ) @@a 11!,, @9 @<n;9r >-3@932<r, >3 @ara@;r ) );r,3nar3 >@9n)ar.

In -<9 >9-. a 3993 >;an( a-ar < 2<r,a;39n ;3>9ara n<,<(na ) @@a '!'&,,

2<r,a;39n >; 3<)<23a ,a3 a> -r32r3@ 3n @<n;a@; 3n;3, @9 a<r;a )>@n)n;a ><2a(9>3 ar;ra -9,<nara >;an(a. C<n@9?33 a>-@;9 CT ) T9 (an(3<nara 3 >;an( @9

a)n<-a;33 ,)3a>;3na >3 );r,3nar3 >@ a-3@aa )ra-;a. S9>-3@39n an(3<, -a;3@

n@>3;a ,<n3;<r3?ar.

• 3ibrobron?oscopie. /1297;22.0.2011 dr +imon $.: ;raa 3:ra. P3n;n ;raan<r,a. Ar:<r :r<n>3@ )r-; 3:r. Br -r3,3;3a >;( LSS 3:r. Pr<@> -r<32ra;3(;an; @9 <:>;r9@;3 ;<;aa a :r LIS >3 n@r<?a 3n >9-ra2a;a. B3<->3.

• Rezultata anatomopatologic /2,0;2,.0.2011 dr a?arie ".: @ar@3n<, >@9a,a<>

2ara ra;3n3?ar @9 ar33 ar(3 ) n@r<?a >3 ,<ra(3.

• C<n@9?3 @ar@3n<, >@9a,<> nra;3n3?a;.

• E)-!R-A:

• Pa@3n; 3n ar>;a ) %/ ) an3 2<>; 29,a;<r7->; 10PA @9 an;@)n; ) -a;3@a

3raa C > -r?3n;a a@9?an) ;9> -r>3>;n;a @9 -@;<ra;3 ,3n3,a a>;n3

2a;3(a:33;a; >@a)r -<)nraa ( 3n a-r< 9n3 >3,-;<, @ a9 ):9;a; 3n>3)3<> )

a-r<3,a;3 1 9na. C; ;<ra@3@ 2@;9a; an;r3<r 3n;rnar33 3)n;3a?a <-a@3;a; 3ara>;an(a.

• Examenul obiecti( la internare >;ar (nraa ,<)ra;a;ra;aD ;<ra@ n<r,a

@<n2r<,a; ><n<r3;a; 9,<nara @9 MV -r?n; 2ara ra9r3 >9-raa)a9(a; AMC 3n 3,3;

n<r,a Z(<,<; @ar)3a@ ar;3,3@D Or3n;a; ;,-<r<>-a;3a.

• E<4 R> AV=110:!,3nD aa RS n<r,aaD

• R PA O-a@3;a; 3n<,<(na ) )3,n>39n3 ) a-r< 1 ,, <@a3?a;a 3n 39

-9,<nar >;an( @9 @<n;9r nr(9a; ar(3r ,)3a>;3naa @ r3)3@a >9>-3@39na 9n93

-r<@> -r<32ra;3 a a@>; n3 ,<;3 -n;r9 @ar > 3n)3@a 2@;9ara 9n3 FB >3 C;

;<;a@. !" ( ul toracic )>@r3 T9 (an(3<nara 3 >;an( @9 a)n<-a;33 ,)3a>;3na >3

);r,3nar3 >@ a-3@aa )ra-;a >3 >9>-3@39n an(3<, -a;3@n@>3;a ,<n3;<r3?ar.

• Aan) 3n )r a>-@; )@a; a ra)3<(ra23 C; T<ra@3@ > r@<,an)a 2@;9ara9n3 bron?oscopii @ar )@a?a -r<@> -<32ra;3 (;an; @9 <:>;r9@;3 ;<;aa a :r.

LIS >3 n@r<?a 3n >9-ra2a;a. Sa 2@;9a; biopsie: @ar@3n<, >@9a,<> nra;3n3?a;.


• P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7C3-r<2<a@3na ,<>;a;3@

an;33n2a,a;<r -r<;@;<r (a>;r3@ >3 -a;3@ an;3;9>3 @9 a,3<rara >;ar33 (nra >3

<9;3 @3n3@a 2a<ra:3a.•

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• -r?n;ar a IOCN @<n2<r, -r<(ra,ar33.

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

• PNEUMONIE BAZALA BILATERALA.

• SARCOI4OZA.

• FIBROZA PULMONARA 4IFUZA BILATERAL.

• 4ISLIPI4EMIE.

• HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CURISC CAR4IOVASCULAR

MO4ERAT.



• 22.0.11 10:8 : Gran#=/. *10!"L Gran$=60.6 $ HCT=/6.% $ HGB=1&./

(!) L+,-#= *10!"L L+,-$=. $ MCH=8.1 -( MCHC='. (!) MCV=8&.' 2L M3)#=0.% *10!"L M3)$=10. $ MPV=8.' 2L

PCT=0.1& $ P45=1&. $ PLT=60 *10!"L RBC=&./8 10*10!"L

R45CV=1/. $ R45S4=/&./ 2 5BC=6. *10!"L VSH 71=1,, VSH 7=& ,, ALAT=0 U!L ASAT=1 U!L B33r9:3na ;<;aa=0.6

,(!) C<>;r<=1 ,(!) Cra;3n3na=1.' ,(!) F<>2a;a?a a@a3na=18& U!L

G3@,3= ,(!) L4H=/0/ U!L Pr<;3n ;<;a=%.8 ,(!) Tr3(3@r3)=& ,(!) Ur=1 ,(!)

• 22.0.11 11:2, : Ta:<9 >an(3n=PMN =66

• EO =

• BA =

• L = 8

• MO = /

4>@r3r

• )3R n<r,a

• Radiogr pulm: <-a@3;a;3 -<3@3@3@ -ara;raa :3a;raD ,9;3- ,3@r<<-a@3;a;3

n<)9ar >3 3narar )3>,3na; 3n an,:33 @a,-3 -9,<nar3 9n @9 ;n)3n;a a@<n29ara. )>n 3n;r>;3;3a a@@n;9a; :3a;ra.

• !" torace/22.0.2011 dr 4uttman " a;a>a, @<-3 3n -arn@3,9 -9,<nar :3a;ra

-r)<,3na; >-r >(,n; :a?a 3>;a 2<@ar ) @<n)n>ar -9,<nara ) & @, @9

)3>-<?3;3 nr(9a;a @9 a>-@; -n9,<n3@ - 2<n)9 9n3 23:r<? -9,<nar )329?

:3a;ra. 4 a>,na :3a;ra 3>;a 3,a(3n3 ,33ar ,9;3- @ar ar -9;a 3n@a)raa>-@;9 @a >ar<3)<?a -arn@3,aa @<n;r< ->; '6 9n3 3n;ra,)3a>;3na 3>;a 3,a(3n3

(an(3<nar ,9;3- ) -ana a 1& ,,, )3a, @a;a @9 @a@323@ar3 @ar)3<,(a3 @9

>,n ) HTP•

• EPICRIZA

• B<na 3n ar>;a ) %' an3 @9n<>@9; 3n an;@)n; @9 HTA > -r?3n;a ) 9r(n;a

-n;r9 ,<)323@ara >;ar33 (nra ,<-;3?3 )3>-n 9><ara ) r-a9> a>;n3

a)3na,3 2a;3(a:33;a;.

52

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• O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; -a3) ;ran>-3ra;D

-9,<nar ;<ra@ a>;n3@ MV 3na>-r3; :a?a :3a;ra rar ra9r3 @r-3;an; :a?a

:3a;ra.

• B3<<(3@ >)r. 3n2a,a;<r 9><r 3-r;r3(3@r3),3.

• Ra)3<(ra23a -9,<nara 3)n;3a?a <-a@3;a;3 -<3@3@3@ -ara;raa :3a;raD ,9;3-

,3@r<<-a@3;a;3 n<)9ar >3 3narar )3>,3na; 3n an,:33 @a,-3 -9,<nar3 9n @9;n)3n;a a @<n29ara. )>n 3n;r>;3;3a a@@n;9a; :3a;ra @ r3)3@a >9>-3@39na 9n3>ar@<3)<? -9,<nar ,<;3 -n;r9 @ar > n)3@a 2@;9ra 9n93 CT ;<ra@3@.

• CT ;<ra@3@ a;a>a; @<-3D 3n -arn@3,9 -9,<nar :3a;ra -r)<,3na; >-r >(,n;

:a?a 3>;a 2<@ar ) @<n)n>ar -9,<nara ) & @, @9 )3>-<?3;3 nr(9a;a @9

a>-@; -n9,<n3@ - 2<n)9 9n3 23:r<? -9,<nar )329? :3a;ra. 4 a>,na

:3a;ra 3>;a 3,a(3n3 ,33ar ,9;3- @ar ar -9;a 3n@a)ra a>-@;9 @a >ar<3)<?a -arn@3,aa @<n;r< ->; '6 9n3 3n;ra,)3a>;3na 3>;a 3,a(3n3 (an(3<nar ,9;3-

) -ana a 1& ,,, )3a, @a;a @9 @a@323@ar3 @ar)3<,(a3 @9 >,n ) HTP.

• P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r

-a;3@ -r<;@;<r (a>;r3@ @9 <9;3 2a<ra:3a. S ;rna?a @9 r@<,an)ar3

•

•

• r(3, a3,n;ar 3-<>)a; 3-<(9@3)3@ >3 3-<3-3)3@D


• r3n a @<n;r< ->; 1 9naD

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

• 4ETERMINARI SECUN4ARE PULMONARE

• 4IABET ZAHARAT TIP TRATAT CU A4O

•HTAE ST4 II

•

•

•

•

•


• 10.0.11 07:07 : Gran#=6.6 *10!"L Gran$=6/.6 $ HCT='%.8 $ HGB=1.&

(!) L+,-#=.6 *10!"L L+,-$=&.' $ MCH=8./ -( MCHC=''(!) MCV=86 2L M3)#=1 *10!"L M3)$=10.1 $ MPV=. 2L

PCT=0.188 $ P45=1&.% $ PLT=0& *10!"L RBC=/./ 10*10!"L

R45CV=1/ $ R45S4=/&. 2 5BC=10. *10!"L VSH 71=& ,, VSH 7=&% ,, 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(. 4;@;ara

9@<@3;<r 7P=n(. 4;@;ara -r<;3n<r 7A=n(.

• 10.0.11 10:9 : Ta:<9 >an(3n=PMN = 68

• EO =

• BA =

• L = 6

• MO = /

53

7/24/2019 69625104-epicrize


12.0.11 07:11 :

• ALAT=8 U!L ASAT=18 U!L B33r9:3na ;<;aa=0.%1 ,(!) C<>;r<=00

,(!) Cra;3n3na=1. ,(!) F<>2a;a?a a@a3na=11/ U!L G3@,3=%' ,(!)

L4H='8/ U!L Pr<;3n ;<;a=6.1 ,(!) Ur=&& ,(!)

•

• E<4: R> AV=60:!,3nD 2ara ,<)323@ar3 3>@,3<?3<na.• Bioumoral9@<@3;<?a 9><araD an,3 ,3@r<@3;araD 9><ara r;n;3 a?<;a;aD >3n)r<,

3n2a,a;<r ,<)ra;.

• Rx )A O-a@3;a; @ > >9-ra-9n ->; >39;a @ar)3a@a @9 ar(3r ,)3a>;3naa 29

)3,3;a;a ) 3n;n>3;a; @<>;aa @9 a;@;a?3a ;ra3 ) -ar;a )ra-;a.

•

•

•

•

• Pa@3n; 3n ar>;a ) 68 ) an3 2<>; 29,a;<r70PA @9n<>@9; @9 4Z ;3- ;ra;a; @9 A4O

H3-r;n>39n ar;r3aa >n;3aa > -r?3n;a a C3n3@a ) Pn9,<<(3 a@9?an) ;9>>a@a )3>-n ) 2<r; >@a)r -<n)raa 70( 3n ' 9n3 @9 r(3, a3,n;ar3-<(3@,3@ >@a)ra ;<ran;3 a 2<r; >3,-;<, @ >a9 3n>;aa; 3n 9r,a @9 9n3 @

>a9 a@r:a; 3n 9;3,3 ?3.

• Ea,n9 <:3@;3a 3n;rnar >;ar (nraa,<)ra;a;ra;aD r>-3ra;<r ;<ra@ n<r,a

@<n2<r,a; ><n<r3;a; -9,<nara @9 MV 3na>-r3; TA=10!60,,H( AV=6&:!,3nD

• E<4: R> AV=60:!,3nD 2ara ,<)323@ar3 3>@,3<?3<na.

• Bioumoral9@<@3;<?a 9><araD an,3 ,3@r<@3;araD 9><ara r;n;3 a?<;a;aD >3n)r<,

3n2a,a;<r ,<)ra;.

• Rx )A O-a@3;a; @ > >9-ra-9n ->; >39;a @ar)3a@a @9 ar(3r ,)3a>;3naa 29

)3,3;a;a ) 3n;n>3;a; @<>;aa @9 a;@;a?3a ;ra3 ) -ar;a )ra-;a.• !t toracic 2@;9a; 3)n;3a?a ,9;3- ?39n3 n<)9ar )3>,3na; 3n -arn@3,9

-9,<nar :3a;ra @9 )3,n>39n3 ) -ana a @, )3a, a>-@;9 -)a?a -n;r9

);r,3nar3 >@9n)ar -9,<nar. C<n)n>ar -n9,<n3@a ;3n>a LI4.

• Ecografia toracica 3)n;3a?a @<@;3 <r(an3?a;a a n39 ,3;<ra@93 )r-; 2ara

r-r -n;r9 -9n@;3.

• 4a;<r3;a a>-@;<r )@a; a ra)3<(ra23 >3 CT ;<ra@3@ > r@<,an)a 2@;9ara 9n3

bron?oscopii @ 3)n;3a?a -r<@> -r<32ra;3 3n23;ra;3>;n<?an; :r >(, )<r>aLI4

@9 >9-9ra;3 >@9n)ara7>a 2@;9a; :3<->3>3 :r<>aK.

• Ea,n9 3>;<-a;<<(3@ )@a?a a>-@; >9>-@; ) ,a3(n3;a; r)9>a :r<n>3;a

@r<n3@a @9 r@<,an)ara r:3<->3r33.

• )3R =6&'!0.08.011 r>;r3@;3 ,)3.• Aan) 3n )r @ara@;r9 )3>-n3 >a 2@;9a; >3 ecografie cardioasculara @ar

)@a?a A< 3n=/,, A< a>@='8,,D S-;!PP=1/,,D AS=/0 VS=60!/'D

FVS=60$ V4 n<r,aD >-a;39 @<2r -<>;r3<r ) VS=6,,D Vaa -9,<nara )

a>-@; n<r,aD C<n@9?3 HVSD 43>29n@;3 )3a>;<3@a VS ;3- raar a;ra;aD M3@a@<@;3 -<>;r3<ara.

• P :a?a a,n993 @3n3@ ra)3<<(3@ CT ;<ra@3@ >3 ) a:<ra;<r > >9>;3n )3a(n<>;3@9

) ,a3 >9>.

54

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• P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7C3-r3n< ,<>;a;3@

an;33n2a,a;<r -r<;@;<r (a>;r3@ >3 -a;3@ @9 a,3<rara >;ar33 (nra >3 <;93

@3n3@a 2a<ra:3a.

•

•

• r3n -n;r9 r?9;a;9 3>;<-a;<<(3@D• @<n;3n9ara ;ra;a,n;993 r@<,an)a; ) @ar)3<<( @<n2r<, >@,3D

• @<n;3n9ara ;ra;a,n;993 r@<,an)a; ) )3a:;<<(D

• PNEUMONIE INTERSTITIALA.

• SARCOI4OZA.

• SPON4ILOZA ANJILOPOETICA ST4 III•


• 29.0.11 07:1 : Gran#='.1 *10!"L Gran$=6.8 $ HCT=/1 $ HGB=1'.'

(!) L+,-#=1.' *10!"L L+,-$=%.' $ MCH=8./ -( MCHC='./

(!) MCV=8%.8 2L M3)#=0.& *10!"L M3)$=. $ MPV=8.1 2L PCT=0.1' $ P45=1&.& $ PLT=6/ *10!"L RBC=/.68 10*10!"L

R45CV=1'.% $ R45S4=/'. 2 5BC=/. *10!"L VSH 71='0,, VSH 7=6' ,, ALAT=1& U!L ASAT=1 U!L B33r9:3na ;<;aa=0.%

,(!) C<>;r<=18& ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=1&1 U!L

GGT=1 U!L G3@,3=8 ,(!) L4H='&% U!L Pr<;3n ;<;a=6.8 ,(!)

Tr3(3@r3)=' ,(!) Ur=1% ,(!)

• 29.0.11 08:9 : Ca@39 ;<;a=8.6 ,(!)

• 2,.0.11 07:29 : Ca@39r3a=01.8 ,(!/

• E<4: R> AV=%6:!,3nD 2ara ,<)323@ar3 3>@,3<?3<na.

•

)3R: )3>29n@;3 r>-3ra;<r3 ,3;a r>;r3@;3 >ra <:>;r9@;3 >ra - ;<; ar:<rr>-3ra;<r . VEMS >9: 1L

• Radiografia toracica: C<r) (<:a ,ar3; 33 @<n(>;33. O-a@3;a; n<)9ara

29),33;a;a -ara3ar )r-;,9- <-a@3;a;3 n<)9ar >3 3nar )3>,3na; 3n @a,-33

-9,<nar3 :a?a3 :3a;ra.

• -munologie( 3n 9@r9 7ANA ANCA an(3<;n>3n@<nr;a?a.•

• E)-!R-A:

• Pa@3n; ) && ) an3 n29,a;<r 2ara APP >,n323@a;3 >9-@; ) ;9,<ra -9,<nara

LI4 -n;r9 @ar a 2@;9a; ;<ra@<;<,3 )3a(n<>;3@a >3 -<ra;<r3 - >@;3a ) C3r9r(3

T<ra@3@a > -r?3n;a -n;r9 ra9ar @3n3@<:3<<(3@a a@9?an) )3>-n a 2<r;9r3

,<)ra; a>;n<a)3na,3 2a;3(a:33;a;.• Examenul obiecti(la internare >;ar (nraa ,<)ra;a;ra;aD ;<ra@ @9 MV 9><r

3na>-r3; 2ara ra9r3 >9-raa)a9(a;.

• Rx )A C<r) (<:a ,ar3; 33 @<n(>;33. O-a@3;a; n<)9ara 29),33;a;a -ara3ar

)r-;,9- <-a@3;a;3 n<)9ar >3 3nar )3>,3na; 3n @a,-33 -9,<nar3 :a?a3 :3a;ra.

La 3n;rnara -@)n;a >a 2@;9a;a ;<ra@<;<,3 )3a(n<>;3@a @9 :3<->3. Ea,n93>;<-a;<<(3@ >9>;3n )3a(n<>;3@9 ) (ran9<, >ar@<3)<?3@.

55

7/24/2019 69625104-epicrize


• E<4 R> AV=%6!,3nD 2ara ,<)323@ar3 3>@,3<?3<na.

• )robele imunologice 3n [email protected] ANCA an(3<;n>3n@<nr;a?a.

• )3R )3>29n@;3 r>-3ra;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3a 9><ara - ;<; ar:<r

r>-3ra;<r . VEMS r)9> @9 '/$.

• In a@>; @<n;; >9>;3n, )3a(n<>;3@9 ) ,a3 >9>.

• In @9r>9 3n;nar33 a 9r,a; ;ra;a,n; an;3:3<;3@7C2<r; 1 (!?3 an;33n2a,a;<r

an;3;r,3@ an;3a(3@ -@;<ran; >3 > 3n3;3a?a @<r;3@<;ra-3a @9 <9;3 2a<ra:3a.

• S ;rna?a a,3<ra; @9 r@<,a)ar3.

•

•

•

•

3;ara 3r3;an;3<r r>-3ra;<r3D r(3, )><)a;D

• ;ra;a,n; ,)3@a,n;<> @9 PRE4NISON &;: &;:0 7;3,- ) 9n3

•r3n a @<n;r< ->; 9n3 @@9 :3; ) ;r3,3;r ) a ,)3@9 ) 2a,33 >3 @9-<n ) ->3.

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

PNEUMONIE INTERSTITIALA.SUSPCT BRONSIECTAZII.

CAR4IOPATIE ISCHEMICA CRONICA.

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULAR INALAT.

AVC IN ANTECE4ENTE 7 CU SECHELE PARALIZIE


22.0.11 10:07 :Gran#='.8 *10!"L Gran$=60.8 $ HCT=/. $ HGB=1'.% (!) L+,-#=1. *10!"L L+,-$=.& $ MCH=8.6 -( MCHC='1. (!)

MCV=8.8 2L M3)#=0.6 *10!"L M3)$=.% $ MPV=.' 2L PCT=0.& $

P45=1&.& $ PLT=/' *10!"L RBC=/.%8 10*10!"L R45CV=1&.% $ R45S4=&0.6 2 5BC=6.' *10!"L VSH 71='& ,, VSH 7=/ ,, ALAT=18

U!L ASAT='8 U!L B33r9:3na ;<;aa=0.8 ,(!) C<>;r<=1'0 ,(!)

Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na='11 U!L GGT=&1 U!L G3@,3=%% ,(!) L4H=/ U!L Pr<;3n ;<;a=%.1 ,(!) Ur=% ,(!)

22.0.11 10:7 /96,;29.0.2011 S-9;a Fr<;39 BAAR A=NEGATIV

S-9;a Fr<;39 BAAR B=NEGATIV

S-9;a Fr<;39 BAAR C=NEGATIV

22.0.11 10: : S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a<r<2ar3n(3ana. S-9;a Ea,n ,3@<<(3@=CAn)3)a >--. '0 UFC! -a@a. S-9;a Fr<;39

Gra,=A>-@; ,a@r<>@<-3@ M9@<3)A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,-

C9 -3;3a >@9a,<a> &!@a,-

F3:r3na -r?n; 2<ra ,3@r<:3ana -<3,<r2a.S@<r ) @a3;a; 1

56

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Rgr toracica : ,3@r<-a@3;a;3 n<)9ar >3 3nrar )3>,3na; 3n a,:33 @a,-3 -9,<nar3 9n @9

?<n ) 3-r;ran>-arn;a 3n2ra3ar )r-;. 33 @n(>;33 )>n 3n;r>;3;3a a@@n;9a; :3a;ra.

E)-!R-A:

Pa@3n; 3n a>;a ) 80 an3 @9n<>@9; @9 an;@)n) @ar)3<a>@9ar 7 HTA CIC >3 AVC

3>@,3@ > 3n;rna?a ) 9r(n;a -n;r9 ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n @9

<r;<-n 2:ra 2r3><an ;ran>-3ra;33 )9r3 ;<ra@@ )329?. O:@;3 a 3n;rnar -a@3n; a2:r33,<:33?a; a -a; @9 >;ar (nraa 3n29n;a;aD ;(9,n; 9>@a;D -9,<nar MV 3na>-r3; @9 -3r

-r9n(3; ra9r3 r<n2an; )3>,3na; 3n a,:33 @a,- -9,<nar3 >3 ra9r3 @r-3;an; :a?a :3a;raD

TA= 1'0!80,,H(D AV= 0 :a;a3! ,3n9;. aan) 3n )r >;ara a@3n;993 7 -a@3n; @ar n9 >,<:33?a?a PFR n9 a9 -9;9; 23 2@;9a;.

R(r ;<ra@3@a )>@r3 ,3@r<-a@3;a;3 n<)9ar >3 3nrar )3>,3na; 3n a,:33 @a,-3 -9,<nar3

9n @9 ?<n ) 3-r;ran>-arn;a 3n2ra3ar )r-;. 33 @n(>;33 )>n 3n;r>;3;3a a@@n;9a;

:3a;ra @ r3)3@a >9>-3@39na 9n<r :r<n>3@;a?33. aan) 3n )r 3,a(3n ra)3<<(3@a )>@r3>aa 9n -a@3rn; ar>;n3@ > r3)3@a >9>-3@39na 9n<r :r>3@;a?33 >a9 a 9n3 TBC -9,<nar. ,n9

) >-9;a -n;r9 BJ >; BAAR n(a;3 a ,3@r<>@<-3 @9;9r3 >9n; 3n 9@r9@a @ 3n23r,a

>9>-3@39na ) TBC -9,<nar. B3<9,<raD >)r 3n2a,a;<r 9><r 7 VSH a@@ra; FA >3 GGT

9><r @r>@9;.In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ > >;a:3>; )3a(n<>;3@9 ) ,a3

>9>.P -ar@9r>9 3n;rnar33 a 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> 2!?30 an;3;r,3@ an;3<a(@

:r<n<)3a;a;<r 3a;,3n -r<;@;<r (a>;r3@ >3 -a;3@ >39 ) r@33:rar 3)r<@;r<3;3@aD a

9r,a; ;ra;a,n;9 @ar)3<<(3@. S ;rna?a a,3<ra; @9 r@<,an)ar3

r(3, a3,n;ar @33:ra; @a<r3@D

a@@3nar an;3(r3-a an9aaD ;ra;a,n; @9 TAVAIC &00 ,( 1 @-r! 3 7 % ?3D

ER4OME4 '00 ,( 7% ?3D

VENTOLIN 1000 ,33(ra, -929r3 a n<3D >a -r>@r3> RP -; < 9na >r3a CSB4 nr 1//'%6 7 an;3:3<;3@

,<n3;<r3?ar -r3n ,)3@9 ) 2a,33.

BOALA PULMONARA CRONICA OBTRUCTIVA ST4 II GOL4 IN EACERBARE.PNEUMONIE INTERSTITIALA.


COLECTIE PLEURALA BILATERALA.FIBROZA PULMONARA 4IFUZA.

ANEMIE SECUN4ARA.

INSUFICIENTA CAR4IACA CONGESTIVA CLASA NHA III.

CAR4IOPATIE ISCHEMICA PRIN AFECTARE TRIVASCULARA.INSUFICIENTA MITRALA MO4ERATA.

INSUFICIENTA TRICUSPI4IANA MO4ERATA.

HTP SECUN4ARA MO4ERATA! SEVERA.INFARCT MIOCAR4IC VECHI ANTEROINFERIOR TRATAT CONSERVATIV.

4IABET ZAHARAT TIP INSULINONECESITANT.

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1.0.11 07:17 :Gran#=/ *10!"L Gran$=60.' $ HCT='6.& $ HGB=11./ (!) L+,-#=.' *10!"L L+,-$=''.6 $ MCH=&.6 -( MCHC='1. (!)

MCV=8./ 2L M3)#=0./ *10!"L M3)$=6.1 $ MPV=8.6 2L PCT=0.61 $

P45=1&.% $ PLT='0/ *10!"L RBC=/.// 10*10!"L R45CV=16 $ R45S4=/%./ 2 5BC=6.% *10!"L VSH 71=1& ,, VSH 7=/1 ,, ALAT=1

U!L ASAT=1% U!L B33r9:3na ;<;aa=1.06 ,(!) C<>;r<=1 ,(!)

Cra;3n3na=0.8 ,(!) F3r=0 9(!)

1.0.11 07:1 : F<>2a;a?a a@a3na=1& U!L GGT='1 U!L G3@,3=1'6 ,(!)

L4H='% U!L Pr<;3n ;<;a=&. ,(!) Ur=' ,(!)

1.0.11 11:02 : Ta:<9 >an(3n=PMN =&6

EO = BA =

L = '8

MO =/4>@r3r An3?<@3;<?a n<r,<,3@r<@3;ara. H3-<@r<,3. Rar @<)<@3; 3-;<@3;.

29.0.11 12:1, /986;2,.0.2011: L. -9ra Fr<;39 -;. )@rar BAAR=NEGATIV

29.0.11 12:1 : L. -9ra Ea,n ,3@<<(3@=N9 >a9 )?<;a; 29n(3. L. -9ra 2r<;39

Gra,=23:r3na rar ,a;33

29.0.11 12:17 : L3@3) -9ra G9@<?a=1&% ,(!) L3@3) -9ra L4H=18 U!L

2,.0.11 0:, : L3@3) -9ra Pr<;3n=1.8 (!)

2.0. 2011: ASTRUPD -O= 8%.1 ,,H(D -CO= '6.% ,,H(D Sa;O= 8%.1$

J= /.0 ,,<!D Na= 1/1 ,,<! D Ca= 0.1 ,,<!

R43 stand. )A( @<r) (<:a ,ar3; 33 @<n(>;33D <-a@3;a;3 3ar :3a;raD ,9;3- ,3@r<-a@3;a;3

n<)9ar >3 3nrar )3>,na; 3n2ra3ar :3a;ra. C<@;3 -9raa :3a;raa.

E!4 RS AV= 0 :a;a! ,3n9; a RS a 0 (ra)D a>-@; ) S 3n V1 V&D 9n) T n(a;3 V'V& 73>@,3 >9:-3@ar)3@a.

)3R/21.07.2011 )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3 ,<)ra;a 3n ;<;

ar:<r :r<n>3@. R)9@ra VEMS @9 '&$

E)-!R-A

B<na 3n ar>;a ) &6 an3 2<>; 29,a;<r a ->; &0 PA @9n<>@9; @9 an;@)n; -r><na

-a;<<(3@ @ar)3<a>@9ar 7ICC CIC HTP IM @3 >3 ,;a:<3@ 74Z ;3- 3n>93n<n@>3;an; ;rna; )3n C3n3@a n<a>;ra 9n 9na 393 011 > r3n;rna?a -n;r9

ra9ar @3n3@<:3<<(3@a. Pa@3n;9 a -r?3n;a; )3>-n a 2<r; ,3@ ;9> @9 -@;<ra;3

,9@<-9r9n;a a>;n<a)3na,3 2a;3(a:33;a; ;ran>-3ra;33 >@a)ra ;<rn;3 a 2<r; K9n(3;<ra@3@ -<>;r3<r >3,-;<, a@r:a; 3n 9;3, ?3 an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; >3 ,9@<a> -a3) -9,<nar

>9:,a;3;a; :a?a :3a;ra @9 MV )3,3n9a; a a@>; n3 ra9r3 @r-3;an; 3n 1! 3n2r3<ar aa,3<r @a,-3 -9,<nar3 >3 23n ra9r3 >3:3an; )3>,3na; :3a;raD @ar)3<a>@9arD >929 >3>;<3@

3n 2<@ar9 ,3;raD TA= 10!60,,H(D AV= %6 :a;a3! ,3n9; -a;<,(a3 9><ara.

B3<<(3@ >)r. 3n2a,a;<r 7VSH 9><r a@@ra; >)r an,3@ (3@,3 :a?aa 9><r @r>@9;a

3-<-r<;3n,3. EJG 9 ) ra-9> 3)n;3a?a >,n ) IM an;r3<r @3 >3 3>@,3

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>9:-3@ar)3@a .Ra)3<(ra23a -9,<nara 3)n;3a?a <-a@3;a;3 3ar :3a;ra >3 ,9;3- ,3@r<-a@3;a;3

n<)9ar >3 3nrar )3>,na; 3n2ra3ar :3a;ra @<@;3 -9raa :3a;raa.

PFR )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3 ,<)ra;a 3n ;<; ar:<r :r<n>3@ r)9@ra VEMS @9 '&$. P -ar9r>9 3n;rnar33 >a 2@;9a; ;<ra@<@n;?a )3a(n<>;3@a >3

3n >@<- ;ra-9;3@ @9 a@9ara a a-r<3,a;3 .& 3;r3 3@3) -9ra @9 a>-@; ) ;ran>9)a;.

In 9r,a ana,n?3 a a,n993 @3n3@ >3 )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> 2!?3 HHC an;3;9>3 an;3;r,3@ an;33n2a,a;<r

an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3 >3 )

r@33:rar 3)r<@;r<3;3@a a @<n;3n9a; ;ra;a,n;9. - @ar 3 9r,a a,:9a;<r @9 <9;32a<ra:3a.

r(3, a3,n;ar 3-<><)a; 3-<3-3)3@ 3-<(9@3)3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D 3;ara 2a@;<r3<r 3r3;an3;3D

a@@3nar an;3(r3-aa an9aD

;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->!?3D VENTOLIN 100 ,3@r<(ra, -929r3 a n<3D

TAVANIC &00 ,( 1 @-r! ?3D 7% ?3D

ER4OME4 '00 ,( 1 -r ?3 7110D @<n;3n9ara ;ra;a,n;993 @ar)3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>;D

@<n;3n9ara ;ra;a,n;993 )3a:;<<(3@D

( consult cardiologicC

r3n a @<n;r< ->; ' 9n3 3n a:>n;a a@r:ar3<rD )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

TU BRONHOPULMONARA LSS T/N'M0.

BPOC >;) II G<) IN EACERBARE.

4ISFONIE SECUN4ARA 7Par?a @<ar)a <@aa >;an(a.

HEPATOPATIE CR. 4E ETIOLOGIE NEPRECIZATA.

4ETERMINARI SECUN4ARE CUTANATE


17.0.11 07:9, : Gran#=&.& *10!"L Gran$=6%.8 $ HCT=/%.1 $ HGB=1&.% (!) L+,-#=1.8 *10!"L L+,-$=.8 $ MCH='' -( MCHC=''.' (!)

MCV=.' 2L M3)#=0.8 *10!"L M3)$=./ $ MPV=8.1 2L PCT=0.1/ $

P45=1&.6 $ PLT=6& *10!"L RBC=/.%& 10*10!"L R45CV=1/. $ R45

S4=&1. 2 5BC=8.1 *10!"L VSH 71=0 ,, VSH 7=&1 ,, ALAT=%/U!L ASAT=% U!L B33r9:3na ;<;aa=1./ ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a

a@a3na=06 U!L GGT=88 U!L G3@,3=& ,(!) L4H=106' U!L Pr<;3n

;<;a=% ,(!) Ur=11 ,(!)

17.0.11 07:,/911;1.0.2011 : S-9;a Fr<;39 BAAR A=NEGATIV



17.0.11 11:02 :B33r9:3na )3r@;a=0./ ,(!)

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EFg RS a RS /& (r) AV %0 :!,3n

)3R /70098;16.0.2011 43>29n@;3 n;3a;<r3 r>-3ra;<r3 ,3;a r>;r3@;3 ,<)ra;a

<:>;r9@;3 ,<)ra;a @n;ra >3 >r 3n -r32r3. VEMS >@a?9; @9 /%$

Radiografia pulmonara: <-a@3;a; LS4 ra;3 <,<(na -<>3:3 :3n )3,3;a;a ) >@3?9ra

<r3?<n;aa >3 ?<n ) 3-r;ran>-arn;a @9 -r; -r<-r39>9:@a3@9ara )r-;D <-a@3;a; @

;ra@;3<na?a ;raa >3 39. O-a@3;a; ra;3 <,<(na 29 )3,3;a;;a -ara3ar >;an(.!" toracic/16.0.2011 dr 4uttman ".: a;a>a; @<-3.

Pr<@> ;9,ra ) /866 ,, @n;ra; - BLSS @9 3n@9)ra AP >;( >3 3na?3 3n FAP -ana a

-r; BPS. 2<r,a;39na >; 3n @<n;a@; ar( @9 A< )>@n)n;a >3 @r<>a. A)n<-a;3 -ara;aaa)r ) /.& @, )3a,;r97 >3 r;r<>;rnaa )ra-;a ) & ,, )3a,;r9. A)n<-a;3 -ara@ar3naa )

& ,, )3a,;r9 >3 3ara >;( ) % ,,. 23:r<?a -9,<nara )329?a :3a;raa @9 ,<)323@ar

3,-<r;an;a 3n LS4 ) ;3- 23:r<@a3;ar @9 @a3;a;3 ) -ana a &0 ,,. N9 > @<n>;a;a a>-@; )

@<@;3 -9raa. N9 > @<n>;a;a ,<)32@ar3 -ar3;a ;<ra@3@. F3@a;9 ar )3,n>39n3 >3 >;r9@;9ran<r,a. N9 > @<n>;a;a ,<323@ar3 :33ar >a9 -<r;a. C<@3>;9 n9 >; <@93;. Gan) SR )

a>-@; n<r,a. R3n@33 :3a;ra a9 )3,n>39n3 >3 3n)3@ @<r;3@a n<r,a. S9:@9;an <,:ar >;(

3>;a 9n n<)9 ) 0 ,, )3a,;r9.

C<n@9?3 TU BLSS T/N'M0Bron?oscopia/1291;18.0.2011 dr +imion $ a;a>a; @<-3

CV ,<:3 ;ra 3:ra -3n;n ;raa n<r,a. ar:<r :r<n>3@ )r-;3:r BPS LIS 3n(9raa 3:r -r<@> -r<32ra;3 (;an; @9 <:>;r9@;3 ;<;aa a :r @9,3na7

B3<->3 3n 9@r9

E)-!R-A:

B<na 3n ar>;a ) &' an3 2<>; 29,a;<r a /0 PA @9n<>@9; @9 an;@)n; :a@3ar >3 -ar?a )

@<ar)a <@aa >;an(a> -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> >a@a )3>-n a 2<r;

,)39)3>2<n3 a>;n3 a)3na,3 2a;3(a:33;a; >3,-;<, a@r:a; 3n 9;3, >a-;a,an3an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;an(3@;a?33 2a@3a ;<ra@ n<r,a

@<n2<r,a; MV )3,3n9a; a n39 @a,-993 -9,<nar >;( M @9 -3r -r9n(3; ,3;<ra@)r-; 2ara ra9r3 >9-raa)a9(a; TA 1'0!80 ,,H(

B3<<(3@ >)r. 3n2a,a;<r 9><r >3n)r<, ) @<>;a?a

Ra)3<(ra23a -9,<nara )>@r3 <-a@3;a; LS4 ra;3 <,<(na -<>3:3 :3n )3,3;a;a ) >@3?9ra<r3?<n;aa >3 ?<n ) 3-r;ran>-arn;a @9 -r; -r<-r39>9:@a3@9ara )r-;D <-a@3;a; @

;ra@;3<na?a ;raa >3 39 -r@9, >3 <-a@3;a; ra;3 <,<(na 29 )3,3;a;;a -ara3ar >;an(

@a @ r3)3@a >9>-3@39na 9n93 -r<@ -r<32ra;3 :r<n<-9,<nar ,<;3 -n;r9 @ar > 3n)3@a

2@;9ara 9n93 C; ;<ra@3@ >3 a 9n3 23:r<:r<n<>@<-33. CT9 ;<ra@3@ @<n23,a >9>-3@39na3)n;33) TU BLSS T/N'M0 3ar :r<n<>@<-3a 3)n;3a?a -r<@> -r<32ra;3 (;an; @9

<:>;r9@;3 ;<;aa a :r @9,3na. E ana;<,<-a;<<(3@ @<n23r,a -r?n;a 9n93 @ar@3n<, @9 @9

,[email protected] 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3

>9>.

A 9r,a; ;ra;a,n; an;3:3<;3@ 7C3-r3n< 1 2!?3HHC an;3;r,3@ an;3a(3@ -@;<ran; -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3n >3 )r@33:rar 3)r<@;r<3;3@a @9 <9;3

2a<ra:3a.


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r(3, a3,n;ar @33:ra; @a<r3@D

;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->! ?3

VENTOLIN 100 ,3@r<(ra, -929r3 a n<3

;ra;a,n; @9 an;3a(3@ a n<3D -r?n;ara a IOCN C9K @<n2<r, 3n;(r99 @9 ). )r U)ra A.

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33D

r3n a @<n;r< ->; 6 9n3 3n 3->a a@r:ar3<r.

B)%! +". - 4%* -& E=A!ERBARE -&3E!"-%A+A

!)! !%$)E&+A"

'"AE 3$. $%ERA"A


2,.0.11 0:9 :

5BC=% *10!"L L+,-#=* 1. *10!"L M3)#=0.8 *10!"L Gran#=& *10!"L L+,-$=* 1%.% $ M3)$=10. $ Gran$=%1./ $ HGB=16.% (!) RBC=&.'8

10*10!"L HCT=* &.& $ MCV=* %.% 2L MCH='1 -( MCHC='1.8 (!) R45CV=* 1&.1 $ R45S4=&.8 2 PLT=16 *10!"L MPV=8.8 2L P45=16

$ PCT=0.1/ $ Ta:<9 >an(3n=PMN = %0EO = 8BA = L = 0MO = 84>@r3r

VSH 71= ,, VSH 7=/ ,, ALAT=1% U!L ASAT=1% U!L B33r9:3na;<;aa=0.% ,(!) C<>;r<=1 ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=*

&/ U!L GGT=11 U!L G3@,3=88 ,(!) L4H='8' U!L Pr<;3n ;<;a=6.8

,(!) Ur=1& ,(!)

RGF stand. PA-desen interstitial accentuat bazal bilateral, voalarea sinusului costo-diafragmatic dr, hilifibrozati, mariti, ascensionati, cu calcificari.

PFR- disfunctie mi'ta, restrictie severa, obstructie severa segment central si in periferie. &educerea(%)S cu <3+

#P$%R$&A- !olnav in varsta de ani, fost mare fumator, > "A, cunoscut cu !"7; st. 6( D7L$,

;"; compensat, aflat sub tratament cu Seretide 5/5, ventolin - la nevoie, se interneaza pentrumodificarea starii generale, tuse cu e'pectoratie muco-purulenta, dispnee la efort mic/mediu, astenie,subfebrilitati, inaptetenta, transpiratii predominent nocturne, simptome e'acerbate in ultimele zile anterior internarii.7biectiv - la internare2 starea generala mediu modificata, tes. cel. subcutanat slab reprezentat8

p'()onar 2 torace astenic, )( inasprit, raluri crepitante si rare sibilante diseminate bilateral.&adiografia pulmonara -desen interstitial accentuat bazal bilateral, voalarea sinusului costo-diafragmatic dr, hilifibrozati, mariti, ascensionati, cu calcificari."#&- disfunctie mi'ta, restrictie severa, obstructie severa segment central si in periferie. &educerea(%)S cu <3+

"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus. A urmat tratament antibiotic, antitermic, e'pectorant, bronhodilatator, antimicotic, 00;, A6=S, a continuattrat. pe care il urma ambulator, cu evolutie favorabila.Se e'terneaza cu recomandarile

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Reco)andari-tratament cu 2 Seretide 5/5 '1 puff/zi Spiriva 1cps/zi

-reevaluare cardiologica, tratament conform recomandarilor

-control pneumologic peste 3 luni, cu bilet de trimitere de la medical de familie si dovada de asiguratcupon de pensie din ultimele 3 luni calendaristice

S-A %L6!%&AT &%T%TA ;7)". S%&6A ;S!! =&. 3<<< Seretide 5/5, Spiriva

INSUFICIENTA RESPIRATORIE ACUTA.FIBROZA PULMONARA 4IFUZA 4E ETIOLOGIE NEPRECIZATA. ALVEOLITA

EU4ATIVA. COLECTIE PLEURALA BILATERALA 7 IN CANTITATE MICA.

EN4OCAR4ITA INFECTIOASA.

INSUFICIENTA AORTICA MO4ERATA! SEVERA. INSUFICIENTA MITRALA

MO4ERATA! SEVERA. INSUFICIENTA CAR4IACA CONGESTIVA CLASA NHA III.HIPERTENSIUNE PULMONARA MO4ERTA. HIPERTENSIUNE ARTERIALA

SECUN4ARA RENALA. INSUFICIENTA RENALA CRONICA HEMO4IALIZA.ANEMIE SECUN4ARA FORMA MO4ERATA.


29.0.2011: !oagulograma: INR= 1.'/D APTT= '0.%D T= 1&.%D IP= &.

2,.0.11 07:26 : Gran#=6 *10!"L Gran$=%%.% $ HCT=&.% $ HGB=8.' (!)

L+,-#=1. *10!"L L+,-$=1& $ MCH='1.6 -( MCHC='. (!)

MCV=8.' 2L M3)#=0.& *10!"L M3)$=%.' $ MPV=8./ 2L PCT=0./ $ P45=1&.8 $ PLT='&0 *10!"L RBC=.6 10*10!"L R45CV=1&.' $ R45

S4=&.1 2 5BC=%.% *10!"L VSH 71=11% ,, VSH 7=1/ ,, ALAT=6

U!L ASAT=&0 U!L B33r9:3na ;<;aa=0.6 ,(!) Ca@39 ;<;a=%./ ,(!) C<>;r<=1&& ,(!) Cra;3n3na=8.& ,(!) F<>2a;a?a a@a3na=/' U!L GGT=/'

U!L G3@,3=%/ ,(!) L4H=60/ U!L Pr<;3n ;<;a=& ,(!) Tr3(3@r3)=1'/

,(!) Ur=8 ,(!)

2,.0.11 07:9 :/ 98;2,.0.2011 S-9;a Fr<;39 BAAR A=NEGATIV S-9;a Fr<;39 BAAR B=NEGATIV


2,.0.11 07:97 : S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a

<r<2ar3n(3ana. S-9;a Ea,n ,3@<<(3@=Can)3)a >--. UFC ! -a@a. S-9;a Fr<;39

Gra,=A>-@; ,a@r<>@<-3@ Sa3arA>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,-

C9 -3;3a >@9a,<a> &!@a,-

F3:r3na a:>n; @<@3 (ra, -<?3;33 3n an;9r3 >3 (ra,?3 @<@3(ra, n(a;33 3n (ra,?3.

S@<r ) @a3;a; 0

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2,.0.11 08:, /98;2,.0.2011: *aa bron?oaleolar Fr<;39 -;. )@rar

BAAR=NEGATIV

2,.0.11 08:,6 : *aa bron?oaleeolar C9;9r3 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a<r<2ar3n(3ana. LaaK :r<n<a<ar Fr<;39 Gra,=A>-@; ,a@r<>@<-3@

A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 1& 0 ,a@r<2a(!@a,-

C9 -3;3a >@9a,<a> >3 :r<n>3@ rar @9 -3;3a :r<n>3@

F3:r3na a:>n; rar3 @<@3 (ra, n(a;33.

S@<r ) @a3;a;

2,.0.11 10:98 : Ta:<9 >an(3n=PMN = %6

EO =

BA =

L = 18MO = /

4>@r3r An3?<@3;<?a n<r,<,3@r<@3;ara. H3-<@r<,3. H,a;33 3n 23>3@9r3.

)rocalcitonina= /.6.

A+"R#): /.08.011 -= %.&D -CO= '.' ,,H(D -O= /%.8 ,,H( Sa; O= 88.&$ Na= 1'6 ,,<!D J= '.' ,,<!D Ca= 0.&6 ,,<! D

&.08.011 -CO= '6.% ,,H(D -O= &'.1 ,,H(D Sa;O= 8%.1$ Na= 1/1 ,,<! D J= /.0 ,,<D Ca= 0.1 ,,<!

'emoculturi3n 9@r9 7 -r@3D

-munologie: ( 3n 9@r9

Rgr toracica @<r) (<:a ,ar3;.M9;3- <-a@3;a;3 ,3@r<n<)9ar >3 n)9ar3n23;ra;3

)3>,3na; 3n a,:33 @a,-3 -9,<nar3 -r)<,3nan; :a?a.

3ibrobron?scopie /12;2,.0.2011 dr +imon $.:( atasat copie: ;raa 3:ra. P3n;n

;raa n<r,a. Ar:<r :r<n>3@ :3a;ra 3:r 2ara ,<)323@ar3 a ,9@<a>3 :r<n>3@. BAL @3;<<(3@ BJ 2<ra n>-@323@a ,3@<<(3@.

A&4-% !" "%RA!-! / 29.0.2011 dr 4uttman ": ( atasat copie: ;<a; @a3:r ar;r3a

3n;ra,)3a>;3na 7 a<r;a ;r9n@39 ar;r3 -9,<nar A4PAPS0 >9n; -r,a:3 2ara,<)323@ar3 ;r<,:;3@. @a3:r9 ar;r3a -9,<nar @r>@9; :3a;ra -n;r9 ,<)323@ar3 ) HTP.

Car)3<,(a3 3,-<r;an;a @9 >,n ) HTP. A)n<-a;33 ,)3a>;3na -r?n; 3n ;<a; (r9-D

) 100 ,, )3a,;r9. M<)323@ar3 3,-<r;an; ) 23:r<?a >3 a<3;a 9)a;3a :3a;ra -r)<,3nan; 3n <:33 >9-r3<r3 )ar >3 3n @3 3n2r3<r3. C<@;3 -9raa ,3@a :3a;raa. N9 >

@<n>;a;a ,<)323@ar3 ;9,<ra ,)3a>;3n< -9,<nar. N9 > @<n>;a;a ,<)323@ar3 -ar3;a

;<ra@3@. F3@a;9 ar )3,n>3n3 >3 >;r9@;9ra n<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar >a9

-<r;a.. C<@3>;9 n9 >; <@93;. Gan) >9-rarna ) a>-@; n<r,a. R3n3@33 :3a;ra a9)3,n>39n3 >3 3n)3@ @<r;3@a n<r,a.

C<n@9?3 A)n<-a;33 ,)3a>;3na. C<@;3 -9raa :3a;raa. Car)3<,(a3 @9 HTP. 2ara

a>-@; TEP.

!onsult cardiologic /2,.0.2011 dr Radu Rosu: ( atasat copie.

E@<@ar)3<(ra23 A< a 3n= 1. A< a>@= '6. AS /& VS @<n@n;r3 n<r,a 6&!&0D S3V= 1D

PP=1D F=/0$. VT4VS= '1 ,D VTSVS= 1'&. Vaa A< @a@323@a;a )@3)r= D2<r,a;39n 3-<@<(na a n39 @9>-3 n<n@<r<nar3n.

C<n@9?3 SA< ,)3! >;ran>a. IA< ,<)ra;a. IM 9><ara! ,<)ra;a.

EJG R> AV= 100 :;a3! ,3n9; a RS a 1& (ra) HVS.

In)3@a;33 ' -r@3 ) ,<@9;9r3.

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@<(ra23 ;ran>><2a(3na 7 @<n2<r, -r<(ra,ar33

@<n;3n9ara ;ra-33.

Eco( transesofagiana /26.0.2011 conf. dr ana )op:( atasat copie: 2<r,a;39n @<(na,<:3a ) a-r<3,a;3 0.&1 @, a)rn;a ) @9>- a3 A< @9 a>-@; ) (;a;33.

In>923@3n;a A< r@n;a ,<)ra;a! >ra. In>92@3n;a ,3;raa ,<)ra;a! >ra. F9 ;ran>,3;ra

@9 a>-@; ) (;a;33.C<n>9; ,a;<<(3@ 76.08.011 -r<2 )r. P;r< LK9:<,3r An,3 @r<n3@a >3,-a

In)3@a;33 a H:8(!) > 3n)3@a ;ran>29?3.

Ana3? a;a>a; @<-3.

E)-!R-A:

Pa@3n; 3n ar>;a ) 6' an3 @9n><>@9; @9 an;@)n; rna 7 In>923@3n;a rnaa @r<n3@a

H,<)3a3?a >3 @ar)3<a>@9ar 7 HTA >@ rnaa ICC >; 3n;rna; -r3n ;ran>2r ) a S-3;a9A:a I93a -n;r9 ,<-;3?3 3n @an;3;a; ,3@a )3>-n a 2<r;9r3 ,3@3 >3 ) r-a9> a>;n<

a)3na,3 2a;3(a:33;a; >@a)ra ;<ran;3 a 2<r;>)r 2:r3 -r9n(3; 2r3><n ;ran>-3ra;33

>3,-;<,a;<<(3 ):9;a;a 3n 9r,a @9 >a-;a,an3. O:3@;3 a 3n;rnar -a@3n; >9:2:r3 7'%./

(ra) C @9 >;ar (nraa 3n29n;a;aD ;(9,n; -a3) ;ran>-3ra;D -9,<nar MV 3na>-r3; @9-3r -r9n(3; :3a;ra ra9r3 @r-3;an; :a?a :3a;raD @ar)3<a>@9ar >929 >3>;<3@ (ra) IV 3n

2<@ar9 ,3;ra >3 A< @9 3ra)3r 3n ;<a;a ar3a @ar)3a@a >3 a n39 @ar<;3)<rTA= 110!60,,H(DAV= 0 :a;a3! ,3n. R(r ;<ra@3@a PA 3)n;3a?a @<r) (<:a ,ar3;D ,9;3- <-a@3;a;3

,3@r<n<)9ar >3 n)9ar3n23;ra;3 )3>,3na; 3n a,:33 @a,-3 -9,<nar3 -r)<,3nan; :a?a.

Aan) 3n )r >3,-;<,a;<<(3a ):9;a;a a@9; ,<-;3?3a >3 3,a(3na ra)3<<(3@a 2<ar;)3na,3@a > r3)@a >>-3@39na 9n93 Tr<,:,:<3>, -9,<nar -n;r9 @ar > 2@;9a?a an(3<CT

;<ra@3@. An(3<CT9 ;<ra@3@ 3n23r,a ;r<,:,:<3>,9 -9,<nar )ar )>@r3 -r?n;a

a)n<-a;33<r ,)3a>;3na a @ar)3<,(a3 3,-<r;an; @9 >,n ) HTP -r@9, >3 ,<)323@ar3

) 23:r<?a -9,<nara >3 >,n ) a<3;a 9)a;3a :3a;raa -r)<,3nan;a 3n <:33 >9-r3<r3)ar >3 3n @3 3n2r3<r3. Pn;r9 >;a:33ra ;3<<(33 23:r<?3 >3 a<3;3 -9,<anar > 2@;9a?a

23:r<:r<n<>@<-3 @9 aaK :r<n>3<a<ar >3 > r@<;a?a -r<: 3,9n<<(3@ 7 a2a; 3n 9@r9.

-a@3n;9 n9 r@9n<a>; < -9nr a@9;a a 2a;<r3 ar(3@3 -n;r9 a -9;a )3a(n>;3@a < a<3;aar(3@a ) ;3<<(3 ;r3n>@a 3ar )3na,3@a 3,a(3n33 ra)3<<(3@ @9) -r?n;a 9n93 -r<@>

n<-a?3@ >a9 ;9:r@9<> 7 . >-9;a -n;r9 BJ BAAR n(a;3 a ,3@r<>@<-3 >3 @9;9r3 3n

9@r9 . Ga?<,;r3a 2@;9a;a >9>;3n )3a(n<>;3@9 ) In>923@3n;a r>-3ra;<r3 ,an32>;a 7 Sa;O= 88.& $. Pn;r9 >)r 2:r3 -r9n(3; >3 >929 >3>;<3@ A< >3 ,3;ra 7@ n9 )>@r3> 3n

;rnar3 )3n >r3@33 an;r3<ar > r@<;a?a -r<@a@3;<n3naD -r<@a@3;<n3na= /.6 7-<?3;3a

0.&DVSH ,9; a@@ra;D > @<n;3n9a 3n>;3(a;33 >3 3n )ra @9)r33 -r?n;3 9n3

n)<@ar)3; 3n2@;3<a>. C<n>9;9 @ar)3<<(3@ @<@ar)3<(ra23a >3 @<;ran>><2a(3an >9>;3n)3a(n<>;3@9 ) )<@ar)3;a 3n2@;3<a>a. Sa9 r@<;a; -r@3 ) ,<@9;9r3 @ar >9n; 3n 9@r9.

In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ 7ra)3<<(3@ 3,a(3>;3@ >3 :3<<(3@

>a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.P -ar@9r>9 3n;rnar33 a 9r,a; ;ra;a,n; an;3:3<;3@ 7 TIENAM &0,(0&0,( a @ar >a

a><@3a; C3-r3n< 1!2 0 1! 2 )<? a9 2<>; aK9a; @<n2<r, (3)9r3<r -n;r9 -a@3n;33

,)3a3?a;3D 29@<na?a< an;3;9>3 a;3;r,3@ an;3a(3@ an;33n2a,a;<r33 )39r;3@. Sa 3n)3@a;>3 <3(n<;ra-3 / 3;r3! ,3n9; 0 ,3n9;!.Sa9 2@;9a; >)3n; ) ,<)3a3?a @<n2<r,

-r<(ra,ar3<r.

In @9r>9 3n;rnar33 a n@>3;a; 2@;9ara 9n3 >)3n; >9-3n;ar ) ,<)3a3?a )>3 3n@ar@ara

@9 3@3) a 2<>; 3,3;a;a 71&0, >r 23?3<<(3@ 9;33?a; -n;r9 )39;3a an;3:3<;3@<r. 4a>,na

64

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3n @9r>9 ?33 ) )9,3n3@a 78.08.011 -a@3n;9 a -r?n;a; 9n -3><) 9><r ) )?<r3n;ar

;,-<r<>-a;3aa. aan) 3n )r @<n;;9 3n2@;3<> >a r3)3@a; >9>-3@39na 9n<r ,:<33 >-;3@ .

S )@3) ;ran>2r9 -a@3n;r993 3n >r3@39 ;ra-3 3n;n>3a C3n3@a B<3 In2@;3<a> @<n2<r,3n;(r33 ;2<n3@ @9 ). )r LUPSE M.

S 3n)3@a 2@;9ara 9n3 r(r ;<ra@3a@ PA >3 -r<23 3n )a;a )'1.08.011 -n;r9 a9ara 3n

)3na,3@a a 3,a(3n33 ra)3<<([email protected] ;rna?a @9 r<,an)ar3

;ran>2r - >@;3a TI a C3n3@33 B<3 In2@;3<a> @<n2<r, 3n;(r33 ;2<n3@ @9 )<a,na )r.

L9-> M. r3n )9-a r?9;a;9 ana3?<r a2a; 3n 9@r9 >3 @9 r(r ;<ra@3@a -n;r9 a9ara 3n )3ana,3@a

a 3,a(3n33 ra)3<<(3@

B)%! A!#"-A" +" - 4%*

BR%&+-E!"A-- BAA*E B-*A"ERA*E

-&+#3-!-E&"A RE+)-RA"%R-E !R. A!#"-A"A

!)! !%$)E&+A"

3-BR%A )#*$%A&RA -3#A

'"AE +". -- !# R-+! !AR-%A+!#*AR $%ERA".-+*-)-E$-E.

"B! RE&A*-& A&"E!EE&"E.


26.0.11 08:1 : Gran#='.% *10!"L Gran$=6.& $ HCT=/8. $ HGB=1&.' (!) L+,-#=1.% *10!"L L+,-$=.& $ MCH='0.1 -( MCHC='1.% (!)

MCV=&.1 2L M3)#=0.& *10!"L M3)$=8 $ MPV=10. 2L PCT=0.10' $

P45=16 $ PLT=101 *10!"L RBC=&.0% 10*10!"L R45CV=1&./ $ R45S4=&'.6 2 5BC=&. *10!"L VSH 71=1 ,, VSH 7=' ,, ALAT=1% U!L

ASAT=/ U!L B33r9:3na ;<;aa=1 ,(!) C<>;r<=%1 ,(!) Cra;3n3na=0.

,(!) F<>2a;a?a a@a3na=161 U!L GGT=1' U!L G3@,3=8 ,(!) L4H='/0U!L Pr<;3n ;<;a=6.% ,(!) Tr3(3@r3)=6' ,(!) Ur=8 ,(!)

26.0.11 10:06 : Ta:<9 >an(3n=PMN = 66

EO =

BA = 0L = 8

MO = /

E<4 RS AV= %& :a;a3!,3n.aRS 3n;r,)3ar HAS 2ara ,<)323@ar3 3>@,<?3<na.

R43 stand. )A()>n 3n;r>;3;3a a@@n;9a; :3a;ra -r)<,3nan; a n39 ,3;<ra@93

>;an( -ara >3 >9-ra3ar 33 23:r<>3 ,ar3;3 @9 @a@323@ar3. C<r) (<:a ,ar3;. V<aara >3n9>993

@<>;<)3a2ra(,a;3@ )r-;.

)3R/2692;26.0.2011( )3>29n@;3 ,3;a r>;r3@;3 >ra <:>;r9@;3 2. >ra >(,n;@n;ra >3 3n -r32r3.VEMS1 3;r9.

E)-!R-A B<na 3n ar>;a ) & an3 29,a;<r /& PA @9n<>@9; @9 BPOC 2,. >ra

3n>923@3n;a r>-3ra;<r3 @r<n3@a CPC :r<n>3;a?33 :a?a TBC rna 3n 00/> -r?3n;a -n;r9

,<)323@ara >;ar33 (nra ;9> @9 -@;ra;3 ,9@<-9r9n;a )3>-n a 2<r; ,3@ a>;n<a)3na,3 2a;3(a:33;a; >a@)ra ;<ran;3 a 2<r; >3,-;<, a@r:a; 3n 9;3,a >a-;a,ana

an;r3<r 3n;rnar33.

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O:3@;3 a 3n;rnar -a@3n; a2:r3 @9 >;ar (nraa ,)39 ,<)323@a;a Dpulmonar ;<ra@

,23?,a;<> MV 3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;ra >3 rar >3:3an;

:3a;raD Ta= 1'0!80,,H( AV= %6 :a;a3! ,3n9;. B3<9,<ra 3-r@<>;r<,3. Ra)3<(ra23a -9,<nara 3)n;3a?a )>n 3n;r>;3;3a a@@n;9a; :3a;ra -r)<,3nan; a n39 ,3;<ra@93

>;an( -ara >3 >9-ra3ar 33 23:r<>3 ,ar3;3 @9 @a@323@ar3. PFR )3>29n@;3 ,3;a r>;r3@;3

>ra <:>;r9@;3 >ra >(,n; @n;ra >3 3n -r32r3D VEMS1 3;r9.In 9r,a ana,n?3 a a,n993 @3n3@ >3 )a;<r -ara@3n3@ >a >;a:33; )3a(<>;3@9 ) ,a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@ AINS -@;<ran; :r<n<)3a;a;<r HHC a;3a(3@ an;3;r,3@ a

@<n;3n9a; ;ra;. 3-<;n><r - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.S ;rna?a @9 r@<,an)ar3

r(3, a3,n;ar @33:ra; ,<)3na,3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D ;ra;a,n; @9 Cn3 K; 00 ,3@r<ra, -92!?3

I-ran; ' -929r3!?3D

Vn;<3n 100 ,3@r<(ra, -929r3 a n<3.

>a 3:ra; R- @<,-n>a;a -; < 9na. r3n a @<n;r< ->; 6 9n3 3n a:>n;a a@r:ar3<rD

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.TU BRONHOPULMONAR LIS.

BPOC ST4 II GOL4 IN EACERBARE.

COLECTIE PLEURALA STANGA.4ILIPI4EMIE.


29.0.11 07:0 : Gran#=8.% *10!"L Gran$=%./ $ HCT=/&./ $ HGB=1/.8 (!) L+,-#=1.& *10!"L L+,-$=1'. $ MCH='1.' -( MCHC='.& (!)

MCV=6. 2L M3)#=0.% *10!"L M3)$=6.% $ MPV=8.8 2L PCT=0.''1 $

P45=1&.% $ PLT='%% *10!"L RBC=/.% 10*10!"L R45CV=1'.6 $ R45S4=/%.6 2 5BC=10. *10!"L VSH 71=6' ,, VSH 7=10 ,, ALAT=1

U!L ASAT= U!L B33r9:3na ;<;aa=1.1 ,(!) C<>;r<='% ,(!)

Cra;3n3na=1 ,(!) F<>2a;a?a a@a3na=/' U!L GGT=& U!L G3@,3=8 ,(!)

L4H=%8 U!L Pr<;3n ;<;a=6.% ,(!) Tr3(3@r3)=106 ,(!) Ur=// ,(!)

28.0.11 11:29 : L3@3) -9ra Ea,n @3;<<(3@=PMN $ E< 1$ L+ &/$ @9

,?<;3a $ 1$ @9 a;3-3@ ) ;a3 ,ar ,<n< >a9 ,9;3n9@a; n9@<a; @9

3-r@r<,a?3 9n @9 a@9< @3;<-a>,a;3@. Ra;3 2r@n; ,a;33. L3@3) -9ra G9@<?a=8' ,(!) L3@3) -9ra L4H=10 U!L L3@3) -9ra Pr<;3n='. (!)

L3@3) -9n@;3 N9,. ,n;=/&00

28.0.11 11:2, : L. -9ra 2r<;39 Gra,=L9@<@3; 23:r3na.

91.0.11 07:96 : 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n( 4;@;ara 9@<@3;<r 7P=n(

4;@;ara -r<;3n<r 7A=n(

R43 stand. )A)>n 3n;r>;3;3a a@@n;9a; :a?a :3a;ra 33 23:r<?a;3 a>@n>3<na;3D <-a@3;a; 29

)3,3;a;a 3n<,<(na @9 ?<n ) 3-r;ran>-arn;a -ara3ar >;an(D <-a@323ra >3n9>93

@<>;<)3a2ra(,a;3@ >;an(.

)3R /701,8;22.0.2011 )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a>(,n; @n;ra >3 >ra 3n -r32r3. R)9@ra VEMS @9 &0$.

66

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!" toracic /16.0.2011 dr +amoilescu -.4.A;a>a; @<-3

Ea,3nara a 2<>; 2@;9a;a 3n 3n@3)n; a3a @<r<na >3 >a(3;a.

R?9;a; In 39 -a,an993 >;an( > 3?9a3?a?a < 2<r,a;39n ;9,<raa ) )n>3;a; ;3>9ara,<)ra; 3<)<23a @9 )3a,n>39n3 a3a ) a-r<3,a;3 6& @, >3 < 3n;3n)r @ran3<@a9)aa )

a-r<3,a;3 % @,. F<r,;39na >; >3;9a;a 3n;r ,n; 3993 -a,an993 >;an( >3 a<r;a

)>@n)n;a. M)3a > @<n;3n9a @9 9n :<@ (an(3<nar >9:@ar3nar ) a-r<3,a;3 // @,.F<r,a;39na 3n(<:a?a :r<n3a -r3n@3-aa AP >;an(a >3 :r<n3a >3 ar;ra <:ara 3n2r3ara

>;an(a. Br<n>3a <:993 3n2r3<r a-ar @9 9,n 3n(9>;a; 3ar -arn@3,9 -9,<nar a <:993

3n2r3<r >; ,a3 3-<n;3a;.In @a3;a;a -9raa >;an(a > <:>ra < @<@;3 3@3)3ana @9 (r<>3, ) a-r<3,a;3 '.& @,

@<a?<na;a 3n ,a3 ,9; -<r;39n3 a -r;93 -<>;r3<r ;<ra@3@. In -arn@3,9 -9,<nar n9 >9n;

3?3:3 a; 2<r,a;39n3 3n<@93;<ar ) >-a;39.F3@a; >-3na -an@ra> >9-rarna 2ara ?39n3

3n<@93;<ar ) >-a;39.C<n@9?3 N< :r<n<-9,<nar @n;r<3ar >;an(. P9r?3 >;an(a.

3ibrobron?oscopie /128;29.0.2011 dr +imon $. a;a>a; @<-3

CV ,<:3 ;ra 3:ra -3n;n ;raa ar(3;. Ar:<r :r<n>3@ )r-; 3:r. Pr<@> -r<32ra;3

-<3:9rK<na; :r LIS LSS -3n;n 3n;r<:ar >;( @9 ;n>3 - BPS - a-r<3,a;3 .& @,.S9-9ra;3 >@. B3<->33.

Rezultat anatomopatologic /2,6;2,.0.2011 dr a?arie ".: @ar@3n<, >@9a,<>nra;3n3?a; 3na?3.

E)-!R-A B<na 3n ar>;a ) % an3 2<>; 29,a;<r > -r?3n;a -n;r9 ,<)323@ara >;ar33

(nra ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r; ,)39!,3@ a>;n<a)3na,3

2a;3(a:33;a; 3na-;;n;a )9rr3 ;<ra@3@ >3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r

3n;rnar33.O:3@;3 a 3n;rnar -a@3n; a2:r3 @9 >;ar (nraa ,)39 ,<)323@a;a ;(9,n; -a3)

-9,<nar >9:,a;3;a; :a?aa >;an(a MV ,9; )3,3n9a; :a?a >;an( ra9r3 @r-3;an; :3a;ra

Sa;O & $D TA= 1'0!80 ,,H(D AV= %& :a;a3! ,3n9;.B3<<(3@ >)r. 3n2a,a;<r 7 VSH a@@ra; 9@<@3;<?a 3-r@<>;r<,3D L4H @r>@9;.P

-ar@9r>9 3n;rnar33 >a 2@;9a; ;<ra@<@n;?a 3n >@<- ;ra-9;3@ >3 )3a(n<>;3@ @9 a@9ara a &00 ,

3@3) -9ra >r<@3;r3n. E. 3@3)993 -9ra L4H ,9; @r>@9;. PFR )3>29n@;3 n;3a;<r3 ,3;ar>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n; @n;ra >3 >ra 3n -r32r3 r)9@ra VEMS @9

&0$.Ra)3<(ra23a -9,<nara 3)n;3a?a <-a@3;a; 29 )3,3;a;a 3n<,<(na @9 ?<n )

3-r;ran>-arn;a -ara3ar >;an( @ r3)3@a >9>-3@39na 9n93 -r<@> 3n<@93;<r ) >-a;39 -r@9, >3<-a@323ra >3n9>93 @<>;<)3a2ra(,a;3@ >;an(.

CT9 ;<ra@3@ @<n23r,a a@a>;a >9>-@39n )>@r33n) n< :r<n<-9,<nar @n;r<3ar >;an( >3

-9r?3 >;an(a. S 3n)3n)3@a 2@;9ara :r<n<>@<-33. F3:r<:r<n<>@<-3a 3)n;3a?a 9n

-r<@> -r<32ra;3 -<3:9rK<na; :r LIS LSS -3n;n 3n;r<:ar >;( @9 ;n>3 - BPS -a-r<3,a;3 .& @,.


A 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r-a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.


r(3, a3,n;ar @3:ra; @a<r3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

a@@3nar an;3(r3-aa an9aaD

67

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;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->! ?3D

VENTOLIN 100 ,3@r(ra, -929r3 a n<3.

( prezentarea in sericiul c?irurgie toracica pentru continuarea inestigatiilor conform

programarii.

r3n a @<n;r< ->; 6 9n3 3n a:>n;a a@r:ar3<rD

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.SUPURATIE PULMONARA SECUN4ARA

TUMORA PULMONARA LOB INFERIOR STANG

METASTAZA LATEROCERVICALA 4REAPTA SI GLAN4A SUPRARENALA STANGAFIBROZA PULMONARA MICRORETICULONO4ULARA

CAR4IOPATIE ISCHEMICA 4UREROASA

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II


22.0.11 07:11 :

Gran#=1%./ *10!"L Gran$=%8.% $ HCT='.8 $ HGB=10.8 (!) L+,-#=.

*10!"L L+,-$=1'. $ MCH=.% -( MCHC='. (!) MCV=0.6 2L

M3)#=1.8 *10!"L M3)$=8.1 $ MPV=6.6 2L PCT=0.'% $ P45=1&.% $ PLT='60 *10!"L RBC='.6' 10*10!"L R45CV=1&.' $ R45S4=&0.6 2

5BC=.1 *10!"L VSH 71=11/ ,, VSH 7=1& ,, ALAT=0 U!L

ASAT=/ U!L B33r9:3na ;<;aa=0./ ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a

a@a3na='// U!L GGT=%0 U!L G3@,3=%1 ,(!) L4H=/6 U!L Pr<;3n;<;a=&.8 ,(!) Ur='1 ,(!)

22.0.11 11:2 :

Ta:<9 >an(3n=PMN =8EO =

BA =

L = 1/MO =

4>@r3r,a;33 3n 23>3@9r3.

26.0.11 07:10 :

4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(. 4;@;ara 9@<@3;<r 7P=n(. 4;@;ara -r<;3n<r 7A=n(.

Bioumoral9@<@3;<?a >raD (ran9<@3;<?a @9 3,2<@3;<-n3D an,3 >@9n)ara ,3@r<@3;ara

@3;<3?a -a;3@a 9><ara @<>;a?a.

Examenul de urina n(a;3.

R= )A O-a@3;a; LIS 2 ),33;a;a @9 ,3@r<<-a@3;a;3 n<)9ar3n23;ra;3 )3>,3na; 3n a,:33@a,-3 -9,<nar3.

!t toracic 2@;9a; an;r3<r 3n;rnar33 3)n;3a?a -r<@> 3n<@93;<r ) >-a;39 -9,<nar >;an(<@a3?a; 3n >(,n; -<>;r<:a?a ) LS aan) @<n;9r >-3@932<r, >3 )3a,;r9 a3a ,a3,

) '%!/&,,.

4a;<r3;a a>-@;993 )@a; a ra)3<(ra23 > r@<,an)a 2@;9ara 9n3 fibrobron?oscopii @

3)n;3a?a 2<r,a;39n ;9,<raa @9 n@r<?a 3n >9-ra2a;a @ -r<a:a?a 3n ;ra @9 >9-9ra;3

68

7/24/2019 69625104-epicrize


>@9n)ara. N9 > -<a; 2@;9a @;r<r?@;3a )3n @a9?a )3,n>39n3<r 2<r,a;39n33 >3 3n23;ra;33

)3n K9r. S9-9ra;3 r;r<>;n<;3@a.

Pa@3n; 3n ar>;a ) && an3 @9n<>@9; @9 a)n<@ar@3n<, -9,<nar >;an( >;) II @3,3<;ra;a;

3n>923@3n;a r>-3ra;<r3 @r<n3@a a@9;3?a;a -a;<-a;3 @r<n3@a > -r?3n;a a C3n3@a )Pn9,<<(3 a@9?an) ;9> @9 -@;<ra;3 ,9@<-9r9n;a a>;n<a)3na,3 2a;3(a:33;a;

>@a)r -<n)raa 3na-;n;a K9n(3 ;<ra@3@ >;an( >3,-;<, @ >a9 3>n;aa; @9 a-r< % ?3

an;r3<r 3n;rnar33.

Examenul obeicti(la internare >;ar (nraa3n29n;a;aD ;(9,n; >3 ,9@<a> -a3)D 2a@3>

an3<>D r>-3ra;<r ;<ra@ a;>n3@ MV 3na>-r3; @9 -3r -r9n(3; ra9r3 r<n2an; )3>,3na;

:3a;raD TA=10!%&,,H( AV=60:!,3nD 9><ara >n>3:33;a; a -a-ara 3-<(a>;r993 >3

3-<@<n)r993 )r-;.

Bioumoral9@<@3;<?a >raD (ran9<@3;<?a @9 3,2<@3;<-n3D an,3 >@9n)ara ,3@r<@3;ara

@3;<3?a -a;3@a 9><ara @<>;a?a.

Examenul de urina n(a;3.

R= )A O-a@3;a; LIS 2 ),33;a;a @9 ,3@r<<-a@3;a;3 n<)9ar3n23;ra;3 )3>,3na; 3n a,:33@a,-3 -9,<nar3.

!t toracic 2@;9a; an;r3<r 3n;rnar33 3)n;3a?a -r<@> 3n<@93;<r ) >-a;39 -9,<nar >;an(<@a3?a; 3n >(,n; -<>;r<:a?a ) LS aan) @<n;9r >-3@932<r, >3 )3a,;r9 a3a ,a3,

) '%!/&,,.

4a;<r3;a a>-@;993 )@a; a ra)3<(ra23 > r@<,an)a 2@;9ara 9n3 fibrobron?oscopii @3)n;3a?a 2<r,a;39n ;9,<raa @9 n@r<?a 3n >9-ra2a;a @ -r<a:a?a 3n ;ra @9 >9-9ra;3

>@9n)ara. N9 > -<a; 2@;9a @;r<r?@;3a )3n @a9?a )3,n>39n3<r 2<r,a;39n33 >3 3n23;ra;33

)3n K9r. S9-9ra;3 r;r<>;n<;3@a.

P :a?a a,n993 @3n3@ ra)3<<(3@ :r<n<>@<-3 > ) a:<ra;<r > >9>;3n )3a(n<>;3@9 ) ,a3>9>.

P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7C2<r; C3n)a,3@3na @<r;3?<n3@

an;33n2a,a;<r an;3,3@<;3@ -r<;@;<ar -a;3@ >3 (a>;r3@ @9 a,3<rara >;ar33 (nra >3<9;3 @3n3@a >;a;3<nara.

• an;3a(3@ ,aK<r 3n @a? ) n<3D

• @<n;3n9ara >@,3 ) @3,3<;ra-3 @<n2<r, -r<(ra,ar33.• PNEUMONIE INTERSTITIALA.

• HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULAR MO4ERAT.


• 28.0.11 0:, : Gran#=/. *10!"L Gran$=%0.8 $ HCT=/0.% $

HGB=1'.6 (!) L+,-#=1.' *10!"L L+,-$=./ $ MCH='0. -(

MCHC=''./ (!) MCV=0.% 2L M3)#=0./ *10!"L M3)$=6.8 $

MPV=8. 2L PCT=0.166 $ P45=1&./ $ PLT=0' *10!"L RBC=/./10*10!"L R45CV=1'./ $ R45S4=//.% 2 5BC=&. *10!"L VSH

71=1% ,, VSH 7=/' ,, ALAT=1% U!L ASAT=0 U!L B33r9:3na

;<;aa=0. ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=10 U!L GGT=

U!L G3@,3=%6 ,(!) L4H=&& U!L Ur=& ,(!)

• 91.0.11 07:98 : 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n( 4;@;ara 9@<@3;<r

7P=n( 4;@;ara -r<;3n<r 7A=n(

69

7/24/2019 69625104-epicrize


• R43 stand. )A)>n 3n;r>;3;3a a@@n;9a; :a?a :3a;ra 33 23:r<?a;3 a>@n>3<na;3 @9

@a@323@ar3.

• E!4 RS. In@ar@ar V4.

• !" toracic/2,.0.2011 +tanescu 4. A;a>a; @<-3


• R?9;a; A;@;a?3a >( 8 )3n )r. In r>; @a,-9r3 -9,<nar 2ara a; ,<)323@ar3

)n>3;<,;r3@. -a3-9r3;a @a@ara @9 3n(r<>ara ,a>3a a -9r3 -ar3;a )3n

)ra-;a @9 )n>3;a3 ;3>9ar >3 n9,r<a> 3n@9?39n3 @a@ar. 49-a a),3n3>;rara>9:>;an;3 ) @<n;ra>; 3. ?<n 3n(r<>a; >9n; 3<)<23. M)3a>;3n 2ara ,a> (an(3<nar

>,n32@a;3 )3,n>3<na. Pr; ;<ra@3@ r;ra@;a; 3n )ra;-a;. In r>; 2ara a; ,<)323@ar3

)n>3;<,;r3@. a3ar n9 a-ar ,a> (an(3<nar >,n32@a;3 )3,n>3<na. F3@a; >-3na >3(an) SR 2ara ?39n3 2<@a. R3n3@3 3n Q-<;@<aaQ @9 39r3 an;r3<ar >3 @a@9

-33@ <:>;r9@;3 3n >;( @9 3)r<n2r<?a.

• C<n@9?3 A>-@; CT ) -a3-9r3; @a@ara :a?a -<>;r< a;ra )r @9 3n@939n3

@a@ar >3 a;@;a?3. n9 > -<a; @9) 9n ,?<;3<,. R3n3@3 3n -<;@<aa @9 @a@9 -33@ <:>;r9@;3 >;(.

• 3ibrobron?oscopie/1279;28.0.2011 dr. +imon $. a;a>a; @<-3

• CV ,<:3 ;ra 3:ra -3n;n ;raa n<r,a. Ar:<r :r<n>3@ >;( 3:r. BP4 :r

LS4 LM 3:r. M9@<a>a a>-@; ) :r<n>3;a @r. S9r> ,<-;3?33 :r >(,n; LI4.C3@a;r3@ -<>; TBC :r LI4 @9 )-<?3; an;ra@<;3@. N9 >9n; >,n n<-a?3@.

• )unctie transtoracica 7)r R)n3@ N.

• Rezultat anatomopatologic /269;02.08.2011 dr. a?arie ".: @33n)r9 :3<-9n@;a;

a,3na; >; 2<r,a; )3n;r9n ,;r3a a,<r2 <?3n<23 7 n@r<;3@0. N9 3>;a ,n;

) <r(an >a9 ) ,a3(n3;a;. S 3,-9n r:3<->3.

• )3R/7079;28.0.2011 ra;33 n<r,a.

•

• E)-!R-A B<na 3n ar>;a ) %0 an3 n29,a;<r @9n<>@9; 3n an;@)n; @9 HTA > -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-na 2<r; ,)39 a>;n3 >9:2:r33;a;3 3na-;;n;a >@a)r -<n)raa ;ran>-3ra;33

-r)<,3nn; n<@;9rn )9rr3 ;<ra@3@ >3,-;<, a@r:a; 3n 9;3, >a-;a,an3

an;r3<r 3n;rnar33.

• O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; -a3) ;ran>-3ra;33

n<@;9rnD -9,<nar ;<ra@ a>;n3@ MV 3na>-r3; ra9r3 @r-3;an; :a?a :3a;ra >3 rar

>3:3an;.

• B3<<(3@ >)r. 3n2a,a;<r

• Ra)3<(ra23a -9,<nara

•

CT ;<ra@3@ a;a>a; @<-3• F3:r<:r<n<>@<-3a a;a>a; @<-3

• PFR )3>29n@;3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n; @n;ra >3 >ra

3n -r32r3. R)9@ra VEMS @9

•


• A 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r

-a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3

70

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2a<ra:3a.


•

•

•

• INSUFICIENTA RESPIRATORIE CRONICA PRIN COMPRESIUNE TRAHEALA• S4R 4E COMPRESIUNE ME4IASTINALA

• GUSA RETROSTERNALA SUSPECT MALIGNIZATA

• HTA ST II C

• CIC SILENTIOASA

• BRONSITA CRONICA ACUTIZATA

•


•

90.0.11 08:00 :

• Gran#=/.8 *10!"L Gran$=6%. $ HCT=/. $ HGB=1/.1 (!)

L+,-#=1.8 *10!"L L+,-$=&. $ MCH=./ -( MCHC=''./ (!) MCV=88. 2L M3)#=0.& *10!"L M3)$=6. $ MPV=10. 2L PCT=0.181$ P45=1&.% $ PLT=1%8 *10!"L RBC=/.% 10*10!"L R45

CV=1'.& $ R45S4=//.% 2 5BC=%.1 *10!"L VSH 71=10 ,, VSH

7=' ,, ALAT= U!L ASAT=1 U!L B33r9:3na ;<;aa=0. ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=1% U!L G3@,3=11' ,(!)

L4H=//0 U!L Pr<;3n ;<;a=% ,(!) Ur=6 ,(!) I)n;323@ara @9 ;r9>

a; PCR=n(a;3

• E!4 RS 8! ,3n 3n@ar@ar VS 3>@,3 an;r<a;raa

• !" torace:W'0.08.011XC<n@9?33 (9>a r;r<>;rnaa @9 @<,-r>39n a@@n;9a;a a

;ra3. L3;3a?a rnaa :3a;raa 7 ... >9:(<;3@ )3a,. ;ran>r>a a ;ra3 & ,,

7H3-r)3a 4r G9;;,an :99;3n

•

•

• EPICRIZA

•

• -a@3n;a 3n ar>;a ) %& an3 @9 3>;r@;<,3 ;<;aa a / an3 @@ @<a@a <-ra; >3 3ra)3a; 3n

001 @3>;<r@;<@ <- 18/ 3;3a?a rnaa <- 00& HTA CIC ;a;a;a )3n 00& ;ra;a;a 3n9;3,33 an3 @a BPOC @9 :r<n<)3a;a;<ar 7 Sr;3) S-3r3a >; 3n;rna;a -n;r9

a(raara -r<(r>3a >ra a )3>-n3 @9 >9>-3@39n r@n;a ) ;9 ;raaa C3n3@ >

>9>-@;a?a < (9>a -<nKan;a -<>3:3 ,a3(n3?a;a >9>-3@39n >9>;3n9;a >3 ) a,n9 CT

;<ra@3@. S)r ) @<,-r>39n ,)3a>;3naa >9-r3<ara @9 >;n<?ar ;raaa -ana a & ,,)3a, >9:(<;3@ >3 a>@9ara @9 @3r@9a;3 @<a;raa ;<ra@3@a -r)<,3nan; >;(.

• Br<n<>@<-3a a 2<>; @<n>3)ra;a r3>@an;a >3 n@<n@9)n;a. C<n>9;9 IOCN r@<,an)a

3n>;3(a;33 >9-3,n;ar S@3n;3(ra23 ;3r<3)3ana 74r P3@39

• A 9r,a; ;ra;a,n; @9 4a,;a?<na 1 2!?3 439r;3@ ;ra;a,n;9 HTA -r<-r39 7A;a@an) 8

,(!?3 A,<3-9> 1 (!?3 3.N3>;a;3na '1 ;:!?3 Ga>;r<-r<;@;<ar.

• E>; ;rna;a @9 r@<,an)ar3

71

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• 1.C<n;3n9a 3n>;3(a;33 >3 ;ra;a,n;9 @<n2<r, r@<,an)ar3<r IOCN

• ;ra-3a HTA -r3n MF

• . R(3, a3,n;ar 3-<><)a;

• '. Ra9ar -n9,<<(3@a a n<3 7 @9 :3; ) ;r3,3;r @9-<n ) -n>3

•

•

• ASTM BRONSIC MO4ERATPERSISTENT AGRAVAT

• PNEUMONIE ACUTA INTERSTITIALA

• FI4 IN OBSERVATIE

• 4Z TIP II 4EZECHILIBRAT CU A4O

• HTA ST II C

• CPC

• ICC NHA III

•

•

•

Analize de laborator:•

29.0.11 08:9, :

• Gran#='.% *10!"L Gran$=&%.6 $ HCT='%.' $ HGB=1.6 (!)

L+,-#= *10!"L L+,-$='0.6 $ MCH=8.8 -( MCHC=''.% (!)

MCV=8&.& 2L M3)#=0.8 *10!"L M3)$=11.8 $ MPV=.% 2L PCT=0.1%$ P45=1&.8 $ PLT=1%8 *10!"L RBC=/.'% 10*10!"L R45

CV=1. $ R45S4=/./ 2 5BC=6.& *10!"L VSH 71= ,, VSH

7='0 ,, ALAT=1 U!L ASAT=8 U!L B33r9:3na ;<;aa=0.8 ,(!) Cra;3n3na=1 ,(!) F<>2a;a?a a@a3na=10 U!L G3@,3=180 ,(!)

L4H=1%8 U!L Pr<;3n ;<;a=6. ,(!) Ur=1& ,(!) I)n;323@ara @9 ;r9>

a; PCR=n(a;329.0.11 08:9 :

• 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(. 4;@;ara 9@<@3;<r 7P=n(.

4;@;ara -r<;3n<r 7A=n(. S)3,n; 9r3nar=rar3 @33n)r3 3a3n3 S-9;a

C9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a

Ea,n ,3@<<(3@=Can)3)a >--. 10 UFC ! -a@a. S-9;a Fr<;39 Gra,=A>-@;,a@r<>@<-3@ Sa3ar

• A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,-

• C9 -3;3a >@9a,<a> &!@a,-

• F3:r3na a:>n; @<@3 (ra, -<?3;33 3n (ra,?3 an;9r3 >3

)3-<.• S@<r ) @a3;a; 0

29.0.11 11:2 :

• Ta:<9 >an(3n=PMN =60

• EO = 6

• BA =

• L = '0

72

7/24/2019 69625104-epicrize


• MO = /

• 4>@r3r

2,.0.11 12:,7 :

• Ur<@9;9ra=N9 >a9 )?<;a; (r,n3.

90.0.11 0:08 :

• G3@,3=16 ,(!) !6& ,($! 1%6 ,($

91.0.11 07:1 :

• A@3) 9r3@='.18 ,(!) C<>;r<=1&' ,(!) G3@,3=1&/ ,(!)

Tr3(3@r3)=1'' ,(!)

•

• R3 )A: ,23?, a@@n;9ara )>n993 -9,<nar 3n;r>;33a 3n -r32r3 @ar)3<,(a3

-r>3>;n;a.

• )3R/ '&61% CV&/6$ VEMS&0$ MMEF &!%& '0%$. 43>29n@;3 n;3a;<r3

,3;a r>;r3@;3 ,<)ra;a<:>;r9@;3a ,<)ra;a >(,n; @n;ra >3 >ra -r32r3@R)9@ra V ,a @9 &0 $ .

• E!4 !onsult !ardiologic G Ec?o cord:A>-@; ) CPC. Ca3;a;3 @ar)3a@ ,ar3;H3-r;r<23 @<n@n;r3@a VS. VS @9 29n@;3 >3>;<3@a -a>;ra;a )3>2. r>;r. ,)3.R(9r(3;ar

;r3@9>-3)3ana (r I!II HTP ,<)ra;a! ,)3. RE@. 7 4r Ia V B9;3n.

• !onsult diabetologic: 4Z ;3- n<9 )-3>;a; S9-ra-<n)r.R@ 1800 J@a!?3 0 HC

S3<2<r 1000 ,(!?3. L9ar 3n 3)n;a @a:3n;993 )3a:;<<(3@ ;r3;<r3a.7 )r I>-a>

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

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•

•

•

•

•

•

•

•

•

•

• BRONSIECTAZII SUPRAINFECTATE.

• BPOC FORMA MO4ERATA.

• FIBROZA PULMONARA 4IFUZA BILATERAL.

• 4ISFONIE SECUN4ARA.

• CAR4IOMIOPATIE 4ILATATIVA.

• HIPERTENSIUNE ARTERALA ESENTIALA ST4 II CU RISC CAR4IOVASCULAR

INALAT.• F3A PAROISTICA .

• INSUFICIENTA VENTRICULARA STANGA CALASA NHA II.

• ANEVRISM 4E AORTA ASCEN4ENTA.

• 4IABET ZAHARAT TIP CONTROLAT CU ANTI4IABETICE ORALE.

• POLIMIALGIE RUMATICA.

• VASCULITA SISTEMICA IN OBSERVATIE.

• A4ENOM 4E PROSTATA.

• TBC GANGLIONAR IN ANTECE4ENTE.

• ANTECE4ENTE 4E EPA REPETITIVE.

•

•


• 91.0.11 08:99 : Gran#=&.% *10!"L Gran$=6&.1 $ HCT=/&. $ HGB=1/.8

(!) L+,-#=1.8 *10!"L L+,-$=0.& $ MCH=6. -( MCHC='.

(!) MCV=81.& 2L M3)#=1.' *10!"L M3)$=1/./ $ MPV=8.6 2L PCT=0.1/& $ P45=16.1 $ PLT=16 *10!"L RBC=&.6/ 10*10!"L

R45CV=1&.6 $ R45S4=/6. 2 5BC=8.8 *10!"L VSH 71=1/

,, VSH 7=// ,, ALAT=1/ U!L ASAT=1' U!L B33r9:3na ;<;aa=0.8,(!) Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na=111 U!L GGT= U!L

G3@,3=%8 ,(!) L4H='% U!L Pr<;3n ;<;a=%.8 ,(!) Ur=&0 ,(!)

• Ex sputa pt B< BAAR n(a;3 @9;9r3 3n 9@r9• PFR )3>29n@;3 n;3a;<r3 <:>;r9@;3a ,)ra;a 3n >(,n;9 -r32r3@. R)9@ra VEMS

@9 /$.

• R43 stand. PA @<r) (<:a ,ar3; 33 @<(>;33D 3n;r>;3;39 a@@n;9a; 3n2ra3ar )r-;. P

ra)3<(ra23a ) -r<23 > )>@r39 ,9;3- <-a@3;a;3 3nar.

• !" toracic/91.0.2011 dr 4uttman ". A;a>a; @<-3


74

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• R?9;a; F3:r<?a -9,<nar )329?a )ar >3 @9 a>-@; 2<@a :3a;ra @9 @a;a ;ra3@;

:r<n>3@;a;3@ -r3n ;ra@;39n. N9 > @<n>;a;a ,<)323@ar3 ;9,<ra >a9 a)n<-a;3@

,)3a>;3n<-9,<nar. N9 > @<n>;a;a a>-@; ) @<@;3 -9raa. N9 > @<n>;a;a,<)323@ar3 -ar3;a ;<ra@[email protected]@a;9 ar )3,n>39n3 >3 >;r9@;9ra n<r,a. N9 > @<n>;a;a

,<)323@ar3 :33ar >a9 -<r;a.

• Gan)a SR )ra-;a @9 9n n<)9 ) ' ,, )3a,;r9. Gan)a SR >;an(a @9 ,<)323ar33-r-a?3@ >3 9n n<)9 ) a-r<3,a;3 0 ,, )3a,;r9. R3n3@33 :3a;ra a9)3,n>39n3 >3 >;r9@;9ra n<r,a

• C<n@9?3 F3:r<?a -9,<nar )329?a @9 ;ra3@; ) :r<n>3@;a?3 -r3n ;ra@;39n. N<)93

SR :3a;ra 7a)n<a,.

•

• E)-!R-A B<na 3n ar>;a ) 6 an3 2<>; 29,a;<r a /0PA @9n<>@9; 3n an;@)n; @9

TBC (an(3<nar >3 -9,<nar -r@9, >3 @9 ,9;93- an;@)n; -ra><na -a;<<(3@

@ar)3<a>@9ar r9,a;<<(3@ n)<@r3n<<(3@ >3 ,;a:<3@ > 3n;rna?a -r3n ;ran>2r ) a C3n3@a R9,a;<<(3 @9 >9>-3@39na ra@;ar33 TBC -9,<nar -n;r9 ra9ar

@3n3@< :3<<(3@a. La 3n;rnar -a@3n;9 -r?n;a )3>-n a 2<r;9r3 ,<)ra; )3>2<n3

;9> @9 -@;<ra;3 ,9@<-9r9n;a a>;n<a)3na,3 2a;3(a:33;a; ;ran>-3ra;33 -r)<,3nn; n<@;9rn )9rr3 ;<ra@3@ >3,-;<, a@r:a; 3n 9;3, >a-;a,an3an;r3<r 3n;rnar33. O:3@;3 a 3n;rnar -a@3n; a2:r3 )3>2<n3@ @9 >;ar (nraa ,)39

,<)323@a;a ;(9,n; -a3) ;ran>-3ra;D )9rr3 a ,<:33a?ara ar;3@9a;33<r ,3@3D

-9,<nar MV 3na>-r3; 3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;raSa;O %$D TA= 1/0!80 ,,H( AV= 88 :a;a3! ,3n9;. B3<<(3@ >)r. 3n2a,a;<r 7 VSH

9><r a@@ra;. PFR )3>29n@;3 n;3a;<r3 <:>;r9@;3a ,)ra;a 3n >(,n;9 -r32r3@

r)9@ra VEMS @9 /$.

• Ra)3<(ra23a -9,<nara 3)n;3a?a - ra)3<(ra23a ) -r<23 > )>@r39 ,9;3- <-a@3;a;3

3nar @ar r3)3@a >9>-3@39na 9n<r :r<n>3@;a?33. S 3n)3@a 2@;9ra 9n93 CT ;<ra@.

CT9 ;<ra@3@ )>@r3 23:r<?a -9,<nar )329?a @9 ;ra3@; ) :r<n>3@;a?3 -r3n ;ra@;39n

3ar a n39 (an)<r >9-rarna > )>@r39 n<)93 SR :3a;ra 7a)n<a,.


• A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<-9> 2!?3an;33n2a,a;<r an;3;r,3@ an;3a(3@

-@;<ran; -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3n >3 ) r@33:ra

3)r<@;r<3;3@a a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.


•

• r(3, a3,n;ar @33:ra; @a<r3@D

• 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

• ;ra;a,n; ,)3@a,n;<> @9 TAVANIC &00 ,( 7% ?3D

• ER4OME4 '00 ,( 1 @-r !?3 710 ?3D

• @<n;39n9ara ;ra;a,n;993 @ar)3<<(3@ )3a:;<<(3@ r9,a;<<(3@ >3 n)<@r3n<<(3@

-r>@r3> ) @a;r ,)3@33 >-@3a3>;3D

• r3n )9-a r?9;a;9 ana3?<r a2a; 3n 9@r9D

• r3n -n;r9 2@;9ara TLCO ->; < 9naD

• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

"#$%RA BR%&'%)#*$%&ARA *++

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B)%! +" -- 4%* !# E=A!ERBARE

-ABE" A'ARA" "-) 2 &%# E)-+"A" /4*-!E$-E BAA*A

$%-3-!A"A.

• %BE-"A"E 4R --.•

•


• 28.0.11 0:,8 : Gran#=&. *10!"L Gran$=66. $ HCT=/./ $ HGB=1/.

(!) L+,-#=1. *10!"L L+,-$=1. $ MCH=.8 -( MCHC=''./

(!) MCV=8.' 2L M3)#=1.1 *10!"L M3)$=11. $ MPV= 2L

PCT=0.18& $ P45=1&.8 $ PLT=06 *10!"L RBC=/.%& 10*10!"L R45CV=1'.% $ R45S4=/'. 2 5BC=8. *10!"L VSH 71=1&

,, VSH 7=/0 ,, ALAT=18 U!L ASAT=1/ U!L Cra;3n3na=0.8

,(!) F<>2a;a?a a@a3na=18 U!L GGT=& U!L G3@,3=166 ,(!) L4H='00 U!L Pr<;3n ;<;a=%.1 ,(!) Ur=6 ,(!)

• 28.0.11 10:09 :Ta:<9 >an(3n=PMN = %0

• EO =

• BA =

• L = 6

• MO =

• 4>@r3r !

• 91.0.11 07:97 : 4;@;ara 3)ra;3<r ) @ar:<n 7Z=-<?3;3 4;@;ara 9@<@3;<r

7P=n( 4;@;ara -r<;3n<r 7A=n(


a;@;a?3 ) LSS.

• E<4 R> AV=8:!,3nD ?39n3 3>@,3@ )329?.

• )3R/ nr.70062 43>29n@;3 n;3a;<r3 ,3;a. r>;r3@;3a ,<)ra;a. O:>;r9@;3a 9><ara

>(,n; @n;ra ,<)ra;a 3n -r32r3. r)9@ra VEMS @9 '%$

3ibrobron?oscopia /1272;28.0.2011 dr +imon $.: ;raa 3:ra. P3n;n ;raa

n<r,a. Ar:<r :r<n>3@ )ra-; 3:r. Pr<@> -r<32ra;3 BPS @9 -9n@; ) -@ar LSS.

E@;r<r?@;3a 2<r,a;39n33 ) - BPS @9 )?<:>;r9@;3 ,@an3@a a BPS. ra,an -r<@>

-<3:9rK<na; :r LSS. Br. LIS 3:ra.

• E)-!R-A:

• Pa@3n; 3n ar>;a ) 6/ an3 2<>; 29,a;<r780PA @9n<>@9; @9 BPOC a2a; >9: ;ra;a,n;

@9 S-3r3a 18,3@r<(ra,!?3 S+,:3@<r; 160!/&,3@r<(ra, 1-922!?3 r@n; ;rna;

)3n @3n3@a n<a>;ra > r3n;rna?a -n;r9 @<n;3n9ara 3n>;3(a;33<r. La 3n;rnar

-a@3n;9 -r?n;a )3>-n a 2<r;9r3 ,3@3!,<)ra; ;9> @9 -@;<ra;3 ,9@<-9r9n;a3n @an;3;a; ,3@a a>;n<a)3na,3 2a;3(a:33;a; >3,-;<, @ >a9 3n>;aa; @9 ' ?3

an;r3<r 3n;rnar33.

• O:3@;3 a 3n;rnar -a@3n; a2:r3 >99-ra-<n)ra @9 >;ar (nraa 9><r 3n29n;a;aD

;(9,n; ;an(3@;a?33 2a@3aD -9,<nar ;<ra@ ,23?,a;<> ><n<r3;a; -9,<nara @9

MV 3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;ra ra9r3 >3:3an; a n39

@a,-993 -9,<nar >;an(D SaO=/$.TA=1'0!80,,H(D AV=6/:!,3n.

76

7/24/2019 69625104-epicrize


• B3<9,<ra VSH a@@ra; 3-r(3@,3. E >9,ar ) 9r3na 3)ra;3 ) @ar)<n. PFR

)3>29n@;3 n;3a;<r3 ,3;a. r>;r3@;3a ,<)ra;a. O:>;r9@;3a 9><ara >(,n; @n;ra

,<)ra;a 3n -r32r3. r)9@ra VEMS @9 '%$

• R(r ;<ra@3@a PA <-a@3;a; n<)9ara ) a-r<3,a;3 / @,)3a,;r9 <@a3?a;a 3n LSS @9

a;@;a?3 ) LSS. La 23:r<:r<n<>@<-3a 2@;9a;a a 3n;rnara -r@)n;a >a 3)n;3a;

< 2<r,a;39n (;an;a ,<:3a a ;9> >3 r>-3ra;3 @9 -9n@; ) -@ar :r LSS >3 -3n;n 3n;r<:ar 2<r,a;39n @ n@>3;a ;3r-ar n)<>@<-3@a. Sa 2@;9a;23:r<:r<n<>@<-3 >3 >a -ra@;3@a; @;r<r?@;3a 2<r,a;39n33.

• In 9r,a ana,n?3 a,n993 @3n3@ >3 a)a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 )

,a3 >9>.

• P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7C3-r3n< 12! ?3

,<>;a;3@ @<r;3?<n3@ :r<n<)3a;a;<r 3;a,3n7B1 B6 an;3;9>3 an;3-3r;3@ >3

an;3a(3@ @9 a,3<rara >;ar33 (nra >3 <9;3 @3n3@a 2a<ra:3a.

•

•

•

• r(3, a3,n;ar 3-<><)a; 3-<(9@3)3@D 3-<3-3)3@D

• 3;ara 3n2@;33<rD

• )<?ara a@;33;a;33 23?3@ 3n 29n@;3 ) ;<ran;a a 2<r;D


@<n;3n9ara ;ra;a,n;993 @9 +piria 1micrograme 1cps;zi dimineataC6 luniC

• +@mbicort 160;, micrograme 2x1puff;zi 6 luni.

• consult diabetologic


• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33D

• @<n>9; a I.O.C.N.

BPOC ST III GOL4 ACUTIZAT

FIBROZA PULMONARA ETINSA POSTTBCBRONHOPNEUMONIE ATIPICA RECI4IVANTA

INSUFICIENTA RESPIRATORIE CRONICA

RINOPATIE CRONICA OBSTRUCTIVA

CPC ST II!IIIHIPOGLICEMIE


29.0.11 07:20 :

Gran#='.8 *10!"L Gran$=66./ $ HCT=/.8 $ HGB=16.1 (!) L+,-#=1.'*10!"L L+,-$='.6 $ MCH='/.1 -( MCHC='.' (!) MCV=10&.6 2L

M3)#=0.6 *10!"L M3)$=10 $ MPV=8. 2L PCT=0.68 $ P45=16.1 $

PLT='% *10!"L RBC=/.% 10*10!"L R45CV=16 $ R45S4=61.8 2

5BC=&.% *10!"L VSH 71=' ,, VSH 7=% ,, ALAT=1 U!L ASAT=&U!L B33r9:3na ;<;aa=0.8 ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=16% U!L

G3@,3=68 ,(!) L4H=/00 U!L Pr<;3n ;<;a=6. ,(!) Ur=1 ,(!)

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I)n;323@ara @9 ;r9> a; PCR=n(a;3 S-9;a Fr<;39 BAAR A=NEGATIV

'866!'.08.011 S-9;a Fr<;39 BAAR B=NEGATIV

29.0.11 07:21 :

S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a

Ea,n ,3@<<(3@=Can)3)a >--. 6 UFC ! -a@a. S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@

M9@<3)A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,- ,a@r<2a(

C9 -3;3a >@9a,<a> &!@a,-

F3:r3na -r?n; @<@3 (ra, -<?3;33 3n )3-< >3 an;9r3 @<@3 (ra,n(a;33 3n (ra,?3.

S@<r ) @a3;a; 1

29.0.11 11:27 :

Ta:<9 >an(3n=PMN = %0EO =

BA =

L =

MO = 64>@r3r

2.0.11 07:28 :

G3@,3=66 ,(!)

28.0.11 07:8 :

G3@,3=6' ,(!)

R3 )A E,23?, 23:r<?a -<>;;:@ 2ra@;9ra ) @<r- >;rna >3 @<a>; 3n @9r> ) @<n><3)ar

@ar)3<,(a3 ,<)ra;aHTPA

PFR 7%86 43>29n@;3 n;3a;<r3 ,3;a >ra. O:>;r9@;3 >ra @n;raa >3 -r32r3@a. V

,a r)9> @9 60$.

78

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BOALA PULMONARA CRONICA OBSTRUCTIVA ST4 II GOL4 IN EACERBARE.

INSUFICIENTA RESPIRATORIE CRONICA.S4R. 4E APNEE IN SOMN.

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4OVASCULAR INALT.

CAR4IOPATIE ISCHEMICA.

INFARCT MIOCAR4IC VECHI.OBEZITATE GR4 III


90.0.11 10:1 : 5BC=. *10!"L L+,-#=1.6 *10!"L M3)#=0. *10!"L

Gran#=* %./ *10!"L L+,-$=* 16.1 $ M3)$=.' $ Gran$=%/.6 $

HGB=1/. (!) RBC=/.88 10*10!"L HCT=/6.6 $ MCV=* &.6 2L MCH='0.& -( MCHC='1. (!) R45CV=* 1&.6 $ R45S4=&'.6 2 PLT=1/ *10!"L

MPV=.8 2L P45=1&.6 $ PCT=0.1 $ ALAT=11 U!L ASAT=1 U!L

B33r9:3na ;<;aa=0.8 ,(!) Cra;3n3na=1. ,(!) F<>2a;a?a a@a3na=1%% U!L

GGT=0 U!L G3@,3=8' ,(!) L4H='1' U!L Pr<;3n ;<;a=%./ ,(!) Ur=/ ,(!)

R43 stand. )A @<r) (<:a ,ar3; 2a>@ - )3a2ra(,D 33 @<n(>;33 )>n 3n;r>;3;3a

-r3:r<n<a>@9ar a@@n;9a; -r)<,3nan; 3n2ra3ar :3a;raD <aara >3n9>993 @<>;<)3a2ra(,a;3@>;an(.

E!4( RS AV= 60 :a;a3! ,3n9;D 3n 4II 4III aVF.

)3R/,12,;90.0.2011: )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3 ,<)ra;a

>(,n; @n;ra >3 >ra 3n -r32r3. R)9@ra VEMS @9 &0$

E)-!R-A

B<na 3n ar>;a ) 6/ an3 29,a;<r a 80 PA @9n<>@9; @9 an;@)n; -r><na -a;<<(3@

-9,<nar 7BPOC a2a; >9: ;ra;a,n; @9 Sr;3) &0!&0 ,3@r<(ra, 1 -92!?3 >3 S-3r3a 18

,3@r<(ra, 1 @->!?3 @ar)3<a>@9ar 7 HTA CIC IM @3 >3 ,;a:<3@ 7 O:?3a;>3n;rna?a -n;r9 ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r; ,<)ra; a>;n<

a)3na,3 2a;3(a:33;a; >@a)ra ;<ran;3 a 2<r; ;ran>-3ra;33 >3,-;<, a@r:a; 3n 9;3,a

79

7/24/2019 69625104-epicrize


>a-;a,ana an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar -a@3n; <:? a2:r3 @9 >;ar (nraa ,)39 ,<)323@a;a ;(9,n;

@3an<?a -r3<raaD -9,<nar ;<ra@ ,23?,a;<> MV 3na>-r3; @9 -3r -r9n(3; ra9r3@r-3;an; :a?a :3a;ra Sa; O= $D TA= 1/0!80,,H(D AV= 68 :a;a3! ,3n9;.B3<<(3@ VSH

9><r a@@ra;. PFR )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3 ,<)ra;a

>(,n; @n;ra >3 >ra 3n -r32r3 r)9@ra VEMS @9 &0$.Ra)3<(ra23a -9,<nara 3)n;3a?a 33 @<n(>;33 )>n 3n;r>;3;3a -r3:r<n<a>@9ar a@@n;9a;

-r)<,3nan; 3n2ra3ar :3a;raD <aara >3n9>993 @<>;<)3a2ra(,a;3@ >;an(.

In 9r,a ana,n?3 a a,n993 @3n3@ >3 - :a?a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ),a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> 2!?3HHC an;3;r,3@ an;3a(3@ an;33n2a,a;<r

-@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a

a,:9a;<r @9 <9;3 2a<ra:3a.S ;rna?a @9 r@<,an)ar3

r(3, a3,;ar 3-<><)a; 3-<3-3)3@ 3-<(9@3)3@D 2<r 23?3@ 3n 3,3;a ;<ra:33;a;33D


;a;a,n; ,)3@a,n;<> @9 SERETI4E &0! &0 ,3@r<(ra, 1 -92!?3 D SPIRIVA 18 ,3@r<(ra, 1 @->! ?3D

VENTOLIN 100 ,@r<(ra, -929r3 a n<3D

> a 3:ra; R- -; < 9na >r3a CSBE nr /86001D 9r,a?a ;ra;a,n;9 @ar)3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>; @ar)3<<(3@D

r3n a @<n;r< ->; 9n3D

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.SUPURATIE CRONICA ACUTIZATA

INSUFICIENTA REPIRATORIE CRONICA ACUTIZATA.

ASPERGILOZA PULMONARA INVAZIVA

FISTULA BRONHOPULMONARAFISTULA PLEUROTEGUMENTARA

TULBURARE ANIOASA4EPRESIVA.

ANEMIE SECUN4ARA.


17.0.11 12:2/910;1.0.2011 :S@r;3 -a(a Fr<;39 -;. )@rar BAAR=NEGATIV17.0.11 12:9 : S@r. -a(a C9;9r3 ar<:=S;a-+<@<@@9> a9r9> ,;3@33n<r?3>;n;

S@r. -a(a Ea,n ,3@<<(3@=N9 >a9 )?<;a; 29n(3.

S@r. -a(a Fr<;39 Gra,=F3:r3na @<@3 (ra, -<?3;33 3n (ra,?3.

22.0.11 12:98 : An;3:3<(ra,a ar<:3=

1. AMIJACIN 7P3ra,3 R . CEFIIM 7E23@2

. AMPICILINA 7O,n3-rn P<3@33n R '. IMIPENEM7T3na,

80

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'. AMPICILINA SULBACTAM 7Una>+n R /. JANAMICINA

7Jana,+@3n R

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6. COLISTIN 7C<3,+@3n %. MEROPENEM 7Mr<n,

%. CIPROFLOACIN 7C3-r3n<E9@3-r3n R 8. NALI4IIC ACI47N(ra,

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NITROFURANTOIN 7Ma@r<)an;3n. CLORAMFENICOL 7Br3@;3n S '0. NORFLOACIN

7N<3@3n

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7Pr<>;a-+n R

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1/.CEFTRIAON 7R<@-3n '&. TETRACICLINA7A@r<,3@3n

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R

1.AZTREONAM /0.CLIN4AMICINA R 0.CEFTIBUTEN /1.CEFOITIN R

1.TICARCILINA /.LEVOFLOACINA

R?9;a; >9n; -r3,a; @a3;a;3 3n ,, ?<na ) 3n3:3;3 >a9 @an;3;a;3 CMI (!

S= >n>3:3D I= 3n;r,a)3arD R= r?3>;n;D N=N3n;r-r;a:3D C<n;a,3na;D

2,.0.11 12:91 : S@r. -a(a Ea,n ,3@<<(3@7A>-r(39>=A>-r(39> n(a;3.

02.08.11 07:9 : Gran#='.1 *10!"L Gran$=6&.& $ HCT='.& $ HGB=10. (!) L+,-#=1.1 *10!"L L+,-$=.6 $ MCH='.' -( MCHC='1.' (!)

MCV=%/.& 2L M3)#=0.& *10!"L M3)$=11. $ MPV=%. 2L PCT=0./1 $

P45=16.1 $ PLT='06 *10!"L RBC=/.'% 10*10!"L R45CV=1& $ R45S4=/0. 2 5BC=/.% *10!"L VSH 71=/& ,, VSH 7=8% ,, ALAT=10

U!L ASAT=1& U!L B33r9:3na ;<;aa=0.' ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a

a@a3na=1%1 U!L GGT=/ U!L G3@,3=%0 ,(!) L4H=16' U!L Pr<;3n;<;a=6.& ,(!) Ur=& ,(!)

02.08.11 10:0 :Ta:<9 >an(3n=PMN = 6/

EO = /

BA =

81

7/24/2019 69625104-epicrize


L = 6

MO = 6

4>@r3r An3?<@3;<?an<r,<,3@r<@3;ara.H3-<@r<,3.P<33<@3;<?a>;<,a;<@3;)a@r3<@3;.H,a;33 3n 23>3@9r3.

ASTRUP -CO= 1.& ,,H(D -O= 6./ ,,H(D Sa;O= 1$.

!onsult psi?iatric /dr. !orina $arginean:C3n3@ -a@3n; 9><r n3n3>;3; an3<> @ar )>@r3 < 2r3@a -r,ann;a ) ,<ar; 3n><,n33 )

a)<r,3r -a-3;a;33 3r3;a:33a;.

In an;@)n; @<n>9, ) -an; ;n<:<;an3@ 7a23r,a;3 % 9n3 3n 9r,a @9 6 9n3 )>@r3 9n-3><) ->3<;3@ 3n)9> ) >9:>; @9 )9ra;a ) 6 9n3.

4(. In;@; a 3,3;a. U;33?ar ) -an; ;n<:<;an3@ n<@3 -n;r9 >ana;a; 7a:>;3nn;a ) 6

9n3.T9:9rar a3<a>a (nra3?a;a.

R@<,an)ar3 3;ara >3;9a;33<r @<n23;9a a:>;3nn;a ) a @<n>9,9 ) ;<3@ 7a@<< ;n<:<;an3@

;ra;a,n; ,)3@a,n;<> @9 SERTRALINA &0 ,( 100

ANA 0.& ,( 111 7 >a-;a,an3 a-<3 1!

1! 1 7< >a-;a,ana a-<3 1!/ 1!/ 1! 7< >a-;a,ana a-<3 001! 7< >a-;a,ana CARBAMAZEPINA 00 ,( 1! 1! 1!

ra9ar ->33a;r3@a a n<3.

E)-!R-A:

Pa@3n; 3n ar>;a ) ) an3 a2a; 3n 3)n;a C3n3@33 ) Pn9,<<(3 r@n; ;rna; )33n>r3@39 n<>;r9 @9 S9-9ra;3 -9,<nara @r<n3@aA>-r(3<?a -9,<nara F3>;9a :r<n<-9raa

>3 -9r<;(9,n;ara > r3n;rna?a -n;r9 a;rara >;ar33 (nra a@9?an) ;9> @9

-@;<ra;3 ,9@<-9r9n;a ,<-;3?33 3n @an;3;a; ,3@a )3>-n a 2<r;9r3 ,<)ra; )9rr

a;r<;<ra@3@a >;an(a 2a;3(a:33;a; a>;n<a)3na,3 >@a)ra ;<ran;3 a 2<r; an3;a;;ran>-3ra;33 >3,-;<, @ >a9 3n>;aa; 3n 9;3,3 / ?3 an;r3<r 3n;rnar33 )ar >a9 a@9;3?a; 3n

9;3,3 / <r. O:3@;3 a 3n;rnar -a@3n; >9:-<n)ra a2:r3 an3<> @9 >;ar (nraa

3n29n;a;aD ;(9,n; >3 ,9@<a> -a3) 23>;9a -9r<;(9,n;ara a;r<;<ra@3@a >;an(aD -9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a )ra-; Sa;O= 8$D

@ar)3<a>@9ar ?(<,<; @ar)3a@ r3;,3@ ;a3@ar)3@ TA= 100!60,,H( AV= 110 :a;a3! ,3n9;.

B3<9,<ra >)r 3n2a,a;<r n>-@323@ 7VSH ,9; a@@ra; (ran9<@3;<?a an,3 >@9n)ara,3@r<@3;ara 3-<@r<,a.

In 3>;<r3@9 -a@3n;993 ,n;3<na, @a a ar>;a ) % an3 a 2<>; <-ra; ) TBC @a?<a>a 3ar 3n

;3,-9 3n;rn;33 @3r9r(3@a a -r?n;a; ,<-;3?3 ,a>3aD>a9 2@;9a; >9;9r3 ) n@>3;a;

@ a9 ,<)323@a; ,a3 -r<:a:3 ;ra3@; a><r ) >an( >3 a :r<n>33<r. In 9r,a @9 11 an3 a a9;< >9-9ra;3 ) -r; 3n;r-r;a;a @a (ran9<, ) 23r @9 n@r<?a -n;r9 @ar >a 2@;9a;

3n;rn;3 @3r9r(3@aa )<ar a n39 -r;93 ;<ra@3@. In 9r,a @9 ' an3 r3n @9 >9-9ra;3 )

-r; 2ara 3n>a >a @<n;3n9 3n>;3(a;33 -n;r9 >;a:33ra )3a(n<>;3@993. R3n )9-a 1 9na @9>9-9ra;3 ) -r; @9 ,n;39na @a 3n a@>; 3n;ra7' an3 >3,-;<,a;<<(3a a -r>3>;a;.

Pa@3n;9 a ;,-<r3?a; 2@;9ara 3n;rn;33 @3r9r(3@a -r<-9> an;r3<r. 49-a 9n3 )

;ra;a,n; ,)3@a,n;<> @9 In;ra@<na?< / 00 ,(!?3 4<3@3@3na 100,(!?3 >3 A</00,(!?3 > ra9a?a @a?9. Mn;3<na, @a a 23:r<:r<n<>@<-3a 2@;9a;a a 3n;rnar;a

-r@)n;a a @<n23r,a; -r?n;3 9n3 23>;9 :r<n<-9,<nar >3 -9r<;(9,n;ar.

Ea,n9 :a@;r3<<(3@ >-@323@ )3n >-9;a >; BAAR n(a;3D 3ar n>-@323@ a:>n;a

A>-r(39>=A>-r(39> >--.

82

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R?9;a;9 an;3:3<(ra,3 :a@;r3<<(3@ n<nTBC S;a-+<@<@@9> a9r9>7,;3@33n<r?3>;n;.

C9 >n>3:33;a; a C<ra,2n3@< 4<3@3@3na L3n?<3) Van@<,3@3na >3 3n;r,)3ar a

M<32<[email protected],n9 :a@;r3<<(3@ >-@323@ )3n >@r;3a )3n -a(a 2@;9a;a >; BAAR n(a;3D n>-@323@

S;a-+<@<@ @<a(9a?< n(a;3 7 ,;3@33n< r?3>;n; .S;a-+<@<@@9> a9r9> 7 ,;3@3@3n<

r?3>;n; @<@3 (ra, -<?3;33 3n (ra,?3 2ara a > )?<;a 29n(3.Sa 2@;9a; ra)3<(ra23 ;<ra@3@a @ar )>@r3 3-r;ran>-arn;a @9 -r; -r<-r39 a-3@a >;an( @9

;ra@;39na ;ra3 >3 a ,)3a>;3n993 @ar -r?3n;a @3r@9,>@r3>a < <-a@3;a; ) 3n;n>3;a; @<>;aaD

a>@n>3<nara 3993D <-a@3;a;3 ,3@r<n<)9ar >3 3nar a n39 a-993 )r-;. A>-@;>@ar -<>;TBC. La 3n;rnara -r@)n;a >a 2@;9a; C; ;<ra@3@ @ar a )>@r3> 9n a>-@;

3)n;3@ @9 a,3nara -r@)n;a In )ra-;a 23:r<?a -9,<nara a-3@aa @9 @ara@;r r;ra@;3 @9

-r?n;a 9n<r @a3;a;3 ar3@ 3n@9> ) a-ana a /@, )3a, @ar 9n -ar >a a3:a @<n;3n9; ;3>9ar

@9 @a@323@ar37n9 > @9) 9n a>-@; ) a>-r(3<,. In r>;9 2<@ar993 > @<n>;a;a ,9;3-a>-@; ) 23:r<?a @9 :9 ) ,23?, ,3@3 >3 @a@323@ar3 ,9;3- 2<@a.In >;an(a F3:r<?a

-9,<nara a-3@aa @ar 3n@9) ) a>,na @a3;a;3 ar3@ )3n;r @ar 9na ) %@,D ,)3a>;3n9

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);r<@<n@aa. M)3a>;3n9 @9 )3>;r<>39n3 3,-<r;an; 2ara a)n<-a;33. C<n@9?3 C; ;<ra@M<)323@ar3 ,a>3 >@ar @a3;ar -r)<,3nan; a-3@a )r-;7@9 >9>-3@39n a>-r(3<,.

43>;<r>39n3 ,)3a>;3na >3 ar:<r :r<n>3@ -r3n ;ra@;39n >@ara 23:r<;[email protected] -ar@9r>9 3n;rnar33 -r@)n; >a r9a; @<n>9;9 @3r9r(3@a @ar >9>;3n n@>3;a;a

3n;rn;33 @9 2@;9ara 9n3 2r>;r E<>>r7-n;r9 <:;3nra 3n@3)r33 23>;93

:r<n<-9ra. O 3n;rn;3 ra)3@aa -n;r9 < n;9aa <:@;<,3 n9 >; r@<,an)a;a aan)3n )r 3>;<r3@9 -a@3n;993 3n 3n;rn;33 an;r3<ar. P -ar@9r>9 3n;rnar33 a@;9a >a r9a;

@<n>9;9 @3r9r(3@a )ar > ;,-<r3?a?a 2@;9ara 3n;rn;33 @3r9r(3@a aan) 3n )r

3n;rn;33 an;r3<ar.

P :a?a a,n993 @3n3@ra)3<<(3@ :a@;r3<<(3@ >3 :3<9,<ra > >9>;3n )3a(n<>;3@9 ) ,a3>9>.

P -ar@9r>9 3n;rnar33 -a@3n;9 a -r?n;a; 9n -3><) 2:r3 7/0.1 (ra) C 3n><;3; ) 2r3>an

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a -a@3n;993 >a 2@;9a; >3 @<n>9; ->3a;r3@D 2a@an)9> 3n)3@a;33 ) ;ra;a,n; -n;r9 ;9:9rara

an3<a>a -r?n;a.P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@ 7C3n)a,3@3na /12!?3 a-<3 C2<r;

1(!?3 a-<3 4<3@3@3na 1 @-r!?3 I;ra@<na?<7/100,(!?3an;3a(3@7A(<@a,3n

an;3-3r;3@ 7Para@;a,< 3;a,3n7B1 B6 an;3,3@<;3@7S;a,3@3na ) r@33:rar

3)r<@;r<3;3@a -r<;@;<r (a>;r3@ >3 -a;3@ a 9r,a; ;ra;a,n;9 ->33a;r3@ @<n2r, >@,3 @9a,3<rara >;ar33 (nra >3 <9;3 @3n3@a 2a<ra:3a.

• @<n;3n9ara ;ra;a,n;993 @9 I;ra@<na?< @<n2<r, R-D

• @<n;3n9ara ;ra;a,n;993 ->333a;r3@D

• @<n;3n9a -an>a,;9 -a(33 @3r9r(3@a 3n r(3, a,:9a;<r @<n3@ - < -r3<a)a

n);r,3na;aD

• r3n a @<n;r< ->; 1 9na.

PNEUMOPATIE ALVEOLOINTERSTITIALA 4IFUZA

ASTM BRONSIC MO4ERAT SEVER AGRAVAT

83

7/24/2019 69625104-epicrize


RINICHI UNIC STANG

INFECTII URINARE RECURENTE


2,.0.11 12:, :

S-9;a Fr<;39 BAAR A=NEGATIV '1/!&.08.011 S-9;a Fr<;39 BAAR B=NEGATIV

2.0.11 07:19 :

Gran#=%.6 *10!"L Gran$=%.& $ HCT=/0.' $ HGB=1'.' (!) L+,-#=1.*10!"L L+,-$=1.& $ MCH= -( MCHC='' (!) MCV=88.1 2L

M3)#=0.8 *10!"L M3)$=8 $ MPV=%. 2L PCT=0.1& $ P45=1&.' $

PLT= *10!"L RBC=/.&8 10*10!"L R45CV=1/.1 $ R45S4=/6.1 2 5BC=.6 *10!"L VSH 71=' ,, VSH 7=%1 ,, ALAT=10 U!L

ASAT=16 U!L B33r9:3na ;<;aa=0.6 ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a

a@a3na=1&' U!L G3@,3=0 ,(!) L4H=''& U!L Pr<;3n ;<;a=6.& ,(!) Ur=0 ,(!) 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(. 4;@;ara 9@<@3;<r

7P=n(. 4;@;ara -r<;3n<r 7A=n(. S)3,n; 9r3nar=' ,a;33 @<<ra;!@.'/@9 -3;3a -a;!@.

2.0.11 07:1 :

Ur3na Ea,n ,3@<<(3@=N9 >a9 )?<;a; 29n(3. Ur<@9;9ra=S9: 1. 000 UFC! ,.

2.0.11 07:16 :

Ur3na Ea,3nar ,3@r<>@<-3@a BAAR A=NEGATIV '1'!&.08.011 Ur3na Ea,3nar ,3@r<>@<-3@a BAAR B=NEGATIV

2.0.11 07:17 :

S-9;aC9;3ar :a@;r33 ar<:=C3;r<:a@;r >--. S-9;a Ea,n ,3@<<(3@=Can)3)a >--. 0 UFC ! -a@a.

2.0.11 07:20 :

I)n;323@ara @9 ;r9> a; PCR=1 ,(!26.0.11 0:, :

S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a Fr<;39

Gra,=A>-@; ,a@r<>@<-3@ M9@<3)

A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,- ,a@r<2a( C9 -3;3a >@9a,<a> &!@a,-

F3:r3na -r?n; @<@3 (ra, n(a;33 3n (ra,?3 @<@3 (ra,

-<?3;33 3n an;9r3. S@<r ) @a3;a; 1

26.0.11 11:,8 :

S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ P9r9n;

A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,- ,a@r<2a(

C9 -3;3a >@9a,<a>F3:r3na -r?n; @<@3 (ra, n(a;33 3n (ra,?3 @<@3 (ra,

-<?3;33 3n )3-< >3 an;9r3 @<@<:a@33 (ra, n(a;33 9r3.

S@<r ) @a3;a; '

28.0.11 19:0 :

Ur3na Ea,3nar ,3@r<>@<-3@a BAAR C=NEGATIV '%&!6.08.011

90.0.11 19:19 :

An;3:3<(ra,a ar<:3=

84

7/24/2019 69625104-epicrize


1. AMIJACIN 7P3ra,3 S . CEFIIM 7E23@2

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7Jana,+@3n

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0.CEFTIBUTEN /1.CEFOITIN S

1.TICARCILINA /.LEVOFLOACINA



01.08.11 08:26 :

LaaK :r<n>3<<a<ar E. @3;<<(3@=N9,ar ;<;a ) @910./ 1000000. C3;<<(3

)32rn;3aa ,a@r<2a( 8/.$ L %.$ E< %.$. Ra;3 2r@n; ,a;33.

01.08.11 08:27 :

A>-3ra; :r<n>3@ Fr<;39 BAAR A=NEGATIV NR.REG./0!0.0.011

01.08.11 08:2 :

85

7/24/2019 69625104-epicrize


A>-3ra; :r<n>3@ C9;9r3 ar<:=N9 >a9 )?<;a; (r,n3. A>-3ra; :r<n>3@ Fr<;39

Gra,=A>-@; ,a@r<>@<-3@ !

A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 10!@a,- >3 ,a@r<2a( C9 -3;3a >@9a,<a> >3 :r<n>3@ !

F3:r3na !

S@<r ) @a3;a; !06.08.11 11:2 :

C<<ra;3 -n;r9 23r=>@<r G<) 100. C<<ra;3 T<93)3n:a9=Pn9,<@+>;3> @ar3n33 n(a;3.

06.08.11 12:07 :

A>-3ra; :r<n>3@ Ea,n ,3@<<(3@7A; ,3@<?=N9 >a9 )?<;a; 29n(3.

BRONHOLOGIE (data: 01.09.11 09:26, nr. reg. 1288)

Rf PA : INTERSTITIU

CT TORACICA ; ALVEOLTA EU!ATIVA (V "ULETIN)

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TU BRONHOPULMONAR 7A4ENOCARCINOM MUCOI4.

BPOC S4T II GOL4 IN EACERBARE.

INSUFICIENTA RESPIRATORIE CRONICA ACUTIZATA.ANEMIE SECUN4ARA.


90.0.11 07:1 : Gran#=1.8 *10!"L Gran$=80.1 $ HCT=/6.1 $ HGB=1&. (!)

L+,-#=1.& *10!"L L+,-$=.1 $ MCH=''.1 -( MCHC='. (!) MCV=100.& 2L M3)#=1.% *10!"L M3)$=10.8 $ MPV=8.6 2L PCT=0.& $

P45=1&.& $ PLT=1 *10!"L RBC=/.& 10*10!"L R45CV=1'. $ R45S4=&0.6 2 5BC=16 *10!"L VSH 71=/' ,, VSH 7=0 ,, ALAT=1/1

U!L ASAT=%8 U!L B33r9:3na ;<;aa=0. ,(!) Cra;3n3na=1 ,(!) F<>2a;a?a

a@a3na=1' U!L GGT=/1 U!L G3@,3=8& ,(!) L4H='/6 U!L Pr<;3n;<;a=&.% ,(!) Ur='/ ,(!)

90.0.11 10:18 : Ta:<9 >an(3n=PMN = 80

EO =

BA =L = 1/

MO = /

4>@r3r !

91.0.11 07:10 : Ca@39 ;<;a=.0 ,(!) Ca@39r3a=8.6 ,(!/

91.0.11 07:1/,069;91.0.2011 :S-9;a Fr<;39 BAAR A=NEGATIV

S-9;a Fr<;39 BAAR B=NEGATIV S-9;a Fr<;39 BAAR C=NEGATIV

02.08.11 07:19 : 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(

4;@;ara 9@<@3;<r 7P=n(

4;@;ara -r<;3n<r 7A=n(EJG R> AV= 100 :a;a3! ,3n9; 2ara ,<)323@ar3 3>@,< ?3<na.

Rgr toracica : @<r) (<:a ,ar3;D <-a@3;a;3 3n<,<(n -ara3ar :3a;ra. M9;3- <-a@3;a;3

n<)9ar 3n23;ra;3 )3>,3na; 3n a,:33 @a,-3 -9,<nar3 -r)<,3nan; 3n @ !' 3n2r3<ar.

)unctie transtoracica /91.0.2011 dr. Rednic &: >a 2@;9a; -9n@;3 :3<->3 )3n ,a>a

-9,<nara >9:-9ra LI4 3n3a a3ara an;r3<ara.

Examen anatomopatologic /dr za?arie ".: a)n<@ar@3n<, ,9@<3).

E)-!R-A:

Pa@3n; 3n ar>;a ) &6 ) an3 n29,a;<r 2ara an;@)n; -r><na -a;<<(3@ r@n; ;rna;

)3n @3n3@a n<a>;ra > r3n;rna?a -n;r9 a;rara >;ar33 (nra ;9> @9 -@;<ra;3 ,9@<

-9r9n;a 3n @anr;3;a; ,3@a )3>-n a 2<r;9r3 ,<)ra;! ,3@3 >@a)ra ;<ran;3 a 2<r;

87

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3na-;n;a >@a)r -<n)raa a>;n<a)3na,3 2a;3(a:33;a; >3,-;<, a@r:a; 3n 9;3,3

?3 an;r3<r 3n;rnar33.O:3@;3a 3n;rnar -a@3n; a2:r3 @9 >;ar (nraa a;ra;aD ;(9,n;

-a3) ;ran>-3ra; ,9@<a> -a3)D -9,<nar ><n<r3;a; -9,<nara @9 ,9r,9r ?3@9ar3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;raD TA= 1'0!80,,H( AV=86:!,3n.

B3<<(3@ >)r 3n2aa,a;<r n>-@323@ 79@<@3;<?a VSH a@@ra; an,3 ,a@r<@3;ara

n<r,<@r<,a >)r ) -a;<@3;<3?a 3-<-r<;3n,3. R(r ;<ra@3@a 3)n;3a?a <-a@3;a;33n<,<(n -ara3ar :3a;raD ,9;3- <-a@3;a;3 n<)9ar 3n23;ra;3 )3>,3na; 3n a,:33 @a,-3

-9,<nar3 -r)<,3nan; 3n @ !' 3n2r3<ar @ r3)3@a >9>-3@39na 9n93 -r<@> 3n<@93;<r )

>-a;39. In <9;3 3,a(3na ra)3<<(3@a n9 > a,3<ra?a ,<;3 -n;r9 @ar > 3n)3@a 2@;9ra9n3 -9n@;33 ;ran>;<ra@3@. S 2@;9a?a -9n@;3 ;ran>;<ra@3@a )3n ,a>a -9,<nara >9:-9raa

LI4. E 3>;<-a;<<(3@ @<n23r,a >9>-3@39na ) -r<@> -r<32ra;3 )>@r33n) a)n<@ar@3n<,

,9@<3).

In 9r,a ana,n?3 a a,n993 @3n3@ >3 - :a?a )a;<r -ara@3n3@ > >9>;3n )3a(n<>;3@9 ),a3 >9>.

P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7A,<3-9> 2!?3 3;a,3n7B1

B6 an;39>3 -r<;@;<r (a>;r3@ -@;<ran; an;3a(3@ >3 ) r@33:rar 3)r<@;r<3;3@a @9

<9;3 >;a;3<nara.

• r(3, a3,n;ar @33:ra; @a<r3@D

• 3;ara 3n2@;33<rD

• )<?ara 2<r;993 23?3@ 3n 29@n;3 ) ;<ran;a a 2<r;D


;ra;a,n; ,)3@a,n;<> @9 Eficef 200 mg 2x1;ziC 7 zile.

• Erdomed 900mg 2x1tb;zi 7 zile.

• +)-R-A 1 micrograme 1 cps;ziC

• )RE&-+%& mg comprimate; zi cu scaderea progresia

dozei: mg /1 cpr la 2 la zile

• )3>-n>ar3?ar -rn ,)3@9 ) 2a,33D

• @<n>9; On@<<(3@ a S-3;a9 A:a @<n2<r, -r<(ra,ar33 >3 3n;(r33 @9 )r. Sar:9.

B)%! +". -- 4%* A!#"-A"A

"#$%RA "RA'EA*A %)ERA"A RA-%(!'-$-%"RA"A"A/ A#4 2010

+#+)E!" E"ER$-&ARE +E!#&ARA )#*$%&ARA +"A&4A

!A&-%A %R%3AR-&4-A&A

3-BR%A )#*$%&ARA )A"RA'EA*A R

"#$%R- A*E #RE"RE- )E&-E&E %)ERA"E RA-%"RA"A"E / &% 2006

-+3%&-E $A- )R%BAB-* +E!#&ARA RA-%"ERA)-E- /5

"R%$B%3*EB-"A -& A)) /2007 )%+-B-* )ARA&E%)*A-!A


91.0.11 07:18 :

5BC=* /.1 *10!"L L+,-#=* 0. *10!"L M3)#=0.' *10!"L Gran#=. *10!"L

L+,-$=.' $ M3)$=6.% $ Gran$=%1 $ HGB=1/./ (!) RBC=/.

10*10!"L HCT=//.' $ MCV=0.1 2L MCH=. -( MCHC='.& (!) R45CV=* 1&.' $ R45S4=/. 2 PLT=18& *10!"L MPV=8.& 2L

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P45=1&.8 $ PCT=0.1&% $ VSH 71=1 ,, VSH 7=/ ,, ALAT=' U!L

ASAT=1% U!L B33r9:3na ;<;aa=0. ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a

a@a3na=1/' U!L G3@,3=%6 ,(!) Pr<;3n ;<;a=%.1 ,(!) Ur=& ,(!)

R43 stand. )A<-a@3;a; ) 3n;n>3;a; @<>;aa >3;9a;a a;r<;<ra@3@ >;( @9 )3a,. ) a-r<.

@,.. Para;raa )r. <-a@3;a; 3n<,<(na @9 :r<n<(ra,a ar3@a ) 3n;n>3;a; @<>;aa ,a3

-r<:a:3 23:r<?a 33 @9 @a@[email protected]!4 RS. In@ar@ar V4.

!" toracic (A;a>a; @<-3

3ibrobron?oscopie( a;a>a; @<-3

)3R )3>29n@;3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n; @n;ra >3 3n -r32r3.

R)9@ra VEMS @9 '%$

E)-!R-A B<na 3n ar>;a ) &/ an3 2<>; ,ar 29,a;<r '8 PA 3n 3)n;a @9 IOCN @9

APP ) (3n@<,a>;3 >;( <-ra; 3n 1 r>-@;3 r?@;33 n)<>@<-3@ 3n;ra;3 ) ;9,<r3 a

9r;r3 -n3n 7 -<32<@aa 3n 006 r@3)3a; 3ra)3a; >3 <-ra; ra)3@a 3n n<3,:r3 0067 -n@;<,3-ar;3aa 3,2a)n@;<,3 3n(3naa :3a;raaD -T' 7 -r3n 3na?3a @<r-3<r

@arn<>3 N0 a2<>; <-ra; 3n 9r,a @9 1 9n3 -;. @ar@3n<, -3)r,<3) nra;3n3?a; ;raa

1!' 3n2r3<ara a)n<-a;3 -ara;raaa 7 C3n3@a Mar39> Na>;a B9@9r>;3. P<>; <-ra;<r >a2@;9a; < :r<n<>@<-3 ) @<n;r< 7 <@;<,:r3 010 @ar a 3)n;3a; ,9;3-33 :9K<n3 a;ra )r

>3 < 2<r,a;39n a:3@3<a>a a @ar3 a,3nar 3>;<-a;<<(3@a a ra; @ar@3n<, -3)r,<3)

nra;3n3?a;. U;r3<r a 9r,a; ;ra;a,n; ra)3< >3 @3,3<;ra-9;3@ ) >-@3a3;a;.Ea,n9 CT ) @<n;r< 7 ,ar;3 011 a 3)n;3a; )n>323@ar 3n >-a;39 -ara;raa 3n2 )r

7 a>-@; -r<:a:3 -<>; <-ra;<r 2ara >,n @r; ) r@3)3a -<>;<-ra;<r3. B3<->3a 2@;9a;a 3n

,ar;3 011 n9 a 3)n;3a; >,n ) ,a3(n3;a;.

In 9;3, >a-;a,an3 >a @<n>;a;a; @r>;ra ,rr993 ;9,<ra SCC >a 2@;9a; CT ;<ra@3@@ar a 3)n;3a; < <-a@3;a; >9(>;3a -;. );r,3nar >@. a n3. -a,an993 >;( >3 < @<n)n>ar

) a>-@; ,a3 -r<:a:3 -n9,<n3@ -ara@ar)3a@ >;(.

S r3n;rna?a -; ra9ar .La 3n;rnar a@9?a ;9> @9 -@;<ra;3 ,9@<-9r9n;a 3n @an;3;a; ,3@a )3>2<n3 )3>-n a

2<r; ,)39!,ar >3,-;<, a@r:a; 3n 9;3, ?3 an;r3<r 3n;rnar33.

B3<<(3@ VSH a@@ra; 9@<-n3 9><ara!8!011 Ra)3<(ra23a -9,<nara r3)3@a >9>-3@39na ) );r,3nar >@. -9,<nara >;(. >3

3)n;3a?a < 3,a(3n ) @<n)n>ar @9 :r<n<(ra,a ar3@a -r?n;a ) 3n;n>3;a; @<>;aa

-<>3:3 >@a;a -<>;<-ra;<r3 3,a(3na 233n) -r?n;a >3 - ra)3<(ar233 an;r3<ar. .CT ;<ra@3@ @<n23r,a -r?n;a ?39n3<r 7);. >@. >;( 3,a(3n ) @<n)n>ar >@ara

-ara;raa )r.

F3:r<:r<n<>@<-3a n9 -r?3n;a >,n ) r@3)3a <@aa -<>; <-ra;<r 3)n;3a?a )<ar @a;3a

n<)93 ) @<n>3>;n;a 23:r<a>a -r?n;3 >3 3n 9r,a @9 @a;a 9n3 a 9;3,a a9ar - ;ra3@;9@3@a;r3@3 -<>;<-ra;<r33.

PFR )3>29n@;3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n; @n;ra >3 >ra 3n

-r32r3. R)9@ra VEMS @9 '%$P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@ 7 A,<3-9> an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r

-r<;@;<r -a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r 7an;3@<a(9an;<ra a9 2<>; >@3,:a; @9 2ra3-ar3na - -r3<a)a 3n;rnar33 @9 <9;3 2a<ra:3a.


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r3n )9-a r?9;a;9 a>-3ra;993 :r<n>3@ 72<ra n>-@323@a @3;<<(3 ,3@<<(3

-r?n;ara a IOCN -;. ra9ar >3 ;ra;a,n; ) >-@3a3;a;.

2@;9ar CT @ran3an >3 a:)<,3na -;. @9)ra 9n<r );r,3nar3 >@. a a@>; n3.ra9ar @ar)3<<(3@a @<n;3n9ara ;ra;a,n;993 r@<,an)a; ) @a;r ,)3@9 >-@3a3>;

@<n;. ;ra;. @9 +piria 1cps;zi

entolin 2 puff la neoie +introm >9: @<n;r< r(9a; a INR

&izoral 1tb;zi 10 zile

@<n;r< -n9,<<(3@ ->; >a-;. 7)9-a 2@;. CT @ran3an @an) > a ra9a <-<r;9n3;a;a2@;9ar33 3n;rn;33 @3r9r(3@a ;<ra@3@ 7-a,an >;(. )a@a n9 >9n; 3)n;3a; a; );r,3nar3

>@9n)ar 3n a; <r(an.

Sa 3:ra; r;;a @<,-n>a;a >r3a CSBE nr. /8600/ 7@r S-3r3a Vn;<3n

PNEUMONIE INTERSTITIALA.FIBROZA PULMONAR 4IFUZA BILATERALA.

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULAR

FOARTE INALT.CAR4IOPATIE ISCHEMICA PRIN BOALA TRIVASCULARA.

PTCA CU BALON PE C IN ANTECE4ENTE.

ANGINA PECTORALA 4E EFORT.

4IABET ZAHARAT TIP INSULINONECESITANT.INSUFICIENTA CAR4IACA CONGESTIVA CLASA NHA II.

R43 stand. )A @<r) (<:a ,ar3; ,a3 a@@n;9a; VSD 33 @<n(>;337a)n<-a;33 3ar.)>n

3n;r>;3;3a a@@n;9a; :a?a :3a;ra

E!4( RS AV= /& :a;a3! ,3n9; HAS HBAS >9:)n3ar ) ST ) a-r<3,a;3 0.& ,, 3n

;r3;<r39 a;ra.

)3R: 3n 3,3; n<r,a.

!" toracic /0.08.2011 r 4#ttman ". A;a>a; @<-3

Ea,3nara a 2<>; 2@;9a;a 3n 3n@3)n; a3a @<r<na >3 >a(3;a.

R?9;a; F3:r<?a ,3n3,a -9,<nara )329?a :3a;raa @<,2<r, ar>;3.

N9 > @<n>;a;a ,<)323@ar3 ;9,<ra >a9 a)n<-a;3@ 3<-9,<nar. N9 > @<n>;a;a a>-@; ) @<@;3 -9raa.

N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@3@.

F3@a;9 ar )3,n>39n3 >3 >;r9@;9ra n<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar >a9 -<r;a

C<@3>;9 n9 >; <@93;.

Gan) SR ) a>-@; n<r,a.

R3n3@33 :3a;ra a9 )3,n>39n3 >3 >;r9@;9ra n<r,aC<n@9?3 F3:r<?a ,3n3,a -9,<nar )329?a :3a;raa. Fara a>-@; TU BP.

E)-!R-A

Pa@3n; 3n ar>;a ) &% an3 @9n<>@9T @9 an;@)n; ,9;3- @ar)3<a>@9ar 7HTA CIC :<aa;r3a>@9ara AVC 3n an;@)n; >3 ,;a:<3@ 74Z ;3- 3n>93n<n@>3;an; > -r?3n;a -n;r9

)3>-n a 2<r;9r3 ,<)ra; ;9> @9 -@;<ra;3 ,9@<-9r9n;a 3n @an;3a; ,3@a a>;n<

a)3a,3 2a;3(a:33;a; ;ran>-3ra;33 )9rr3 ;<ra@3@ -<>;r3<ar >3,-;<, a@r:a; 3n 9;3,

90

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)<9a ?3 an;r3<r 3n;rnar33. O:3@;3 a 3n;rnar -a@3n; a2:r3 >9-ra-<n)ra @9 >;ar

(nraa ,)39 ,<)323@a;a -9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a

:3a;raD TA= 1/0!80,,H(D AV= %6 :a;a3! ,3n9;.Ra)3<(ra23a -9,<nara 3)n;3a?a 33 @<n(>;337a)n<-a;33 3ar)>n 3n;r>;3;3a a@@n;9a;

:a?a :3a;ra @ r3)3@a >9>-3@39na 9n93 -r<@> -r<32ra;3 ,<;3 -n;r9 @ar > 3n)3@a

2@;9ara 9n93 CT ;<ra@3@. CT 9 ;<ra@3@ )>@r3 23:r<?a ,3n3,a -9,<nar )329?a :3a;raa 2araa 3)n;3a a>-@; TU BP.


A 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r-a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.


r(3, a3,n;ar 3-<><)a; 3-<(9@3)3@ 3-<3-3)3@D a@@3nar an;3(r3-aa an9aaD

r3n a @<n;r< ->; 6 9n3D

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

B)%! st --- 4%* -& E=A!ERBARE

3-BR%A )#*$%&ARA B-*A"ERA*A

+)%&-*%A !ER-!A*A

!AR-%)A"-E -+!'E$-!A &E#RER%A+A

)%*-) ! +"4. %)ERA" /-& A))( A#4.2010

!%&+"-)A"-E 'AB-"#A*A


90.0.11 07:90 : Gran#=&.1 *10!"L Gran$=%.% $ HCT=//.1 $ HGB=1/./ (!) L+,-#=1./ *10!"L L+,-$=1 $ MCH='0.6 -( MCHC='.6 (!)

MCV='. 2L M3)#=0./ *10!"L M3)$=6.' $ MPV=8 2L PCT=0. $

P45=1&.% $ PLT=&1 *10!"L RBC=/.% 10*10!"L R45CV=1/ $ R45S4=/. 2 5BC=6. *10!"L VSH 71='6 ,, VSH 7=80 ,, ALAT=8 U!L

ASAT=10 U!L B33r9:3na ;<;aa=1 ,(!) Cra;3n3na=0.% ,(!) F<>2a;a?a

a@a3na=10 U!L G3@,3=81 ,(!) L4H=1%% U!L Pr<;3n ;<;a=6.1 ,(!)

Ur=' ,(!)

R43 stand. )A)>n 3n;r>;3;3a a@@n;9a; :3a;ra 33 23:r<?a;3 a>@n>3<na;3 ,ar3;3 @9 @a@323@ar3.

E!4 RS. AV=%&:!,3n a RS 60 HAS ESV 9n) T 3na; V'V/.

)3R/91772;90.0.2011 )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 >ra <:>;r9@;3 >ra>(,n; @n;ra ,a3 a@@n;9a;a 3n -r32r3. R)9@ra VEMS @9 61$. VEMS >9: 1L.

E)-!R-AB<na 3n ar>;a ) %% an32<>; ,ar 29,a;<r &0 PA @9n<>@9; @9 BPOC 2,.

>ra ) ,a3 ,9;3 an3 @9 a@9;3?ar3 2r@n; >9: ;ra;. :r)3a;a;<r >-<n)3<?a @3@aa

@ar)3<-a;3 3>@,3@a > 3n;rna?a -;. ;9> -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r;,3@!,)39 >9:2:r33;a;3 a>;n3 3na-;n;a >@a)r -<n)raa;ran>-3ra;33 n<@;9rn r;3K

>3,-;<, a@r:a; 3n 9;3, ?3 an;r3<r 3n;rnar33.Mn;3<na, @a :<na9 a -r?n;a; 3n

a9(9>; 010 < 3n;rn;3 -n;r9 -<3- CV >;( @ar a 2<>; :3<->3a; )ar r?9;a;9 HP n9 a 2<>;r@9-ra;.

O:3@;3 a 3n;rnar >;ara (nraa ,<)323@a;a ;(9,n; n<r,a @<<ra; ;ran>-3ra;33

n<@;9rnD pulmonar: ;<ra@ a>;n3@><n<r3;a; -9,<nara MV 3na>-r3; -3r -r9n(3; ra9r3@r-3;an; :a?a :3a;ra >3 rar >3:3an;.D ;ran?3; 3n;>;3na 3n@;3n3; (3<r)an< -<?3;3 )r.

91

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B3<<(3@ >)r. 3n2a,a;<rD VSH a@@ra;

Ra)3<(ra23a -9,<nara )>n 3n;r>;3;3a a@@n;9a; :3a;ra 33 23:r<?a;3 a>@n>3<na;3 ,ar3;3 @9

@a@[email protected] )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 >ra <:>;r9@;3 >ra >(,n; @n;ra ,a3

a@@n;9a;a 3n -r32r3. R)9@ra VEMS @9 61$. VEMS >9: 1L.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.A 9r,a; ;ra;a,n; an;3:3<;3@7A,<3-9> an;3a(3@7 I:9-r<2n A(<@a,3n

-@;<ran;7 Br<,3n :r<n<)3a;a;<r7S+,:3@<r; T<;ar) a @<n;3n9a; ;ra;. - @ar 3 9r,a

a,:9a;<r @9 <9;3 2a<ra:3a.S ;rna?a @9 r@<,an)ar3

R@<,an)ar3

3;ara 3n;,-r33<r a 3n2@;33<r 3n;r@9rn;

@<n>9; ORL r@9-rar r?9;a; :3<->3 -<3- CV ;ra;a,n; @9

+@mbicort 160;, ug 2x1puff;zi

+piria 1 cps;zi

entolin 2 puff la neoie"eotard 2x1tb;zi

@<n;r< -n9,<<(3@ ->; ' 9n3 @9 :3; ) ;r3,3;r ) a ,)3@9 ) 2a,33 >3 )<a)a )a>3(9ra; 7@9-<n ) -n>3 )3n 9;3, ' 9n3 @an)ar3>;3@

Sa 3:ra; r;;a @<,-n>a; >r3a CSBE nr. /8600'

BRON4OPN#OPA*$# %RON$%A OB*R%*$A *A$3 $$$ GO3 $N#A%#RBAR#*#A*O&A 4#PA*$%AAR$%# #BR#3# $NF#R$OAR# B$3A*#RA3#*$3$ %RON$%. PO3$N#ROPA*$# P#R$F#R$%A *O$%A


28.0.11 10:1 :

5BC=&.& *10!"L L+,-#=* 0. *10!"L M3)#=0./ *10!"L Gran#=/. *10!"L

L+,-$=* 16./ $ M3)$=6./ $ Gran$=* %%. $ HGB=1/. (!) RBC=/.%/10*10!"L HCT=/'.8 $ MCV=.6 2L MCH=. -( MCHC='./ (!)

R45CV=1/. $ R45S4=/6. 2 PLT='0 *10!"L MPV=* 8 2L P45=1&./

$ PCT=0.18/ $ VSH 71=8 ,, VSH 7=/ ,, ALAT=% U!L

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ASAT=8 U!L B33r9:3na ;<;aa=0. ,(!) Cra;3n3na=1 ,(!) F<>2a;a?a

a@a3na=1' U!L GGT='8 U!L G3@,3=* 116 ,(!) L4H='// U!L Pr<;3n

;<;a=6. ,(!) Ur=/ ,(!)

RGF stand. PA-desen interstitial accentuat bazal bilateral, predom. in stg., hili fibrozati,ascensionati, mariti,cu calcificari.%ons'(t cardio(o,ic- #%G- &S. <> b/min, I&SJ, fara modificari ischemice, farapatologie cardiaca

PFR- 5017/ 0.09.2011- disfunctie mi'ta, restrictie severa, obstructie severa segmentcentral si f.severa in periferie. &educerea (%)S cu <5+PFR- 5017/09.0".2011- disfunctie ventil. mi'ta, restrictie moderata, obstructie severasegm. central si periferic. reducerea (%)S cu 5<+

#P$%R$&A- !olnav in varsta de 5 ani, mare fumator 5 "A, cunoscut cu !"7; demai multi ani, dar fara un trat. de fond, steatoza hepatica, potator cr, varice mb. inf.bilateral, polineuropatie periferica to'ica, se interneaza pt. tuse, e'pectoratie muco-purulenta, dispnee la efort mediu, subfebrilitati, astenie, transpiratii nocturne, unghitoracic stg. dependent de miscarile respiratorii, simptome e'acerbate cu o zi in urmainternarii.7biectiv la internare- stare generala modificata, pulmonar- torace voluminos, sonoritatepulmonara, )( inasprit bilateral, raluri crepitante si rare sibilante diseminate bilateral.!iologic- glicemie bazala modificata&adiografia pulmonara -desen interstitial accentuat bazal bilateral, predom. in stg., hilifibrozati, ascensionati, mariti,cu calcificari."#&- la interanre- disfunctie mi'ta, restrictie severa, obstructie severa segment centralsi f.severa in periferie. &educerea (%)S cu <5+"#& -la e'ternare- disfunctie ventil. mi'ta, restrictie moderata, obstructie severa segm.

central si periferic. &educerea (%)S cu 5<+

"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus. 6ntrucatpersista unghiul toracic, se efectueaza consult cardiologic care e'clude o cauzacardiaca.

A urmat tratament antibiotic amo'iplus,antimicotic, antitermic, antialgic,e'pectorant,bronhodilatator/cortizonic inhalator, 00;, A6=S, protector hepatic, protector gastric, a continuat trat. pe care il urma ambulator, cu evolutie favorabila dpdv clinic sifunctional.Se e'terneaza cu recomandarile2

Reco)andari-tratament cu 2 *aanic-500 1tb/;i inca 7 ;i(e piria 1 p'88/;i <)bicort 1!0/=+5 ', 2>1 p'88/;i ento(in 2 p'88 (a neoie

-reevaluare cardiologica, gastroenterologica

-control pneumologic peste 3 luni, cu bilet de trimitere de la medical de familie si dovada de asigurat

93

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adeverinta de serviciu

S-a eliberat reteta compensate seria ;S!% nr. *>5 acut si *>cronic

S-a eliberat concediul8 medical seria ;;)A; nr. << si <>

PNEUMONIE LIS.


06.08.11 07:08 : 5BC=&. *10!"L L+,-#=./ *10!"L M3)#=0.& *10!"L

Gran#=' *10!"L L+,-$=* /0.1 $ M3)$= $ Gran$=&0. $ HGB=1/. (!)

RBC=/.% 10*10!"L HCT=/.& $ MCV=88. 2L MCH=.6 -( MCHC=''./(!) R45CV=* 1/.% $ R45S4=/%.6 2 PLT=0 *10!"L MPV=8.' 2L

P45=1&./ $ PCT=0.1%' $ VSH 71=' ,, VSH 7=11 ,, ALAT=1% U!L

ASAT=1% U!L B33r9:3na ;<;aa=0.% ,(!) C<>;r<=186 ,(!) Cra;3n3na=0.8,(!) F<>2a;a?a a@a3na=& U!L GGT=1& U!L G3@,3=1 ,(!) L4H=/11

U!L Pr<;3n ;<;a=%./ ,(!) Ur= ,(!)

Rgr toracica 33 <n(>;33 )>n 3n;r>;3;3a a@@n;9a; :3a;raD <-a@3;a; 3n<,<(na LIS.

!" toracica /0.08.2011 dr 4uttman ": 2ara a>-@; :r<n>3@;a;3@ )ar @9 @a;a ;ra3@;

-ar3;a :r<n>3@ ,a3 3n(r<>a; :3a;ra.N9 > @<n>;a;a ,<)323@ar3 ;9,<ra >a9 a)n<a;3@

,)3a>;3n<-9,<nar. N9 > @<n>;a;a a>-@; ) @<@;3 -9raa. N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@3@. F3@a;9 ar )3,rn>39n3 >3 >;r9@;99ra n<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar

>a9 -<r;a.. C<@3>;9 n9 >; <@93;. Gan) SR ) a>-@; n<r,a. R3n3@33 :3a;ra a9

)3,n>939n3 >3 3n)3@ @<r;3@a n<r,a.

C<n@9?3 A>-@; ;<ra@3@ CT 2ara ,<)323@ar3 >,n323@a;3.

EPICRIZA

Pa@3n; 3n ar>;a ) 8 an3 29,a;<r a & PA 2ara an;@)n; -r><,a -a;<<(3@

>,n323@a;3 > 3n;rna?a -n;r9K9n(3 ;<ra@3@ -<>;r3<r )3>-n a 2<r;9r3 ,<)ra; 2r3><an>3,-;<,a;<<(3 ):9;a;a 3n 9r,a @9 < >a-;a,ana an;r3<r 3n;rnar33. O:3@;3 a 3n;rnar

-a@3n; a2r:3 @9 >;ar (nraa ,)39 ,<)323@a;aD -9,<nar MV 3na>-r3; @9 -3r -r9n(3; :a?a :3a;ra ra9r3 @r-3;an; :a?a >;an(D TA= 110!%0 ,,H(D AV= %0 :a;a3! ,3n9;. In 9r,a @9

9n3 -a@3nr;9 a 2<>; 3n;rna; 3n C3n3@a B<3 3n2@;3<a> 9n) >a r3)3@a; >9>-3@39na 9n3 TBC

-9,<nar ,<;3 -n;r9 @ar >a 2@;9a; a,n9 >-9;3 -n;r9 BJ 7111/!.06.011D a@>;a

233n) BAAR n(a;3 a ,3@r<@<-3 3ar @9;9r3 -n;r9 9n >an;3<n ) >-9;a a9 2<>; -<?3;3 7&@<<n33 ,a3 -r<:a:3 @<n;a,3nar. B3<9,<ra VSH 9><r ,<)9323@a; 2ara a; ,<)323@ar3

-a;<<(3@. R(r ;<ra@3@a 3)n;3a?a <-a@3;a; 3n<,<(na LIS @ar r3)3@a >9>-3@39na 9n<r

:r<n>3@;a?33 ,<;3 -n;r9 @ar > 2@;9a?a CT ;<ra@3@. C;9 ;<ra@3@ n9 3)n;3a?a a>-@; :r<n>3@;a;3@ >3 n3@3 a; ,<)323@ar3 -a;<<(3@D n9 > 3)n;3a?a ?39n3 >-@323@ TBC.Aan) 3n

)r a,3nar3 ) a:<ra;<r >3 >;ara @3n3@a a -a@3n;993 > )@3) ;,-<r3?ar 3n3;3r33;ra;a,;993 TSS.In 9r,a ana,n?3 a a,n993 @3n3@ >3 -ara@3n3@ > >;a:3>; )3a(n<>;3@9 ) ,a3 >9>.

P -ar@9r>9 3n;rnar33 a 9r,a; ;ra;a,n; an;3:3<;<@ a;3a3(3@ an;33n2a,a;<r -r<;@;<r (a>;r3@

>3-a;3@ @9 <9;3 2a<ra:3a.

S ;rna?a a,3<ra; @9 r@<,an)ar3 r(3, a3,n;ar @33:ra; @a<r3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

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;ra;a,n; ,)3@a,n;<> @9 Taan3@ &00 ,( 1 @-r!?3 7% ?3 >3 E)<,) '00 ,( >1 @-r!?3 7%

?3D

>a 3:ra; @<n@)39 ,)3@a >r;3a CCMA4. nr 01116/D )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

r3n a @<n;r< ->; < 9na.

"#$%RA BR%&'%( )#*$%&ARA E *%B -&3ER-%R RE)" "9&1$1 /+".-E"ER$-&AR- +E!#&ARE 'E)A"-!E +#)RARE&A*E

AE&%)A"-E '-* 'E)A"-!

B)%! A!#"-A"A +". -- 4%*

A&E$-E +E!#&ARA $%ERA"A

"R%$B%!-"%)E&-E #+%ARA

+R. E !%*E+"AA +R. E 'E)A"%!-"%*-A #+%R

AR"ER-%)A"-E !R%&-!A %B*-"ERA&"A A $E$BRE*%R -&3ER-%ARE

B-*A"ERA* %)ERA"A( B>()A++(2010


06.08.11 08:0 :

5BC=* 10. *10!"L L+,-#=1.% *10!"L M3)#=1 *10!"L Gran#=* %.& *10!"L L+,-$=* 16.6 $ M3)$=./ $ Gran$=%/ $ HGB=* 11./ (!) RBC=* '.%%

10*10!"L HCT=* '&.1 $ MCV='.' 2L MCH='0. -( MCHC='./ (!) R45CV=* 16.' $ R45S4=&&. 2 PLT=* 1'' *10!"L MPV=10. 2L

P45=16. $ PCT=0.1'& $ Ta:<9 >an(3n=PMN = %8EO = BA = L = 18MO =

4>@r3r ,a;33 3n 23>3@9r3. VSH 71='& ,, VSH 7=%0 ,, ALAT=* / U!L ASAT=* 68 U!L B33r9:3na )3r@;a=* 1.'% ,(!) B33r9:3na ;<;aa=* .1 ,(!)

Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=* &6 U!L G3@,3=86 ,(!) L4H=* 11

U!L Pr<;3n ;<;a=* &. ,(!) Ur=' ,(!)

RGF stand. PA-largire mediastinala, opacitate de intensitate costala bazala dr., ce ocupa

sinusul cardiodiafragmatic, cu diam. de apro'. >cm., fluu delimitata. desen interstitialaccentuat bazal stg., hili cu calcificari. La incidenta din profil opacitatea se afla situataretrocardiac.

#%G- &S. #recvente e'trasistole atriale si ventriculare

%* toracic -Atasat copie;oncluzie- Tumora pulmonara de lob inferior drept. adenopatie in hilul

pulmonar drept. )etastaze hepatice, suprarenaliene drepte8 adenopatii in hilul hepatic.

Fibrobronhoscopie- atasat copie-;( mobile, trahee libera, pintene traheal normal. Arbore bronsic

stang liber, cu aspect bronsitic. "$ libera, LS$, !& intermed, L) br segm libere."roces prolif infiltrativ stenozant la niv lez piramidei bazale drepte. !iopsie e'histopatologic in lucru.

PFR- disfunctie mi'ta, restrictie moderata, obstructie moderata segment central siperiferic. &educerea (%)S cu <+

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#P$%R$&A- !olnav in varsta de > de ani, fost mare fumator, 5 "A, potator cronic,cunoscut cu A;7)6 bilateral operat in 1, sub trat. cu "ento'i retard, recentdiagnosticat cu o formatiune tu L6$ si multiple det. sec. hepatice si suprarenale, seinterneaza pentru confirmare de diagnostic bronhoscopie, in vederea initieriitratamentului oncologic. 6n perioada premergatoare internarii pacientul a prezentat

modificarea starii generale, tuse cu e'pectoratie muco-purulenta, hemoptizie cant. mica episoade,dispnee la efort mediu, astenie, subfebrilitati, scadere ponderala,transpiratii predominent nocturne, dureri toracice,asociate cu inaptetenta, balonari,greturi,simptome e'acerbate in ultimele saptamani anterior internarii.7biectiv - la internare2 starea generala modificata, tegumente palide,eritroza palmara,transpiratii nocturne8 p'()onar 2 torace astenic, submatitate bazala dreapta, )(diminuat bazal drept,fara raluri 8 ;ardio-vascular2 zgomote cardiace aritmice K>/min,TA?1/>mm0g, puls pedioasa prezent bilateral8 $igestiv2 abdomen cu sensibilitate lapalpare in epigastru, unde se palpeaza o masa compacta, dura, partial mobila,neregulata, de dimensiuni /cm8 hepatomegalie consistenta crescuta , suprafataneregulata, sensibil la palpare.

!iologic- sdr. inflamator (S0 accelerat, leucocitoza usoara cu neutrofilie si limfopenie,anemie moderata, trombocitopenie usoara, hepatocitoliza, colestaza, hipoproteinemie,crestere marcata a L$0.&adiografia pulmonara -ridica suspiciunea de tu. br-pulmonara L6$, confirmata si prin;T toracic care a evidentiat det. sec. hepatice si S&.#ibrobronhoscopia - confirma dgn. de foramt. tumorala L6$. Se preleveaza bipsieendobronsic in lucru"#&- disfunctie mi'ta, restrictie moderata, obstructie moderata segment central siperiferic. &educerea (%)S cu <+

"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

A urmat tratament antibiotic, rehidratare, roborante, vitamine, antitermic, antialgic,antitusiv, bronhodilatator, protector hepatic, a continuat trat. pe care il urma ambulator,cu evolutie favorabila.Se e'terneaza cu recomandarile2

;ra;a,n; @9

+piria 1cps;zi

entolin 2puff la neoie

%meran 20mg 1tb;zi 1(0(0

$etoclopramid 10mg 9x1tb;zi 1(1(1

*i2 9x1 tb;zi

)entoxiflin ,00mg 2x1tb;zi

(antialgice la neoie

r3n )9-a r?9;a;9 3>;<-a;<<(3@ a :3<->33 n)<:r<n>3@-r?n;ara 3n >r3@39 ) <n@<<(3 -;. ;ra;a,n; ) >-@3a3;a;

ra9ar @ar)3<<(3@a @<n;3n9ara ;ra;a,n;993 r@<,an)a; ) @a;r ,)3@9 >-@3a3>;

@<n>9; (a>;r<n;r<<(3@

@<n;r< -n9,<<(3@ ->; 6 9n3 @9 :3; ) ;r3,3;r ) a ,)3@a ) 2a,33 >3 )<a)a )a>3(9ra; 7@9-<n ) -n>3 )3n 9;3, ' 9n3 @an)ar3>;3@

96

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BRONHOPNEUMONIE 4REAPTA ABCE4ATA

INSUFICIENTA RESPIRATORIE CRONICA

CPC ST III

HTA ST II C4Z TIP II CU NECESAR 4E INSULINA

HIPOPROTEINEMIE


90.0.11 07:2, :

S-9;a Fr<;39 BAAR A=NEGATIV /0//!'0.08.011 S-9;a Fr<;39 BAAR


90.0.11 07:2 :

S-9;aC9;3ar :a@;r33 ar<:=Rar @<<n33 ) (r,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana.

S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ Sa3arA>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33

C9 -3;3a >@9a,<a> rar @9 -3;3a >@9a,<a>

F3:r3na a:>n;

S@<r ) @a3;a; 0

90.0.11 07:2 :

Gran#=/.' *10!"L Gran$=%1.' $ HCT='%.8 $ HGB=1./ (!) L+,-#=1.

*10!"L L+,-$=1.1 $ MCH=%.' -( MCHC='.8 (!) MCV=8'.' 2L M3)#=0./ *10!"L M3)$=%.6 $ MPV=%./ 2L PCT=0.' $ P45=1&.% $

PLT='' *10!"L RBC=/.&/ 10*10!"L R45CV=1/.& $ R45S4=//.% 2

5BC=&. *10!"L VSH 71=/6 ,, VSH 7=10' ,, ALAT=6 U!L

ASAT=1/ U!L B33r9:3na ;<;aa=0.& ,(!) Cra;3n3na=0. ,(!) F<>2a;a?aa@a3na=1 U!L G3@,3=1/% ,(!) L4H='88 U!L Pr<;3n ;<;a=&.8 ,(!)

Ur= ,(!) 4;@;ara 9@<@3;<r 7P=n( 4;@;ara -r<;3n<r 7A=n( I)n;323@ara @9 ;r9> a; PCR=/ ,(!

90.0.11 10:20 :

4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(

02.08.11 07:98 :

S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a Fr<;39

Gra,=A>-@; ,a@r<>@<-3@ M9@<3)

A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 10!@a,-C9 -3;3a >@9a,<a> 10!@a,-

F3:r3na -r?n; 2<ra :a@;r3ana -<3,<r2a rar 9r3.S@<r ) @a3;a; 1

0.08.11 10:9 :

Pr<;3n9r3=0. ($<

R3 )AG ** @<n)n>ar @9 :r<n<(ra,a ar3@a >3 ;n)3n;a a 3n<,<(n3;a; LSS >(, >3

LM a@@ 3n;r>;3;3993 -r3:r<n<a>@9ar :3a;

R3 )A G** @<n;r< 7& 0. 11 r><r:;3 3,-<r;an;a.

97

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BPOC ACUTIZAT ST4IUL II GOL4

FIBROZA PULMONARA 4IFUZAHTA IIC

IVS 4E EFORT NHA III

HEPATOPATIE CRONICA

INFECTII URINARE RECI4IVANTE


01.08.11 08:19 :

Gran#='.8 *10!"L Gran$=&1. $ HCT='%.' $ HGB=1./ (!) L+,-#='.

*10!"L L+,-$=/.% $ MCH=.' -( MCHC=''. (!) MCV=88./ 2L

M3)#=0./ *10!"L M3)$=6.1 $ MPV=8.& 2L PCT=0.%8 $ P45=1&.6 $ PLT='8 *10!"L RBC=/. 10*10!"L R45CV=1/.' $ R45S4=//.% 2

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5BC=%./ *10!"L VSH 71='& ,, VSH 7=% ,, ALAT='% U!L ASAT='8

U!L B33r9:3na ;<;aa=0.& ,(!) Cra;3n3na=0.% ,(!) F<>2a;a?a a@a3na=1%6 U!L

G3@,3=11' ,(!) L4H='/ U!L Pr<;3n ;<;a=%.' ,(!) Ur=/ ,(!) I)n;323@ara @9 ;r9> a; PCR=6 ,(!

02.08.11 07:0, :

4;@;ara 9@<@3;<r 7P=-<?3;3 4;@;ara -r<;3n<r 7A=n( S)3,n;9r3nar=1&/ 9@<@3;!@ @r3>;a ) <aa; ) CA 2<ra :a@;r3ana

02.08.11 07:0 :

S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a Ea,n ,3@<<(3@=Can)3)a >-- '0 UFC! -a@a S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@

M9@<3)

A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 10!@a,-

C9 -3;3a >@9a,<a> 10&!@a,-F3:r3na a:>n; 2<ra :a@;r3ana -<3,<r2a 32 ,3@3n

S@<r ) @a3;a; 1

02.08.11 11:9, :

4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(

PFR 7%088 43>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,@n;ra >3 >ra - @a3 ar3n -r32r3@. R)9@ra V ,a @9 &$.

C<n>9; @ar)3<<(3 4( IVS ) 2<r; NHA III. HTAE II r3>@ a)3;3<na 3na;. 43>3-3),3.E@<)<--r @ar)3a@ C<r) @9 a>-@; 3-r;n>3. V4A4 ,ar3; a 3,3;a . H3-r;r<23

@<n@n;r3@a. VS 23@3n;.

ECG RS FC= %/!,3n a RS 0 2ara ,<)323@ar3 3>@,3@aD TA=160!100 ,,H(.

R@ Znra 10 ,(!?3A>-n;r %& ,(!?3

M<)93n MR '&,(!?3

Va>33- 0 ,(!>ara Tr;n>32 SR 1;:!?3.

99

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PNEUMONIE RECI4IVANTA

TUMORA LS4 IN OBSERVATIE

HTA ST I


01.08.11 07:11 :

Gran#=/./ *10!"L Gran$=6.& $ HCT='/.' $ HGB=11./ (!) L+,-#=1.&

*10!"L L+,-$='.6 $ MCH=8.8 -( MCHC=''. (!) MCV=86. 2L M3)#=0./ *10!"L M3)$=6. $ MPV=%. 2L PCT=0.0' $ P45=1&.8 $

PLT=&8 *10!"L RBC='.& 10*10!"L R45CV=1' $ R45S4=/'.1 2

5BC=6.' *10!"L VSH 71=% ,, VSH 7=& ,, ALAT=11 U!L ASAT=1/

U!L B33r9:3na ;<;aa=0.& ,(!) Cra;3n3na=0.% ,(!) F<>2a;a?a a@a3na=1'1 U!L G3@,3=6 ,(!) L4H=''6 U!L Pr<;3n ;<;a=&.% ,(!) Ur=1 ,(!)

I)n;323@ara @9 ;r9> a; PCR=6 ,(!

E!4 RS %8!,3n 2ara ,<)323@ar3 3>@,3@

)3R 7 a<r3 n<r,a

!" toracica7 '1.08.011 4r G9;;,an H3-r)3a F<r,a;39n ;9 LS4 %1 &8,, -a@a;a a

-9ra ,)3a>;3naa a)3a@n;a ;ra3 @9 n@r<? 3n@9> 2ara 3n;r>ara AP. In >(, 6 >;( n<)9

) 1 ,, @a@323@a; a-r<a- 3n 3n;r(3,... C<n@9?33 TU T'N0M0 7:9;3n C43ibrobron?oscopia 7186! 01.0.011 4r Para9 Fara >,n )3r@; >a9 3n)3r@; ) -r<@>

-r<32ra;3. O-ra:3 )-) :r<n<>@<-3@. TBLB >(, LS4.

BPOC CU EACERBARE

100

7/24/2019 69625104-epicrize


TBC PULMONAR FIBRONO4ULAR SECHELAR BAAR NEGATIV

CULTURI IN LUCRU.

SPON4ILITA ANCHILOPOIETICA

CASEIE.


07.08.11 08:2, : Gran#=%.& *10!"L Gran$=6%. $ HCT=/'./ $ HGB=1/./ (!)

L+,-#=.% *10!"L L+,-$=/.' $ MCH=.' -( MCHC=''.1 (!) MCV=88.% 2L M3)#=0. *10!"L M3)$=%.8 $ MPV=8.8 2L PCT=0.& $

P45=1&. $ PLT=&6 *10!"L RBC=/. 10*10!"L R45CV=1'.% $ R45

S4=/&./ 2 5BC=11.1 *10!"L VSH 71=1& ,, VSH 7=/1 ,, ALAT=1U!L ASAT=0 U!L B33r9:3na ;<;aa=0.% ,(!) Cra;3n3na=0.% ,(!) F<>2a;a?a

a@a3na='0' U!L GGT=8 U!L G3@,3=81 ,(!) Pr<;3n ;<;a=6. ,(!)

Ur=/1 ,(!)

07.08.11 08:2 /&R.RE4.,16;07.08.2011 : S-9;a Fr<;39 BAAR A=NEGATIV

S-9;a Fr<;39 BAAR B=NEGATIV S-9;a Fr<;39 BAAR C=NEGATIV

Rgr toracica: 33 @(>;33 )>n 3n;r>;3;3a a@@n;9a; :3a;ra ,9;3- ,3@r<<-a@3;a;3r;3@9<n<)9ar )3>,3na; :3a;ra.

PFR )3>29n@;3 n;3a;<r3 ,3;a >ra 3n ;<; ar:<r :r<n>3@.

E)-!R-A:

Pa@3n; 3n ar>;a ) /' an3 29,a;<r a &0 PA @9n<>@9; @9 an;@)n; -r><na -a;<<(3@

-9,<narTBC -9,<nar@9 ;ra;a,n; 3n@3a; 3n 00@9 23:r<?a ;3n>a -<>; TBC >3 @9>3n)r<, :r<n<<:>;r9@;3 >r > 3n;rna?a -n;r9 ;9> @9 -@;<ra;3 ,9@<-9r9n;a

,<-;3?3 3n @an;3a; ,3@a )3>-n a 2<r;9r3 ,<)ra;! ,3@3 a>;n<a)3na,3 2a;3(a:33;a;

@a)ra ;<ran;3 2<r; ;ran>-3ra;33 -r)<,3nan; n<@;9rn >3,-;<, a@r:a; 3n 9;3,a>a-;a,ana an;r3<r 3n;rnar33.O:. a 3n;rnar -a@3n; a2:r3 @9 >;ar (nraa 9><r 3n29n;a;aD -9,<nar ;<ra@ a>;n3@ MV

3na>-r3; @9 -3r -r9n(3; :a?a :3a;ra ra9r3 @r-3;an; >3 r<n2an; )3>,3na; :3a;raD TA=

1'0!%0 ,,H( A= %/ :a;a3! ,3n9;D a:)<,3na 9><ara >n>3:33;a; 3n -3(a>;r9.B3<9,<ra >)r 3n2a,a;<r 7 9@<@3;<?a. Ea,n9 ) >-9;a -n;r9 B >; BAAR n(a;3 a

,3@r<>@<-3 @9;9r3 233n) 3n 9@r9. R(r ;<ra@3@a 3)n;3a?a ?39n3 >@ar -<>; TBC

-9,<nar. PFR )3>29n@;3 n;3a;<r3 ,3;a >ra ,a3 a@@n;9a;a 3n -r32r3.In 9r,a ana,n?3 a a,an993 @3n3@ >3 - :a?a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 )

,a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@ n>-@323@ 7A,-3@33naan;33n2a,a;<r:r<n<)3a;a;<r -r<;@;<r

(a>;r3@ >3 -a;3@ @9 <9;3 2a<ra:3a. S ;rna?a a,3<ra; @9 r@<,an)ar3

r(3, a3,n;ar @33:ra; @a<r3@D

rn9n;ara a @n>9,9 ) ;<3@7a@<< 29,a;D

a@@3nar an;3(r3-aa an9aaD ;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->!?3D

101

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SERETI4E &0!&00 ,@r(ra, 1 -92!?3D

VENTOLIN 100 ,3@r<(ra, -929r3 a n<3D

r3n )9-a r?9;a;9 @9;9r3<r a2a; 3n 9@r9D r3n a @<n;r< ->; 6 9n3D

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

PNEUMONIE INTERSTITIALA.SARCOI4OZA.

NO4ULI PULMONARI LI4.

ARTRITA TIBIOTARSIANA BILATERALAETRASISTOLE VENTRICULARE.


08.08.11 08:07 :Gran#=&./ *10!"L Gran$=6&.' $ HCT=/0.' $ HGB=1'.&(!) L+,-#=. *10!"L L+,-$=6./ $ MCH=8.& -( MCHC=''./ (!)

MCV=8&.' 2L M3)#=0.% *10!"L M3)$=8.' $ MPV=.1 2L PCT=0.' $

P45=1&.% $ PLT=&6 *10!"L RBC=/.%' 10*10!"L R45CV=1'.6 $ R45S4=/'. 2 5BC=8.' *10!"L VSH 71=& ,, VSH 7=11 ,, ALAT=8 U!L

ASAT= U!L B33r9:3na ;<;aa=0.% ,(!) C<>;r<=1%& ,(!) Cra;3n3na=0.8

,(!) F<>2a;a?a a@a3na=%' U!L GGT=8 U!L G3@,3=8% ,(!) L4H='16 U!L Pr<;3n ;<;a=6.' ,(!) Ur=1 ,(!)

)3R /681;08.08.2011: 3n 3,3; n<r,a.

EJG R> AV= %0 :a;3! ,3n9; E V

Rgr tracica: 33 @3<n(>;33 )>n 3n;r>;3;3a a@@n;9a; :3a;raD <-a@3;a; 3n<,(na 29)3,3;a;a LI4.

!" toracic cu substanta de contrast7)r G9;;,an T. A;a>a; @<-3

Ea,3nara a 2<>; 2@;9a;a 3n 3n@3)n; a3a @<r<na >3 >a(3;a.R?9;a; C<,-ara;3 @9 a,3nar )3n 6.0&.011 > @<n>;a;a < ,3n3,a r)9@r )3,n>3<naa

a ,3@r<n)93<r )>@r3>3 3n LI4. 3n -r?n; a@>;3a ,a>9ran) & r>-@;3 / ,, )3a,;r9 @9

a@@a>3 ;3<<(3 3n@r;a. A)n<-a;33 3ar :3a;ra >a9 r)9> >3 a@>;a )3,n>3<na a @@a 1,, )3a,;r9. N9 > @<n>;a;a ,<)323@ar3 ;9,<ra >a9 a)n<-a;3@ 3<-9,<nar. N9 >

@<n>;a;a a>-@; ) @<@;3 -9raa. N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@3@. F3@a;9 ar

)3,n>39n3 >3 >;r9@;9ra n<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar >a9 -<r;a. Gan) SR )

a>-@; n<r,a. R3n3@33 :3a;ra a9 )3,n>39n3 >3 >;r9@;9ra n<r,a.C<n@9?3 A>-@; C; 3n ,3n3,a 3n<9;3 n<)93 -9,<nar3 LI4 @9 r)9@r )3,n>3<naa.

I,a(3n3 (an(3<nar 3ar >3 ,)3a>;3na @9 )3,n>39n3 ,a3 r)9>. C<n;r< CT ->; 6 9n3.

E)-!R-A

Pa@3n;a 3n ar>;a ) /& an32<a>;a 29,a;<ar a & PA @9n<>@9; 3n an;@)n; @9 Sar@3)<?aDAr;r3;a ;3:3<;ar>3ana ;ra>3>;< n;r3@9ar > 3n;rna?a -n;r9 ra9ara n<)93<r

-9,<anar3 LI4. La 3n;rnar -a@3n;a -r?n;a ;9> >a@a )3>-n a 2<r;9r3 ,<)ra; a>;n<a)3na,3 2a;3(a:33;a; >@a)ra ;ran;3 a 2<r; >3,-;<, a@r:a; 3n 9;3,a >a-;a,anaan;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar -a@3n;a n<r,<-<n)raa a2:r3a @9 >;ar (nraa 9><r 3n29n;a;aD

-9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;raD TA= 10!%0 ,,(DAV= 0 :a;a3! ,3n9;.

B3<<(3@ 2ara ,<)32@ar3 -a;<<(3@ >,n323@a;3. PFR >9n; 3n 3,3; n<r,a. Ra)3<(ra23a

-9,<nara 3)n;3a?a )>n 3n;r>;3;3a a@@n;9a; :3a;ra >3 < <-a@3;a; 3n<,(na 29

102

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)3,3;a;a LI4. In @<,-ara;3 @9 ra)3<(ra233 2@;9a; an;r3<r 3,a(3na ra)3<<(3@a >

-a>;ra?a n,<)323@a;a ,;3 -n;r9 @ar > 3n)3@a >3 ra9ara -r3n a, CT ;<ra@3@ a 3,a(3n33.

Ea,n9 CT ;<ra@3@ 2@;9a; @<,-ara;3 @9 a,3nara r@)n;a )>@r3 < r)9@r)3,n>3<naa a ,3@r<n<)93<r )3n LI4 >3 < ,3@><rar ,3n3,a 3n )3,n>39n a 3,a(3n3<r

(an(3<nar 3ar >3 ,)3a>;3na.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.A 9r,a; ;ra;a,n; an;3:3<;3@ an;3,3@<;3@ an;3;9>3Pr)n3><n &,(!?3 AINS an;3;r,3@ an;3a(3@

r<:<ran; 3;a,3n @9 <9;3 2a<ra:3a. S ;rna?a @9 r@<,an)ar3

r(3, a3,n;ar @33:ra; @a<r3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

a@@3nara an;3(r3-aa an9aaD

;ra;a,n; Taan3@ &00 ,( 1 @-r!?3 7% ?3D P)n3><n & ,( 1 @-r!?3

@<n>9; r9,a;<<(3@ -r3<)3@D

@<n>9; @ar)3<<(3@D

r3n a @<n;r< ->; 6 9n3D )3>-n>ar3?ar -r3n ,)3@9 ) 2a,3.

PNEUMONIE LI4.BOALA PULMONARA CRONICA OBSTRUCTIVA S4T II GOL4 IN EACERBARE.

FIBROZA PULMONARA LI4 SI LM4.

BRONSIECTAZII SUPRAINFECTATE.INSUFICIENTA RENALA CRONICA.

PIELONEFRITA ACUTA IN REMISIE.

ANEMIE SECUN4ARA.

4ISLIPI4EMIE.

R43 stand. )A 33 @<n(>;33 )>n 3n;r>;3;3a a@@n;9a; :3a;raD <-a@3;a; 3n<,<(na 29

)3,3;a;a <@a3?a;a 3n2ra3ar )r-;. S3,23?a @<>;<)3a2ra(,a;3@a.

E!4 RS A=&8 :a;a3! ,3n9; a RS a 0 (ra) 9n) T n(a;3 3n V1V6.

)3R /6866 )3>29n@;3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n; @n;ra >3 >ra 3n

-r32r3. R)9@ra VEMS @9 '%$.

08.08.20118/dr. Rednic &.: -9n@;3 ;ran>;<ra@[email protected]?9;a; ana;<,<-a;<<(3@ 78%!1'.0.011 )r Zaar3 T. ,a;ra9 a,3na; >; 2<r,a; )3n

;>9; ) (ran9a;3 @9 >;r<,a ,<)ra; )n,a;3a;a @ar @<n;3n 3,2<@3; -a>,<@3; >3 <?3n23.

a -r32r3 > (a>>; 9n -3;39 @33n)r3@ 2<@a 9 < ,3@a ?<na ) ,;a-a?3 >@9a,<a>a. N93>;a ,n; ) ,a3(n3;a;.

C<n@9?3 a>-@;9 -)a?a -n;r9 9n ;>9; ) (ran9a;3.

E)-!R-A

B<na 3n ar>;a ) %0 an3 @9n<>@9; @9 an;@)n; -r><na -a;<<(3@ @3r9r(3@a 7>;<,a@r?@a; -n;r9 U4 C<@3>;@;<,3 9r<<(3@ 7P3<n2r3;a a@9;a >3 ,;a:<3@ 743>3-3),3

> -r?3n;a -n;r9 ;9> >a@a )3>-n a 2<r; ,)39 @2a a,;3a>;n3<a)3na,32a;3(a:33;a; 3na-;;n;a >@a)r -<n)raa >3,-;<, a@r:a; 3n 9;3, ?3 an;r3<r

3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa 9><r 3n29n;a;a ;(9,n; >3 ,9@<a> -a3) -9,<nar

;<ra@ a>;n3@ >9:,a;3;a; :a?a )r-; @9 MV )3,3n9a; a a@>; n3 ra9r3 @r-3;an; :a?a :3a;raD Sa; O= %$D TA= 110!%0,,H( AV= % :a;a3! ,3n9;.

103

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Ra)3<(ra23a -9,<nara 3)n;3a?a <-a@3;a; 3n<,<(na 29 )3,3;a;a <@a3?a;a 3n2ra3ar )r-;

@ar r3)3@a >9>-3@39n 9n93 -r<@> -r<32ra;3 a a@>; n3. CT9 ;<ra@3@ 2@;9a; a 3nrnara

-r@)n;a )>@r3 23:r<?a -9,<nara 3n LI4 >3 LM4 @9 ;a3@; :r<n>3@;a;3@ >3 < 2<r,a;39n;3>9ara r;<>;rnaa >;an(a @9 ;3<<(3 (r9 ) -r@3?a;a. Aan) 3n )r a>-@;9 ra)3<<(3@

)>@r3> > 3n)3@a 2@;9ara 9n3 -9n@;33 ;ran>;<ra@3@ @9 -raara ) ,a;r3a :3<-;3@.

Ea,n9 ana;<,<-a;<<(3@ 2@;9a; )3n :3<->3a ;ran>;<ra@3@a 3)n;3a?a 9n a>-@ @ar -)a?a -n;r9 9n ;>9; ) (ran9a;3.


>9>.A 9r,a; ;ra;a,n; an;3:3<;3@ HHC an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r @9

<9;3 2a<ra:3a. S ;rna?a @9 r@<,an)ar3

r(3, a3,n;ar @33:ra; @a<r3@D 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D


;ra;a,n; ,)3@a,n;<> @9D SPIRIVA 18 ,3@r<(ra, 1 @->!?3

VENTOLIN 100 ,3@r<(ran 929r3 a n<3D r3n a @<n;r< ->; 6 9n3 D

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

BRONHOPNEUMONIE.

BPOC ST4 II GOL4 IN EACERBARE.

COLECTIE PLEURALA BILATERALA 7IN CANTIATE MICAHTP MO4ERATAD

CAR4IOMEGALIE.

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 III CU RISC CAR4IOVASCULARINALT.

CAR4IOPATIE ISCHEMICA CRONICA.

F3A CU AV INALTA.CC COLONIC OPERAT IN ANTECE4ENTE.

GUTA.

OBEZITATE GR4 III.

HIPOTIROI4ISM.A4ENOM 4E PROSTATA.


08.08.11 08:07 :Gran#=/. *10!"L Gran$=%1.6 $ HCT=&0.6 $ HGB=16 (!)

L+,-#=1.1 *10!"L L+,-$=18.6 $ MCH=''./ -( MCHC='1.6 (!)

MCV=10&.8 2L M3)#=0.6 *10!"L M3)$=.8 $ MPV=8./ 2L PCT=0.11& $

P45=1&. $ PLT=1'8 *10!"L RBC=/.% 10*10!"L R45CV=1&. $ R45S4=&%.' 2 5BC=&. *10!"L ALAT='' U!L ASAT='8 U!L B33r9:3na

;<;aa=1. ,(!) C<>;r<=16 ,(!) Cra;3n3na=1./ ,(!) F<>2a;a?a a@a3na=1/%

U!L GGT=' U!L G3@,3=101 ,(!) L4H=&%& U!L Pr<;3n ;<;a=6,(!) Tr3(3@r3)=81 ,(!) Ur=&& ,(!)

08.08.11 08:10 : VSH 71=/ ,, VSH 7=% ,,

08.08.11 11:29 : B33r9:3na )3r@;a=0.& ,(!)

104

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)3R/70887;08.08.2011: )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3a

,<)ra;a >(,n; @n;ra >3 >ra 3n -r32r3. R)9@ra n;3a;33 ,a3, @9 &%$.

R(r ;<ra@3@a @<r) (<:a ,ar3; 2a>@ - )3a2ra(,D 33 @<n(>;33D )>n 3n;r>;3;3a a@@n;9a; :3a;raD <-a@3;a; 3n<,<(na -ara@ar)3a@ )r-;D ,9;3- <-a@3;a;3 n<)9ar >3 3nara

)3>,3na; 3n a,:33 @a,-3 -9,<n:ar3.

!" torace /08.08.2011 dr 4uttmn ": @ar)3<,(a3 (<:aa @9 >,n ) HTP. H,3)3a2ra(,)r-; >3 23@a; a>@n>3<na; @9 @r>;ra 3n )3,n>39n3 a <-a@3a;33 -ara@ar)3a@ )r-; . B9 )

,23?, -9,<nar >9:-9ra 3n )r ) -ana a '% ,, )3a,. C<@;3 -9raa ,3@a :3a;ra.

N9 > @<n>;a;a ,<)323@ar3 ;9,<ra >a9 a)n<-a;3@ 3<-9,<nar. N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@[email protected]@a;9 ar )3,n>39n3 >3 >;r9@;9ra n<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar

>a9 -<r;a. C<@3>;9 n9 >; <@93;. Gan) SR ) a>-@; n<r,a. R3n3@33 :3a;ra a9

)3,n>39n3 >3 >;r9@;9ra n<r,a.

E)-!R-A( B<na 3n ar>;a ) 80 an3 2<>; 29,a;<r a /0 PA @9n<>@9; @9 ,9;3- an;@)n;

-r><na -a;<<(3@ @ar)3<a>@9ar n)<@r3n @3r9r(3@a >3 9r<<(3@> -r?3n;a -n;r9

,<)323@ara >;ar33 (nra ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r;9r3 ,3@3 a>;n<

a)3na,3 2a;(a:33;a; >@a)ra ;<ran;3 a 2<r; ;ran>-3ra;33 >3,-;<, a@r:a; 3n 9;3,>a-;a,an3 an;r3<r 3n;rnar33. O:3@;3 a 3n;rnar -a@3n; >9-ra-<n)ra a2:r3 @9 >;ar

(nraa ,)39 ,<)323@a;a ;(9,n; >3 ,9@<a> -a3)D -9,<nar MV )3,3n9ar; 3n,3;<ra@ )r-; ra9r3 @r-3;an; :a?a :3a;raD TA= 1%0!0,,H(D AV= 68 :a;a3! ,3n9;.

B3<<(3@ >2)r ) r;n;3 a?<;a;a K3-<-r<;3n,3 L4H 9><r @r>@9;.Ra)3<(ra23a -9,<nara

3)n;3a?a <-a@3;a; 3n<,<(na -ara@ar)3a@ )r-; @ar r3)3@a >9>-3@39na 9n93 -r@> 3n<@93;<r) >-a;39 a a@>; n3 ,<;3 -n;r9 @ar > 3n)3@a 2@;9ara 9n93 CT ;<;a@[email protected] ;<ra@3@ )>@r3

@ar)3<,(a3 (<:aa @9 >,n ) HTP ,3)3a2ra(, )r-; >3 23@a; a>@n>3<na; @9 @r>;ra 3n

)3,n>39n3 a <-a@3a;33 -ara@ar)3a@ )r-; >3 :9 ) ,23?, -9,<nar >9:-9ra 3n )r )

-ana a '% ,, )3a,.PFR )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3a ,<)ra;a >(,n; @n;ra >3

>ra 3n -r32r3D r)9@ra n;3a;33 ,a3, @9 &%$.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.A 9r,a; ;ra;a,n; an;3:3<;3@ an;3,3@<;3@ an;3;9>3 HHC AINS an;3;r,3@ an;3a(3@

r3)ra;ar r<:<ran; 3;a,3n -@;<ran; :r<n<)3a;a;<r!@<r;3?<n3@ 3naa;<r -r<;@;<r

-a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a. S;rna?a @9 r@<,an)ar3

r(3, a3,n;ar 3-<><)a; 3-<3-3)3@ 3-<(9@3)3@D

>@a)r -<n)raaD

2<r; 23?3@ 3n ,3;a ;<ra:33a;a;33D

a@@3nar an;3(r3-aa an9aaD ;ra;a,n; ,)3@a,n;<> @9 SERETI4E &0!&0 ,3@r<(ra, 1 -92!?3

TAVANIC &00 ,( 1 @-r!?3D ER4OME4 '00 ,( 1 @-r!?3

@<n;3n9ara ;ra;a,n;993 - @ar a a9; 3n a,:9a;<r @<n2<r, >@,3 ;ra-9;3@D

r3n a @<n;r< ->; 6 9n3D

)3>-n>ar3?ar -r3 ,)3@9 ) 2a,33.PNEUMONIE ACUTA INTERSTITIALA

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SIN4ROM 4E HIPERREACTIVITATE BRONSICA

RINITA ALERGICA IN OBSERVATIE

BRA4ICAR4IE SINUSALA


0.08.11 08:, : Gran#='.1 *10!"L Gran$=61. $ HCT=/.6 $ HGB=1/.' (!) L+,-#=1.&

*10!"L L+,-$='0 $ MCH=.1 -( MCHC=''.& (!) MCV=8%.1 2L

M3)#=0./ *10!"L M3)$=8.8 $ MPV=8. 2L PCT=0.1/& $ P45=16.' $ PLT=1%% *10!"L RBC=/. 10*10!"L R45CV=1' $ R45S4=//.% 2

5BC=& *10!"L VSH 71=' ,, VSH 7=& ,, ALAT=1/ U!L ASAT=1'

U!L B33r9:3na ;<;aa=0.6 ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=1'& U!L GGT=11 U!L G3@,3=8 ,(!) L4H=%% U!L Pr<;3n ;<;a=% ,(!)

Ur=0 ,(!)

ECG RS 60!,3n BR4 ,3n<r.

PFR CV=10&$ VEMS=116$ MMEF &%&=1'/$D

Ra)3<(ra23 PA )>n -r3:r<n<a>@9ar a@@n;9a; :3a;ra 3n;r>;3;39 )329? a@@n;9a;.

)&E#$%&-E -&"ER+-"-A*A !# E%*#"-E "RE&A&"A

+R. +#B3EBR-* )RE*#&4-"

"B! )#*$%&ARA -& A)) /2010 "RA"A$E&" -&!'E-A"


07.08.11 07:9, :

5BC=&.% *10!"L L+,-#=./ *10!"L M3)#=0./ *10!"L Gran#=. *10!"L L+,-$=* /1.% $ M3)$=% $ Gran$=&1.' $ HGB=16 (!) RBC=&.11

10*10!"L HCT=/%. $ MCV=./ 2L MCH='1.' -( MCHC=''.8 (!)

R45CV=1./ $ R45S4=/./ 2 PLT=1% *10!"L MPV=8./ 2L P45=1&.8$ PCT=0.1& $ VSH 71=/ ,, VSH 7=8 ,, ALAT=8 U!L ASAT=1&

U!L B33r9:3na )3r@;a=* 0.8& ,(!) B33r9:3na ;<;aa=* 1./ ,(!) Cra;3n3na=1.1

,(!) F<>2a;a?a a@a3na=01 U!L G3@,3=/ ,(!) L4H=% U!L Pr<;3n

;<;a=%. ,(!) Ur=% ,(!)

06.08.11 08:2 :

S-9;a Fr<;39 BAAR A=NEGATIV NR.REG./1'0!06.0.011 S-9;a Fr<;39 BAAR B=NEGATIV S-9;a Fr<;39 BAAR C=NEGATIV

06.08.11 08:26 :

S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ M9@<3) A>-@; ,3@r<>@<-3@

C9 3n2a,a;<r33 10&!@a,- C9 -3;3a >@9a,<a>

10&!@a,- F3:r3na -r?n; 2<ra :a@;r3ana -<3,<r2a

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2r@n; 32 ,3@3nS@<r ) @a3;a; 1 S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n

,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a Ea,n ,3@<<(3@=Can)3)a >-- 8UFC! -a@a

12.08.11 07:06 :

ALAT=/ U!L ASAT=1' U!L B33r9:3na ;<;aa=1 ,(!) F<>2a;a?a a@a3na=1%& U!L

GGT=0 U!L

RGF stand. PA-desen interstitial usor accentuat bazal bilateral, calcificari hilare

PFR- normale

#P$%R$&A- !olnav in varsta de ani, nefumator, cunoscut cu T!; pulmonar in A"" recente- nov.

1 pt care a urmat tratament > luni, incheiat in mai 11,se prezinta pentru subfebrilitati, cefalee, verti,astenie, transpiratii nocturne, tuse initial productiva, ulterior seaca, simptome cu debut brusc in urma cu 3sapt., dar care nu au raspuns decat partial al tratamentele antibiotice repetate, urmate ambulator.7biectiv - la internare2 starea generala nemodificata, tegumente palide8 p'()onar 2 torace normconformat, )( inasprit, fara raluri

&adiografia pulmonara -nu evidentiaza leziuni active.%'. sputei pt. ! este repetat neg. la ), ;- )! !act- in lucru

"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus. A urmat tratament antibiotic, A6=S, protector gastric. %volutia este favorabila dpdv clinic, insa persistasubfebrilitati matinale 3<;Se e'terneaza cu recomandarile2

@<n>9; :<3 3n2@;3<a>

r3n )9-a r?9;a;9 @9;9r3<r BJ BPOC STA4IUL IV GOL4 IN EACERBARE.

INSUFICIENTA RESPIRATORIE CRONICA ACUTIZATA.COR4 PULMONAR CRONIC COMPENSAT

BR4 COMPLET.

HTA STA4IUL II B CU RISC CAR4IOVASCULAR MO4ERAT.4IABET ZAHARAT TIP II ECHILIBRAT PRIN 4IETA.

HEPATITA CRONICA ACUTIZATA 4E ETIOLOGIE PROBABIL TOICA.

4ESHI4RATARE.

Analize de laborator:02.08.11 07:97 : Gran#=./ *10!"L Gran$=8.8 $ HCT=//.6 $ HGB=1'.8 (!)

L+,-#=1.1 *10!"L L+,-$=.8 $ MCH=6.1 -( MCHC='0. (!)

MCV=8/.% 2L M3)#=0.8 *10!"L M3)$=%./ $ MPV=8.% 2L PCT=0.1&' $

P45=1&.8 $ PLT=1%% *10!"L RBC=&.% 10*10!"L R45CV=1&.6 $ R45S4=/%.6 2 5BC=11.' *10!"L VSH 71=1% ,, VSH 7=/' ,, ALAT=/'

U!L ASAT=106 U!L B33r9:3na ;<;aa=0.8 ,(!) Cra;3n3na=1. ,(!) F<>2a;a?a

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a@a3na=1& U!L GGT=1 U!L G3@,3=10/ ,(!) L4H=&1 U!L Pr<;3n

;<;a=&.' ,(!) Ur=& ,(!)

'1.08.011 Sa;O= &%$1.0.011D >a;O= /6$D

.0.011D Sa;O= &$

'.0.011D Sa;O= 60$&.0.011Sa;O= 8%$

%!0.011D >a;O= 88$

10.0.011D Sa;;O= 0$

A+"R#) /1,.08.2011: P= %.'%D -CO=/8.8D HCO'= %.8 ,,<!D -O= 6/.6,,H(D >a;O=

1.$

R43 stand. )A 33 @<n(>;33 @9 @a@323@ar3D )>n 3n;r>;3;3a a@@n;9a; :3a;ra ,a3 a@@n;9a;

3n2ra3ar )r-;D ,9;3- <-a@3;a;3 n<)9ar >3 3nar )3>,3na; 3n a,:33 @a,-3 -9,<nar3.

)3R( )3>29n@;3 ,3;a >ra - ;<; ar:<r :r<n>3@. R)9@ra VEMS >9: 1 3;r9.

E!4 RS AV= 80 :a;a3! ,3n9;D BR4 ,aK<r.

C<n>9; n2r<<(3@ 7UPU )r Ina Ja@>< a;a>a; @<-3.

E)-!R-A:

Pa@3n; 3n ar>;a ) 6' an3 ,ar 29,a;<r a ->; 80 PA @9n<>@9; 3n an;@)n; @9 BPOC>r In>923@3n;a r-3ra;<r3 @r<n3@a BR4 ,aK<rHTA 4Z ;3- II >; -r9a; )3n UPU -n;r9

;ra;a,n; ) >-@3a3;a;. La 3n;rnara - >@;3 -a@3n;9 -r?n;a >;ar (nraa 3n29n;a;a

?3n( ;9> >a@a 3n3;3a 9;r3<r @9 -@;<ra;3 ,9@<-9r9n;a @an;3;a; ,<)ra;a)3>-n) r-a9> @9 <r;<-n a>;n3 an3;a; >3,-;<, a@r:a; 3n 9;3, ?3 an;r3<r

3n;rnar33. O:3@;3 a 3n;rnar -a@3n; a2:r3 @9 >;ar (nraa 3n29n;a;a ;(9,n; -a3)

9><r >3 ;ran>-3ra; @3an<?a -r3<raaD )n;a;3 -ar;3aa @9 ,9;3- 2<@ar )n;arD -9,<nar

;<ra@ a>;n3@ MV 3na>-r3; @9 -3r -r9n(3; :3a;ra ra9r3 r<n2an; >3 >3:3an; )3>,3na; 3na,:33 @a,-3 -9,<nar3 ra9r3 @r-3;an; )3>,3na; :a?a :3a;ra FR= '/ r>-3ra;3a! ,3n9;D

Sa;O= &6$D TA= 110!%0,,H(D AV= 1/ :a;a3! ,3n9;

B3<<(3@ >)r. 3n2a,a;<r ,<)ra; >)r ) -a;<@3;<3?a. Ra)3<(ra23a -9,<nara )>n3n;r>;3;3a a@@n;9a; :3a;ra ,a3 a@@n;9a; 3n2ra3ar )r-; ,9;3- <-a@3;a;3 3nar >3

n<)9ar )3>,3na; 3n @a,-3 -9,<nar3 33 @<n(>;33. PFR )3>29n@;3 ,3;a >ra - ;<;

ar:<r :r<n>3@ VEMS >9: 1 3;r9.In @9r>9 3n;rnar33 -a@3n;9 -r?3n;a a;rara >;ar33 (nra @9 >@a)ra ,ar@a;a a >a;9ra;33 3n

<3(n -ana a /6$ ,<;3 -n;r9 @ar -a@3n;9 >; ;r3,3> 3n >r3@39 UPU 9n) a 2<>;

@33:ra; 7n;3a;3 n<n 3na?3a CPAP>3 a9a; @9 a,3<rara >;ar33 (nra >3 a 29n@;33

r>-3ra;<r33. U;r3<r -a@3n;9 a 2<>; r)3r@;3<na; 3n >3@39 n<>;r9.In 9r,a aa,n?3 a a,n993 @3n3@ >3 - :a?a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 )

,a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@7A,<3-9> 2!?3HHC ,3<233n an;33n2a,a;<r an;3;r,3@an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@> >3 (a>;r3@ 3;a,3n >3 ) r@33:rar

3)r<@;r<3;3@a @9 <9;3 2a<ra:3a. S ;rna?a a,3<ra; @9 r@<,an)ar3

r(3, a3,n;ar 3-<><)a; 3-<(9@3)3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33 @9 @r>;ra ;r-;a;a a ;<ran;3 a 2<r;D


rn9n;ara a 29,a;D ;ra;a,n; ,)3a@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->!?3D

108

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CLENI ET &0 ,3@r<(ra, -92!?3D


>a 3:ra; R- @<,-n>a;a -; < 9na >r3a CSBE nr '06'1D @<n;3n9ara ;ra-33 @ar)3<<(3@ -r>@r3>a ) @a;r ,)3@9 >-@3a3>; @ar)3<<(D

<3(n<;ra-3 a )<,3@339 /6 3;r3! ,3n9;! 1 <r!?3

r3n a @<n;r< ->; 6 9n3 3n a:>n;a a@r:ar3<rD )3>-n>ar3?ar -r3n ,)@9 ) 2a,33.

A+"$ BR%&+-! )ER+-+"E&" $%ERA" &E!%&"R%*A" 3$. )RE%$.

"#+-A -& E=A!ERBARE -&3E!"-%A+A

4A+"R%#%E&-"A !R%&-!A

+R. '-)%A&AB%*-!

'-)ER!%*E+"ER%*E$-E

-&+#3. $-"RA*A #+%ARA-!! &>'A -

A&ER-+$ $-! E )ERE"E A"R-A*

-+!%)A"-E !ER-!%(%R+A*A


12.08.11 07:09 :

5BC=/.8 *10!"L L+,-#=* 1./ *10!"L M3)#=0./ *10!"L Gran#=' *10!"L L+,-$=.6 $ M3)$=%./ $ Gran$=6' $ HGB=1.% (!) RBC=/.'

10*10!"L HCT='8.6 $ MCV=8.& 2L MCH=.' -( MCHC='. (!)

R45CV=1'.& $ R45S4=/6. 2 PLT=0 *10!"L MPV=* %.% 2L P45=1&./ $ PCT=0.' $ VSH 71=% ,, VSH 7=0 ,, ALAT=1 U!L

ASAT=1& U!L B33r9:3na ;<;aa=0./ ,(!) Cra;3n3na=0.6 ,(!) F<>2a;a?a

a@a3na=' U!L GGT=8 U!L G3@,3=8' ,(!) Pr<;3n ;<;a=* 6. ,(!)

Ur='1 ,(!)

RGF stand. PA-desen interstitial accentuat bazal bilateral, hili fibrozati, ascensionati, cucalcificari.

PFR-<11- disfunctie obstructiva moderata segment central si in periferie. &educerea

(%)S cu 5+

Fibrobronhoscopie-- atasat copie

#P$%R$&A- !olnava in varsta de 3 ani, nefumatoare, cunoscuta cu gastroduodenita cr., insuf.mitrala usoara, suflu sistolic, anevrism mic de perete atrial, litiaza ren bilaterala, hidronefroza>, discopatie cervico-dorsala,astm bronsic iun. 11, aflata sub trat. cu !etalo4-zo4- in

doza mica, SGmbicort 1/,5, Lazul, Simvastatin, se interneaza pt. tuse, seaca persisitenta,dispnee paro'istica in A"" , subfebrilitati, astenie, scadere ponderala, transpiratii nocturne,simptome e'acerbate in ultimele sapt., in urma unei crize de dispnee paro'istica cu bronho-spasm. S-au administrat bronhodilatator/cortizonic inhalator si Singulair insa fara ameliorareasemnificativa a tusei.

7biectiv - la internare2 starea generala usor modificata, case'ie, p'()onar 2 torace astenic, )(inasprit, e'pir prelungit, rare raluri sibilante!iologic- sdr. inflamator usor, usoara hipoproteinemie

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&adiografia pulmonara -desen interstitial accentuat bazal bilateral, hili fibrozati, ascensionati,cu calcificari."#&-disfunctie obstructiva moderata segment central si in periferie. &educerea (%)S

cu 5+

Avand in vedere evolutia trenanta a tusei, se efectueaza fibrobronhoscopie, care nuevidnetiaza, insa modificari.

"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus. A urmat tratament antibiotic, antimicotic, antitermic, antialgic, antitusiv, rehidratere,bronhodilatator/cortizonic inhalator, protector hepatic, protector gastric, a continuat trat. pe careil urma ambulator, cu evolutie favorabila.Se e'terneaza cu recomandarile2

-continuarea trat. cu 2 <)bicort 1!0/=+5 2>1 p'88/;i ? 1 p'88 (a neoie in,'(air 1 tb/;i Bara@a >1 tb/;i 9;i(e-reevaluare cardiologica, gastroenterologica, continuare atratamentului, conform recomandarilormedicului specialist-control pneumologic peste 3 luni

TU BRONHOPULMONAR LSS T/N7'M0.BPOC MO4ERAT IN EACERBARE.

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULARINALT.ANEMIE SECUN4ARA.

4ESHI4RATARE.

STEATOZA HEPATICA.COLECTIE PERICARICA 7IN CANTIATE MICA.

COARTROZA BILATERALA.


08.08.11 07:0 : Gran#=1.& *10!"L Gran$=86.& $ HCT='& $ HGB=11.' (!)

L+,-#=1.' *10!"L L+,-$=.' $ MCH=8.8 -( MCHC='. (!)

MCV=8.' 2L M3)#=0.6 *10!"L M3)$=/. $ MPV=6. 2L PCT=0.8' $ P45=1&. $ PLT=/11 *10!"L RBC='. 10*10!"L R45CV=1'. $ R45

S4=/8.' 2 5BC=1/./ *10!"L VSH 71=6& ,, VSH 7=10 ,, ALAT=

U!L ASAT=/1 U!L B33r9:3na ;<;aa=0.6 ,(!) Cra;3n3na=0.% ,(!) F<>2a;a?aa@a3na=6 U!L GGT=/ U!L G3@,3=& ,(!) L4H=6% U!L Pr<;3n

;<;a=&.8 ,(!) Tr3(3@r3)=/% ,(!) Ur='1 ,(!)

08.08.11 08:, : Ta:<9 >an(3n=PMN = 86

EO =

110

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BA =

L = 10

MO = 4>@r3r H,a;33 3n 23>3@9r3.

R43 stand. )A)>n 3n;r>;3;3a a@@n;9a; :a?a :3a;ra 33 23:r<?a;3 @9 @a@323@ar3 <-a@3;a;

3n<,<(na 29 )3n3;a;a;a <@a3?a;a LSS.E!4: RS AV= 80 :a;a3! ,3n9; a RS a 1& (ra) 2ara ,<)323@ar3 3>@,<?3<na.

)3R/70861;0.08.2011: )3>29n@;3 n;3a;<r3 <:>;r9@;3a ,<)ra;a 3n >(n;9 -r32r3@.

!" toracic /1,.08.2011 dr 4uttman ":A;a>a; @<-3Ea,3nara a 2<>; 2@;9a;a 3n 3n@3)n; a3a @<r<na >3 >a(3;a.

R?9;a; F<-<r,a;39n ;9 ) 1610 @, @ar <@9-a -ra@;3@ 3n;r( LSS >3 )-a>>; -<>;r3<r

>@3?9ra <:3@a @9 3na?3a LIS 3ar @a9)a a 3n(93. F<r,a;39na > ;3n) ) a >n;9 @<>;<

r;:ra >3 ,)3a>;3n -ana a -r; ;<ra@3@ 2ara 3n;r>ara >;r9@;9r3<r <><a> a)3a@n;. Ar@<n;a@; >;ran> @9 ar;ra >9:@a3 >;an(a 3ar -<>;r3<r @9 ><2a(9 2ara a @<,-r3,a 3n@9) AP

>;an(a. Pr?3n;a 3n >;r9@;9ra >a @a@323@ar3 3-r)n> >-<n;an. A)n<-a;3 3n FAP ) 16

,,)3a,;r9 a)n<-a;3 -r@ar3naa ) 10 ,, )3a,;r9. N9 > @<n>;a;a a>-@; ) @<@;3

-9raa. C<@;3 -r3@ar)3@a @9 (r<>3, 3n(aa @ar >9:)3a2ra(,a;3@ ,a><ara 1' ,,. N9 >@<n>;a;a ,<)323@ar3 -ar3;a ;<ra@3@. F3@a;9 ar )3,n>39n3 @r>@9; aan) ,ar(3na 3n2r3<ara

a @ra>;a 33a@a 2ara ?39n3 2<@a. Gan) SR ) a>-@; n<r,a.C<n@9?3 TU LSS T/N7'M0. H-a;<,(a3. C<@;3 -r3@ar)3@a.

3ibrobron?oscopie/1992;0.08.2011 dr +imon $. a;a>a; @<-3

CV ,<:3 ;ra 3:ra -3n;n ;raa n<r,a. Ar:<r :r<n>3@ )r-; 3:r. BPS :r LIS3:r. C<,-r>39n ;r3n>@a :r. LSS a ,r(n;a -<>;r3<r. Pr<@> -r<32ra;3 3n23;ra;3

>;n<?an; :r LSS @9,n >(,n; a-3@<)<r>a. B3<->3.

Rezultat anatomo(patologic /27,7;08.08.2011 dr. a?arie ": ,a;r3a9 a,3na; >; 2<ar;

,@ >; n@r<;3@ >3 @<n;3n 9,:r n9@ar a 9nr @9 >9>-@; ,ar3 7-<>3:3 a 9n93@ar@3n<, n<n >,a @>. ,a;r3a9 >; -9?a;.

E)-!R-A:

Pa@3n; 3n ar>;a ) &% an3 2<a; 29,a;<r a /0 PA @9n<>@9; @9 an;@)n; -r><na -a;<<(3@

@ar)3<a>@9ar 7HTA>3 >;<ra;3@9ar 7Car;r<?a :3a;raa> -r?3n;a -n;r9 ,<)323@ara >;ar33(nra K9n(3 ;<ra@3@ -<>;r3<r ;9> @9 -@;<ra;3 ,9@<-9r9n;a ,<-;3?33 3n a@n;3a;

,3@a )3>-n a 2<r; ,)393na-;n;a >@a)r -<n)raa ;ran>-3ra;33 >3,-;<, a@r:a; 3n

9;3, >a-;a,an3 an;r3<r 3n;rnar33.O:3@;3 a 3n;rnar-a@3n; >9:-<n)ra a2:r3 @9 >;ara (nraa 3n29n;a;aD -9,<nar

;<ra@ a>;n3@ MV 3na>-r3; ra9r3 @r-3;an; :a?a :3a;raDTA= 1'0!80,,H( AV= 80

:a;a3!,3n.D -a;<,(a3.

B3<<(3@ >)r. 3n2a,a;<r79@<@3;<?a VSH ,9; a@@ra; >)r an,3@ FA >3 L4H @r>@9;. PFR)3>29n@;3 n;3a;<r3 <:>;r9@;3a ,<)ra;a 3n >(n;9 -r32r3@. Ra)3<(ra23a -9,<nara )>@r3

<-a@3;a; 3n<,<(na 29 )3n3;a;a;a <@a3?a;a LSS @a @ r3)3@a >9>-3@39na 9n93 -r@>

3n<@93;<r ) >-a;39D ,<;3 -n;r9 @ar > 3n)3@a 2@;9ara 9n3 23:r<:r<n<>@<-33 >3 a 9n93 CT;<ra@3@. F3:r<:r<n>@<-3a 2@;9a;a )>@r3 -r<@> -r<32ra;3 3n23;ra;3>;n<?an; :r LSS

@9,n >(,n; a-3@<)<r>a @<n23r,an) >9>-3@39na ) ;9 :r<n<-9,<nar. CT ;<ra@3@ 9

3)n;3a?a a n3 -9,<nar TU LSS T/N7'M0. C;9 ,a3 )>@r3 -a;<,(a3 >3 @<@;3 -r3@ar)3@a. R?9;a;9 ana;<,-a;<<(3@ )3n -3>a -9,<nar :3<->3a;a a FB 3)n;3a?a @ ,a3

-r<:a:3 9n @ar@3n<, n<n >,a @>.

In 9r,a ana,n?3 a a,n993 @3n3@ >3 - :a?a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 )

111

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,a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@ 7C3-r3n< 1 2!?3,>;a;3@ an;3;9>3 AINS an;3;r,3@

an;3a(3@ r3)ra;ar 3)r<@;r<3;@a r<:<ran; 3;a,3n -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ a@<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.


r(3, a3,n;ar @33:ra; @a<r3@D

a@@3nar an;3(r3-aa an9aaD ;ra;a,n; an;3a(3@ a n<3D

@<n;3n9ara ;ra;a,n;993 an;33-r;n>3D

-r?n;ara 3n >r3@39 IOCN C9K @<n2<r, 3n;(r33 @9 )<,n9 )r. U)ra A.

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.BPCO STA4IUL II GOL4 ACUTIZATCIC ANGINA PECTORALA 4E EFORT

PERICAR4ITA CRONICA FIBRINOASA

HTA IIC

ICC NHA IIIFIBROZA PULMONARA 4IFUZA POST TBC

TUMORA VEZICALA OPERATA IN OBSERVATIE

SIN4ROM 4E REFLU GASTROESOFAGIANSIN4ROM 4E COLESTAZA INTRAHEPATICA


0.08.11 08:92 :

Gran#=/ *10!"L Gran$=&/.& $ HCT=//.8 $ HGB=1/.6 (!) L+,-#=.%

*10!"L L+,-$='6./ $ MCH='0. -( MCHC='.& (!) MCV=' 2L M3)#=0.6 *10!"L M3)$=.1 $ MPV=8. 2L PCT=0.& $ P45=1&.% $

PLT='1% *10!"L RBC=/.8 10*10!"L R45CV=1/./ $ R45S4=/. 2 5BC=%.' *10!"L VSH 71=& ,, VSH 7=1 ,, ALAT=1/ U!L ASAT=1&U!L B33r9:3na ;<;aa=0.6 ,(!) Cra;3n3na=1 ,(!) F<>2a;a?a a@a3na=1/0 U!L

GGT=10 U!L G3@,3=1 ,(!) L4H='60 U!L Pr<;3n ;<;a=6./ ,(!)

Ur=/ ,(!) I)n;323@ara @9 ;r9> a; PCR=n(a;3

06.08.11 07:92 :

S-9;a Fr<;39 BAAR A=NEGATIV NR.REG./1&!06.0.011 S-9;a Fr<;39 BAAR

B=NEGATIV

06.08.11 07:9, :

S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a

Ea,n ,3@<<(3@=Can)3)a >-- 0UFC!-a@a S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@

M9@<3)A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 10!@a,-

C9 -3;3a >@9a,<a> 10!@a,-

F3:r3na -r?n; 2<ra :a@;r3ana -<3,<r2a 9r3 >3 32,3@3n

S@<r ) @a3;a; 1

06.08.11 07:9 :

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4;@;ara 9@<@3;<r 7P=-<?3;3 4;@;ara -r<;3n<r 7A=n( S)3,n; 9r3nar=6

8 9@<@3;!@ 101& ,a;33 @<<ra;!@ 2<ra ,3@r<:3ana

06.08.11 12:0 :

4;@;ara 3)ra;3<r ) @ar:<n 7Z=n(

PFR 7/18& CV=%0./$ FEV1=&0.8$ MMEF &!%&= 16.%$. O:>;r9@;3 ,)3 >(,n;,)3a >3 >ra 3n -r32r3. R)9@ra n;3a;33 ,a3, @9 &0$.

C<n>9; @ar)3<<(3@71&.0.011 In2ar@; ,3<@ar)3@ @3 Car)3<-a;3 3>@,3@a. An(3na -@;<raa ) 2<r;. BPCO. HTA IIC. Pr3@ar)3;a >r<23:r3n<a>a @. ICC. NHA III. R@

Ra,3-r3 & ,(!?3 439r @-r &0 ,(!1 @-r a ' ?3 N3;r<,3n; .6 ,(!?3 T<ra@ar)

7A;<ra>;a;3na 0 ,( >ara B3><(a,a & ,(!?3.

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&E% BR%&'%()#*$%&AR *+ ",&2$1

E". +E!#&ARE +#)RARE&A*E

AE&%!!. E !%*%& +"4. %)ERA"/!E*%+"%$-E/200 !'-$-%"RA"A"

$A+A "-+#*ARA +#B-A3RA4$A"-!A /5

'"AE !%&"R%*A"A $E-!A$E&"%+


19.08.11 08:00 :

5BC=* 11.6 *10!"L L+,-#=* 1.1 *10!"L M3)#=0.% *10!"L Gran#=* .8

*10!"L L+,-$=* .1 $ M3)$=6 $ Gran$=* 8/. $ HGB=1/.8 (!)

RBC=&.'8 10*10!"L HCT=/6.' $ MCV=86. 2L MCH=%.& -( MCHC='1.(!) R45CV=* 1/.8 $ R45S4=/6.1 2 PLT=* /%& *10!"L MPV=* 8.1

2L P45=16 $ PCT=0.'8/ $ VSH 71='/ ,, VSH 7=%6 ,, ALAT=

U!L ASAT=10 U!L B33r9:3na )3r@;a=* 0.81 ,(!) B33r9:3na ;<;aa=* 1.& ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=* /0% U!L GGT=* & U!L G3@,3=%8

,(!) L4H=/01 U!L Pr<;3n ;<;a=8.8 ,(!) Ur=// ,(!)

RGF stand. PA-opacitate de intensitate costala, laterotoracic sup. dr., placata la pereteletoracic, cu diam. de apro'. 1cm., desen interstitial accentuat bazal bilateral, hili cucalcificari, aorta derulata %* toracic -Atasat copie

Fibrobronhoscopie- atasat copie-;( mobile, trahee libera, pintene traheal normal. Arbore bronsic

stg. liber, cu aspect bronsitic. "$, br. intermediara, L6$ libere. !r. LSS obstruata

aproape total prin proces proliferativ vegetant.Se recolteaza biopsie in lucru.

PFR-cooperare dificila, probe neinterpretabile

#P$%R$&A- !olnav in varsta de ani, nefumator , cunoscut cu 0TA , neo colon>, pt. care s-a efectuat chimioterapie, aflat sub trat. hipotensor !etalo4,"restarium, aspirina se interneaza in urma suspiciunii de neo br-pulmonar ridicata inurma unui control radiologic.La internare prezinta tuse, seaca trenanta, astenie, transpiratii predominant nocturne,

simptome e'acerbate in ultimele saptamani7biectiv - la internare2 starea generala usor modificata, degete hipocratice, p'()onar 2torace astenic, )( inasprit, bilateral!iologic- sdr. inflamator, sdr. infectios, usoara hiperbilirubinemie.&adiografia pulmonara -ridica suspiciunea de formatiune tu pulm.LS$, evidentiata siprin e'am. ;T toracic, iar #! confirma suspiciunea. Se recolteaza biopsie rezultat inlucru

114

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"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus. A urmat tratament antibiotic, antimicotic, antialgic, antiinflamator, a continuattrat.hipotensor pe care il urma ambulator, cu evolutie favorabila dpdv clinic.Se e'terneaza cu recomandarile2

;ra;. @9 Aelox 1tb;zi inca zile

r3n )9-a r?9;a;9 >;<-a;<<(3@ )3n :3<->3a n)<:r<n>3@ara9ar <n@<<(3@a ;ra;. ) >-@3a3;a;

@<n;. ;ra; 3-<;n><r @<n2<r, r@<,a)ar3<r ,)3@993 >-@. @ar)3<<(

)&E#$%)A"-E -&"ER+"-"-A*A -3#A 3-BR%A&"A

BR%&+-E!"A-- *+ B-*A"ERA* +- *-+

A+"$ BR%&+-! )ER+-+"E&" #+%R -& E=A!ERBARE -&3E!"-%A+A

)%*-$-%-"A +-&E $-%-"A'"A +". -- !%&"R%*A"A $E-!A$E&"%+

A&4%R -&+"AB-*

3-A )AR%=-+"-!A -& A))

-+ !%$)E&+A"A

-+*-)-E$-E $-="A

%BE-"A"E 4R.--


1,.08.11 07:6 : 5BC=&.6 *10!"L L+,-#=1.8 *10!"L M3)#=0./ *10!"L

Gran#='./ *10!"L L+,-$='' $ M3)$=%.1 $ Gran$=&. $ HGB=1'.8 (!)

RBC=/.&6 10*10!"L HCT=/1.' $ MCV=0.6 2L MCH='0. -( MCHC=''./(!) R45CV=1/./ $ R45S4=/6. 2 PLT=0/ *10!"L MPV=8. 2L

P45=1&.8 $ PCT=0.181 $ VSH 71= ,, VSH 7=& ,, ALAT=8 U!L

ASAT=16 U!L B33r9:3na ;<;aa=0.% ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a

a@a3na=186 U!L GGT=11 U!L G3@,3=* 6' ,(!) L4H=* &18 U!L Pr<;3n;<;a=* 6./ ,(!) Ur='0 ,(!)

@<a(9<(ra,a T 1% >@ INR 1/8 IP /%.6 $ APTT '/' >@. >9: 1!;:!?3 1!;:!?3 1!/;:!?3 7)3n ' 3n ' ?3

RGF stand. PA-desen interstitial moderat accentuat bazal bilateral, predom. bazal stg, hili cu calcificari.

;ord moderat marit.

%* toracic -Atasat copie

%onc(';ie- Fibro;a p'()onara di8';a bi(atera(a+ c8. arstei. se reco)anda contro( %*peste !-12 ('ni

PFR- !!=59/1.0".2011- disfunctie mi'ta, restrictie moderata, obstructie moderata segment central si

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periferic. &educerea (%)S cu 3+

3%O- atasat copie

#P$%R$&A- !olnava in varsta de 53 ani, nefumatoare, cunoscuta A0; de astm bronsic fiu, si A"" de

polimiozita sine polimiozita, pneumopatie interstitiala fibrozanta secundara, dgn. in urma cu cateva luni,

0TA gr. 66, angor instabil, 6(S, #iA paro'istica, dislipidemie mi'ta , aflata sub tratament cu "rednisontb/zi, Sintrom, 1/tb/zi, alteramtiv cu 1/ tb/zi, alternativ cu 1/ tb/zi, (erapamil, "renesa, (entolin- lanevoie ,se prezinta pentru reevaluare. La internare acuza modificarea usoara starii generale, tuse cue'pectoratie mucoasa cant. mica, dispnee la efort mediu si paro'istica, astenie, simptome e'acerbate inultimele saptamani anterior internarii.7biectiv - la internare2 starea generala usor modificata8 p'()onar 2 torace voluminos, )( inasprit bazalbilateral, rare raluri sibilante.!iologic- usoara hipoproteinemie, L$0- val la limita&adiografia pulmonara -desen interstitial moderat accentuat bazal bilateral, predom. bazal stg, hili cucalcificari. ;ord moderat marit.

;T toracic- releva, ca si radiografia, reducerea importanta a leziunilor comparativ cu e'aminarileprecedente martie 11, inclusiv ameliorarea semnificativa a aspectului deHsticla mataH.$L;7 -evidentiaza reducerea usoara a difuziei prin membrana alveolo-capilara, proba fiind multameliorata fata de e'aminarea din martie 11.

"#&- disfunctie mi'ta, restrictie moderata, obstructie moderata segment central si in periferie.&educerea (%)S cu 3+

"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus. A urmat tratament antibiotic, antimicotic, antitusiv, A6=S, antitermic, bronhodilatator/cortizonic inhalator, acontinuat trat. pe care il urma ambulator, cu evolutie favorabila.Se e'terneaza cu recomandarile2

;ra;. @9 +eretide 0;100 2x1 puff;zi

entolin 2 puff la neoie

@<n>9; ra9ara @ar)3<<(3@a r9,a;<<(3@a @a<n;3n9ara ;ra;. @<n2<r, r@<,an)ar3<r @<n>9; -n9,<<(3@ ->; < 9na

T: !&7=07":L)7=A&A L6S A$%=7;A&;6=7)."L%:&%@6% S%;:=$A&A STA=DA


1.08.11 10:9, : S@r. -a(a C9;9r3 ar<:=S;a23<@<@ @<a(9a?< n(a;3 S@r. -a(a Ea,n ,3@<<(3@=N9 >a9 )?<;a; 29n(3. S@r. -a(a Fr<;39 Gra,=);r3;9>9r3 @9ar

@<@3 (ra, -<?3;33

21.08.11 12:97 :

An;3:3<(ra,a ar<:3=

1. AMIJACIN 7P3ra,3 R . CEFIIM 7E23@2 . AMPICILINA 7O,n3-rn P<3@33n '. IMIPENEM 7T3na,

'. AMPICILINA SULBACTAM 7Una>+n R /. JANAMICINA7Jana,+@3n R

/. AMOICILINA AC. CLAVULANIC 7A9(,n;3n &. LINEZOLI4

&. BISEPTOL 7Ta(r,3n R 6. LINCOMICINA 7L3n@<@3n6. COLISTIN 7C<3,+@3n %. MEROPENEM 7Mr<n,

116

7/24/2019 69625104-epicrize


%. CIPROFLOACIN 7C3-r3n<E9@3-r3n 3 8. NALI4IIC ACI4

7N(ra,

8. CLARITROMICINA 7Ja@3) R . NITROFURANTOIN 7Ma@r<)an;3n

. CLORAMFENICOL 7Br3@;3n S '0. NORFLOACIN

7N<3@3n10. CEFACLOR 7C@<r '1. OFLOACINA

7Tar33)

11.CEFOPERAZONASULBACTAM 7 S9-ra?<na '. OACILINA7Pr<>;a-+n R

1.CEFOTAIM 7Ca2<ran ''. PENICILINA 7Pn3@33na G

R

1'.CEFTAZI4IM 7F<r;9, '/.PIPERACILINATAZOBACTAM 7Ta?<@3n

1/.CEFTRIAON 7R<@-3n '&. TETRACICLINA

7A@r<,3@3n

1&.CEFUROIM 7Z3na@2J29r< '6. TOBRAMICINA 7N:9@3nR

16.ERITROMICINA 7Er+;r<@3n '%.TICARCILINACLAVULANIC 7T3,n;3n

1%.GENTAMICINA 7Gn;a,+@3n R '8. VANCOMICINA

7L3)3@3n S18.4OICICLINA R '. MOIFLOACINA

S

1.AZTREONAM /0.CLIN4AMICINA R

0.CEFTIBUTEN /1.CEFOITIN R 1.TICARCILINA /.LEVOFLOACINA

/'.CEFEPIM

R?9;a; >9n; -r3,a; @a3;a;3 3n ,, ?<na ) 3n3:3;3 >a9 @an;3;a;3 CMI (! S= >n>3:3D I= 3n;r,a)3arD R= r?3>;n;D N=N3n;r-r;a:3D C<n;a,3na;D

Rezultat anatomopatologic /27,2;08.08.2011: 2ra(,n; ) -r; :r<n>3@ a,3n;a;

-r?3n;a 3n >;r<,a 23:r<@<nK9n@;3a >;r9@;9r3 (an)9ar a 9n93 a)n<@ar@3n<, 7-<>3:3 :r<n>3<<a<ar.

S@;39n3 >r3a; @<n23r,a a)n<@ar@3n<,9.

E)-!R-APa@3n;a 3n ar>;a ) 61 an3 r@n; ;rna;a ) - >@;3a C3r9r(3 ;<ra@3@a 9n) a 2<>;

3n;rna;a -n;r9 2@;9ara 9n93 -9r<)? > r3n;rna?a - >@;3a n<a>;ra -n;r9 ,<-;3?33

,3@3 >3 r-;a; ,<)323@ara >;ar33 (nra ;9> @9 -@;<ra;3 ,3n3,a ,9@<-9r9n;a )3>-na 2<r; ,3@3;ran>-3ra;33 -r)<,3nn; n<@;9rn )9rr3 ;<ra@3@.

O:3@;3 a 3n;rnar-a@3n;a a2:r3a @9 >;ara (nraa 3n29n;a;a ;(9,n; D -9,<nar

MV 3na>-r3; @9 -3r -r9n(3; 3n ,3;<ra@ )r-; >3 MV ,9; )3,3n9a; 3n ,3;<ra@ >;an(ra9r3 @r-3;an; :a?a )r-; TA= 1'0!%0,,H( AV= %6 :a;a3! ,3n9;.B3<<(3@ >)r. 3n2a,a;<r

7VSH a@@ra;


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A 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ -@;<ran;-r<;@;<r -a;3@ -r<;@;<r

(a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.


;ra;a,n; @9 an;3a(3@ a n<3D

-r?n;ara a IOCN C9K @<n2<r, -r<(ra,ar33 7 )r U)ra A.

E4EM PULMONAR ACUT.PNEUMONIE INTERSTITIALA

INSUFICIENTA RESPIRATORIE CRONICA ACUTIZATA

BPOC ST4 III CU EACERBARE

BRS MAOR INSUFICIENTA CAR4IACA CONGESTIVA NHA III

HIPERTENSIUNE ARTERIALA SECUN4ARA CEL MAI PRBABIL 4E CAUZA RENALA.

CAR4IOMIOPATIE 4ILATATIVA.F3A CU AV INALTA.

RINICHI STANG SCLEROTIC.

COR4 PULMONAR CRONIC


0.08.11 08:91 :Gran#=8 *10!"L Gran$=%%.6 $ HCT='./ $ HGB=1' (!)

L+,-#=1.6 *10!"L L+,-$=1&. $ MCH=8.8 -( MCHC='. (!)

MCV=8%.& 2L M3)#=0.% *10!"L M3)$=6.& $ MPV=%./ 2L PCT=0.1 $ P45=1&.8 $ PLT=60 *10!"L RBC=/.&1 10*10!"L R45CV=1& $ R45

S4=/8.' 2 5BC=10.' *10!"L VSH 71=10% ,, VSH 7=11/ ,,

ALAT=18 U!L ASAT=1 U!L B33r9:3na ;<;aa=0.8 ,(!) C<>;r<=1' ,(!)

Cra;3n3na=1.% ,(!) F<>2a;a?a a@a3na=01 U!L GGT='0 U!L G3@,3=/ ,(!) L4H=8/ U!L Pr<;3n ;<;a=6.8 ,(!) Tr3(3@r3)=6& ,(!) Ur=6/ ,(!)

E<4 R> AV=0:!,3nD ,<)323@ar3 3>@,3@ )329?.

Rx )A In;r>;3;39 -9,<nar a@@n;9a; :3a;ra. O-a@3;a;3 n<)9ar >3 3nar 3n23;ra;3 3n 1!'

3n2r3<ara a a,:3<r @a,-3 -9,<nar3.

)3R/70877. 0.08.2011: )3>23n@;3 n;3a;<r3 ,3;a >ra 3n ;<; ar:<r :r<,n>3@. VEMS 1 3;r9.

E)-!R-A:

Pa@3n; 3n ar>;a ) %& ) an3 @9n><@9; @9 BPOC >;) III 3n>923@3n;a r>-3ra;<r3 @r<n3@a

@ar)3<-a;3 3>@,3@a an(3na -@;<raa ) 2<r; ICC NHA III BR4 ,aK<r HTAE >;) III!CCPC 3n2ar@; ,3<@ar)3@ @3 > -r?3n;a -n;r9 )3>-n a 2<r;9r3 ,3@3 ;9> @9 -@;<ra;3

,9@<-9r9n;a 3n a@n;3a; ,3@a >@a)ra ;<ran;3 a 2<r; a>;n<a)3na,3 2a;3(a:33;a;3na-;n;a >3,-;<, @ >a9 3n>;aa; 3n 9r,a @9 ?3. Pa@3n;9 >a -r?n;a; 3n >r3@39 UPU9n) a 2<>; a9a; >3 @33:ra; 233n) 9;r3<r ;r3,3> a C3n3@a ) Pn9,<<(3 3n )ra

>;a:33r33 ;ra-33 ) >-@3a3;a;.

O:3@;3a 3n;rnar -a@3n; a2:r3>9-ra-<n)ra (r9 @<<-ran;D >;ar (nraa 3n29n;a;aD2a@3> an3<>D ;(9,n; -a3) 9>@a;D -9,<nar ;<ra@ ,23?,a;<> MV 3n>-r3; @9 -3r

-r9n(3; ra9r3 r<n2an; )3>,3na; 3n a,:33 @a,-3 -9,<nar3 ra9r3 @r-3;an; :a?a :3a;ra

Sa; O 0 $D TA=160!0,,H( AV=80:!,3n.

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B3<9,<ra >)r 3n2a,a;<r 79@<@3;<?a ,<)ra;a VSH a@@ra;D 9><ara r;n;3 a?<;a;a.

R PA In;r>;3;39 -9,<nar a@@n;9a; :3a;ra. O-a@3;a;3 n<)9ar >3 3nar 3n23;ra;3 3n 1!'

3n2r3<ara a a,:3<r @a,-3 -9,<nar3.PFR )3>23n@;3 n;3a;<r3 ,3;a >ra 3n ;<; ar:<r :r<,n>3@D VEMS 1 3;r9.

P :a?a a,n993 @3n3@ ra)3<<(3@ >3 ) a:<ra;<r > >9>;3n )3a(n<>;3@9 ) ,a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@ 7C3-r3n<12!?3 HHC an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ >3 ) r@33:rar 3)r<@;r<3;3@a a

@<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r.

P -ar@9r>9 3n;rnar3373n )3,3a;a ?3 ) 1%.0.011 -a@3n;9 a -r?n;a; 9n -9>93-r;n>3TA= 0!1'0,,H( AV= 1'0:a;a3! ,3n9; 3n><;3; ) )3>-n -ar<3>;3@a ;ran>-3ra;33.

P9>9 3-r;n>3 n9 a r,3> a a),3n3>;rara ) )39r;3@ n3;r<(3@r3na >9:3n(9a IECA

<3(n<;ra-3. S;ara (nraa a -a@3n;993 >a a(raa; ,<;3 -n;r9 @ar > ><3@3;a >aara >3

>; ;r3,3> 3n UPU -n;r9 >;a:33?ar >3 r)3r@;3<nar >-r >r3@39 n2r<<(3.S ;rna?a @9 a(raa; @9 r@<,an)ar3

prezentarea in sericiul #)# pentru stabilizare si redirectionare in sericiul

nefrologie.

;ra;a,n; ,)3@a,n;<> @9 +eretide 0;20 2x1 puff;zi 6 luniC

+piria 1 micrograme 1 cps;zi

• entolin 100micrograme 2x1 puff;zi la neoie.

• @<n>9; @ar)3<<(3@ 3n )ra >;a:33r33 >@,3 ) ;ra;a,n;D n2r<<(3@D

• 3n;rn;3 @3r9r(3@aa 3n )ra n2r@;<,33.

•

%)A!-"A"E )#*$%&ARA BAA*A R. E E"-%*%4-E &E)RE!-A"A

&E%)*A+$ !%R) #"ER-& %)ERA" !'-$-%(RA-%"RA"A" /-#&-E 2010

-ABE" A'ARA" "-) -- !%&"R%*A" )R-& A%

• RGF stand. PA-opacitate deintensitate slaba , situata la niv. unghiului cardio-frenic dr. La incidenta

din profil, opacitatea pare asituata postero-cardiac inferior. ;alcificari hilare.

•

•

%* toracic -Atasat copie

•

• Fibrobronhoscopie- atasat copie

• -;( mobile, trahee libera, pintene traheal normal. Aspect endobronsic

normal, bilateral. #ara semne directe sau indirecte de proces proliferativ. S-a recolata aspiratbronsic pt. citologie, flora nespecifica in lucru

•

• #P$%R$&A- !olnava in varsta de > ani, nefumatoare, cunoscuta cu $@ sub trat. cu A$7

$iaprel, Siofor, cu neo de corp uterin operat in iunie 1, radio-chimiotratat ,se prezinta pentruinvestigarea unei opacitati pulmonare evidentiata in urma unei ;T toracice. !olnava acuza dureritoracice posterioare, predominent dr., fara alte acuze respiratorii.

• 7biectiv - la internare2 starea generala buna8 p'()onar 2 torace astenic, )( prezent, fara raluri.

• &adiografia pulmonara -evidentiaza o opacitate la niv. unghiului cost-frenic drep, f. greu vizibila,

dar ;T toracic-confirma prezenta acesteia atasat copie

• #ibrobronhoscopia - nu evidentaza modificari.

119

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• "t. confirmare histopatologica a formatiunii pulmonare e necesara interventia chirurgicala in scop

diagnostic si terapeutic programare telefonica- vineri- 3.*.11

•

• "e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

• A urmat tratament antibiotic,antialgic, a continuat trat. pe care il urma ambulator, cu evolutie

favorabila.

• Se e'terneaza cu recomandarile2

•

•

•

•

• @<n;3n9ara ;ra;. an;3:3<;3@ @9

Aelox 1 tb;zi inca zile

• @<n;3n9ar ;ra;. an;3)3a:;3@ @<n2<r, r@<,an)ar3<r

• -r?n;a; a >@;3a C3r9r(3 T<ra@3@a 3n )ra 3n;rn;33 @3r9r(3@a.

A+"$ BR%&+-! )ER+-+"E&" $%ERA" -& E=A!ERBARE -&3E!"-%A+A

"A'-!AR-E /5•


•

08.08.11 07:8 :

5BC=* 1&.% *10!"L L+,-#=.' *10!"L M3)#=1 *10!"L Gran#=* 1./

*10!"L L+,-$=* 1/. $ M3)$=6./ $ Gran$=* %8.% $ HGB=1'.6

(!) RBC=/.&1 10*10!"L HCT=/1.% $ MCV=.& 2L MCH='0.1 -( MCHC='.6 (!) R45CV=1'. $ R45S4=/6. 2 PLT=8

*10!"L MPV=* 8. 2L P45=1&.& $ PCT=0.186 $ VSH 71=1/

,, VSH 7='6 ,, ALAT=' U!L ASAT= U!L B33r9:3na ;<;aa=0.6

,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=108 U!L G3@,3=88 ,(!) L4H=* /&& U!L Pr<;3n ;<;a=* 6 ,(!) Ur='1 ,(!)

•

08.08.11 08:28 :

• S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ M9@<-9r9n; A>-@;

,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,- ,a@r<2a(

C9 -3;3a >@9a,<a> 10&!@a,- F3:r3na -r?n; / @<@3 (ra, -<?3;33!@a,-S@<r ) @a3;a; S-9;aC9;3ar :a@;r33

ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a Ea,n

,3@<<(3@=Can)3)a >-- 1' UFC!-a@a

•

• RGF stand. PA-desen interstitial accentuat infrahilar bilateral, hili cu calcificari.

•

• PFR- <1*</15.*.11 - normale dupa iesirea din criza

•

• *este a(er,o(o,ice- slab poz. la dermatophagoides

•

120

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• Para). Astr'p- >.*.11- p;7- 3*.3 mm0g, p7- mm0g, 7sat-

*,<+

•

• #P$%R$&A-

• !olnava in varsta de 3* ani, fumatoare <-1 "A, cunoscuta cu A0; de astm

bronsic fiica, fara A"" semnificative, se interneaza de urgenta pt.dispneeparo'istica, cu ortopnee, 9eezing, tuse predom. seaca, uneori cu e'pectoratiemuco-purulenta, cant. mica, astenie, simptome cu debut acut in urma cu o zi .!olnava afirma prezenta unor episoade de dispnee paro'istica de intensitatemoderata in A"", la contact cu polen, prezente doar de apro'. luni, in urmaunei infectii respiratorii acute.

•

• 7biectiv - la internare2 starea generala modificata, transpiratii , zgomote

cardiace ritmice, tahicardice8 p'()onar 2 dispnee cu ortopnee, )( inaspritbilateral, e'pir prelungit, raluri crepitante, sibilante, ronflante bilateral.

• Sat 7- in criza- >>+

• !iologic- sdr. inflamator, sdr. infectios, hipoproteinemie usoara

• &adiografia pulmonara -desen interstitial accentuat infrahilar bilateral, hili cu

calcificari.

•

• "e baza datelor clinice si paraclinice s-a stabilit diagnosticul de astm bronsic in

criza, s-au administrat bronhodilatatoare, 00;, 7-terapie cu evolutie favorabilasi remiterea crizei. "e parcursul internarii a urmat tratament antibiotic,antimicotic, antitusiv, 00;, bronhodilatator/cortizonic inhalator, protector hepatic,antiaritmic. A( s-a mentinut la val. mai ridicate pe tot parcursul internarii *-1/min.

• Se e'terneaza cu recomandarile2•

•

•

• -control cardiologic tahicardie F, trat. conform recomandarilor

•

-tratament cu 2 BO%OR* 1!0/=+5 21 p'88/;i 1 p'88 (a neoie

$NG3A$R 10 1tb/;i+ seara

•

• -control pneumologic peste 3 luni, cu bilet de trimitere de la medicul de familie si

dovada de asigurat•

• S-a eliberat reteta compensate seria ;S!% nr. *><

•

•

"#$%RA BR%&'%()#*$%&ARA R. ",&2$1

E"ER$-&ARE +E!#&ARA )#*$%&ARA *-

121

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B)%! A!#"-A"A +". --- 4%*

E$3-E$ B#*%+ B-*A"ERA*

+R. '-)%A&AB%*-!

• A&E$-E !R. +-$)*A $%ERA"A


12.08.11 07:02 :

• 5BC=8.8 *10!"L L+,-#=* 1.1 *10!"L M3)#=0./ *10!"L Gran#=%.'

*10!"L L+,-$=* 1.& $ M3)$=&.1 $ Gran$=* 8./ $ HGB=* 10./(!) RBC=* /.'8 10*10!"L HCT=* ''./ $ MCV=* %6.' 2L MCH=*

'.% -( MCHC=* '1.1 (!) R45CV=* 1&.& $ R45S4=//.% 2

PLT='8% *10!"L MPV=* %. 2L P45=1&. $ PCT=0.%8 $ Ta:<9

>an(3n=PMN = %8EO = BA = L = 16MO = /4>@r3r An3?<@3;<?a n<r,<,3@r<@3;ara.H3-<@r<,3.H,a;33 3n 23>3@9r3. VSH 71=/% ,, VSH 7=0 ,,

ALAT=& U!L ASAT= U!L B33r9:3na ;<;aa=0./ ,(!) Cra;3n3na=0.%

,(!) F<>2a;a?a a@a3na=8 U!L GGT=* %8 U!L G3@,3=8% ,(!) Pr<;3n ;<;a=* &./ ,(!) Ur=6 ,(!)

• RGF stand. PA-opacitate masiva, de intensitate costala ocupand /3 din suprafata

hemitoracelui stg., realizand tractionarea mediastinului spre stg., opacitate deintensitate costala, laterobazal dr., cu diam. de1cm., bine delimitata.

• #%G- %'trasistole supraventriculare, 6ncarcare ($.

• Fibrobronhoscopie- atasat copie

• -

• PFR- disfunctie mi'ta, restrictie moderata, obstructie severa pe tot arborle

bronsic. &educerea (%)S cu 5*+•

#P$%R$&A- !olnav in varsta de ani, mare fumator > "A, fost lucrator in

mediu to'ic, cunoscut cu !"7; de 3 ani, neo br-pulmonar din febr. 11 darneconfirmat 0" tumora fiind inabordabila endobronsic sau transtoracic, iarinterventia chirurgicala a fost temporizata de catre bolnav, aflat sub trat. cuSeretide, Teotard, se interneaza pt. modificarea starii generale, tuse,e'pectoratie muco-purulenta, cant. medie, dispnee la efort mic, subfebrilitati,astenie, inapetenta, scadere ponderala, transpiratii nocturne, unghi toracicintermitent bazal stg, simptome e'acerbate in ultimele saptamani.

• Obiecti - la internare2 starea generala mediu modificata,hipoponderal, degete

hipocratice, tegumente palide, zg. cardiace tahicardice A( >>/min., pulmonar2torace astenic, )( inasprit, bazal bilateral, raluri crepitante bazal bilateral

• !iologic- sdr. inflamator, sdr. anemic, moderat, DDT- val crescute,

hipoproteinemie• &adiografia pulmonara - ridica suspiciunea de proc. proliferativ stg. cu

atelectazie si tractionare si mediastinului spre dr. si determinare secundara la niv.L6$

• #ibrobronhoscopia - confirma diagnosticul, se recolateaza biopsie in lucru

• "#&- disfunctie mi'ta, restrictie moderata, obstructie severa pe tot arborle

bronsic. &educerea (%)S cu 5*+

122

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•

• "e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

• A urmat tratament antibiotic, antimicotic, 00;, antialgic, rehidratare, vitamine,

e'pectorant, bronhodilatator/cortizonic inhalator, protector hepatic, protectorgastric, a continuat trat. pe care il urma ambulator, cu evolutie favorabila.

• Se e'terneaza cu recomandarile2•

• -tratament cu 2

•

#R#*$# 50/250 2>1 p'88/;i

#N*O3$N 2p'88 (a neoie

P$R$A 1cps/;i

•

•

• -revine dupa rezultatul histopatologic al biopsiei endobronsice

• -prezentarea la 67;= pt. tratament de specialitate•

• -reevaluare cardiologica, continuarea tratamentului recomandat de catre medicul

specialist

•

• -control pneumologic peste 3 luni, cu bilet de trimitere de la medicul de familie si

dovada de asigurat cupon de pensie din ultimele 3 luni calendaristice

•

•

B)%! A!#"-A"A +". -- 4%*

+-*-!%A )#*$%&ARA 3%R$A )+#%"#$%RA*A

3-BR%A )#*$%&ARA )%+" "B. E="-&+A B-*A"ERA*

• $-!A !%*E!"-E )*E#RA*A B-*A"ERA*


•

12.08.11 07:01 :

• 5BC=%.% *10!"L L+,-#=1.6 *10!"L M3)#=0.% *10!"L Gran#=&./

*10!"L L+,-$=0. $ M3)$=8.& $ Gran$=%0.6 $ HGB=* 1'.% (!)

RBC=/.%6 10*10!"L HCT=* /0.8 $ MCV=8&. 2L MCH=8.% -( MCHC=''.& (!) R45CV=1/. $ R45S4=//.% 2 PLT=/0 *10!"L

MPV=* %.1 2L P45=1&. $ PCT=0.8& $ VSH 71=1& ,, VSH7=/' ,, ALAT=1/ U!L ASAT='0 U!L B33r9:3na ;<;aa=0. ,(!) Cra;3n3na=0.% ,(!) F<>2a;a?a a@a3na=1 U!L GGT=1% U!L G3@,3=8

,(!) Pr<;3n ;<;a=%.% ,(!) Ur=' ,(!)

•

• RGF stand. PA-opacitati de intensitate costala, diseminate bilateral, cu tendinta la

confluare, realizand pe alocuri, placarde. (oalarea sinusului costo-diafragmatic stg.aspectul nu difera in mod semnificativ fata de e'aminari anterioare. * .0ili

123

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fibrozati,mariti, cu calcificari.

•

• %* toracic -Atasat copie

•

Fibrobronhoscopie- atasat copie

• -;( mobile, trahee libera, pintene traheal normal. Aspectbronsitic difuz bilateral. bronsie supranumerala la niv. LSS. #ara semne directesau indirecte de proces proliferativ.

•

• PFR 5=15=- disfunctie ventilatorie mi'ta, restrictie moderata, obstructie

moderata segment central si severa in periferie. &educerea (%)S cu 3+

•

•

• #P$%R$&A- !olnav in varsta de 53 ani, fost fumator 3 "A, fost lucrator in mediu

to'ic, cunoscut cu cu T!; pulmonar in , recidiva in 5, silicoza

pulmonara din 1**>, !"7;, aflat sub trat. cu Spiriva, se interneaza pt. tuse,e'pectoratie muco-purulenta, cant. redusa, dispnee la efort mediu/mare, astenie,transpiratii nocturne, simptome e'acerbate in ultimele saptamani.

• !olnavul a efectuat o ;T toracica in urma cu cateva zile care ridica suspiciunea

de proc. proliferativ br-pulmonar hilar stg.

• La e'amenul obiectiv, la internare- st. generala usor modificata-p'()onar

2torace astenic, murmur vezicular inasprit, e'pir prelungit, rare raluri sibilante.

• !iologic- minim sindrom inflamator nespecific,

&adiografia pulmonara evidentiaza opacitati reticulonodulare diseminate

bilateral, realizand placarde. Aspectul radiologic nu difera fata de e'aminari ,repetate, anterioare. Avand in vedere suspiciunea ridicata in urma e'am.;Ttoracica, se efectueaza #!- care nu evidentiaza semne directe sau indirecte deproc proliferativ. Se solicita revizuirea e'am. ;T toracica si compararea cu e'am.;T precedenta, efectuata in *, si , intrucat aspectul opacitatii hilare estesimilar, se considera f. probabil ca acesta sa corespunda unor modificaripsudotumorale silicotice8 se recomanda control in timp.

•

• 6n cursul spitalizarii a urmat tratament antibiotic, antimicotic, 00;, antiinflamator,

protectoe hepatic, e'pectorant cu evolutie favorabila si remitereasimptomatologiei .

• "e baza datelor clinice si paraclinice se stabileste diagnosticul de mai sus. Se

e'terneaza ameliorat cu recomandarile2•

Reco)andari:

• - evitarea frigului, a intemperiilor, a intercurentelor respiratorii, fumatului.

• - tratament medicamentos cu

P$R$A 1 cps/;i

- ento(in 2 p'88-'ri (a neoie

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• - control pneumologic peste 3 luni

•

•

•

• BRONHOPNEUMONIE ATIPICA RECI4IVANTA

• BPCO ACUTIZAT STA4IUL II GOL4• FIBROZA PULMONARA INCIPIENTA

• CPC STA4IUL II

• HTA STA4IUL IIB

• CIC CAR4IOPATIE HIPERTENSIVA

• SIN4ROM 4E REFLU GASTROINTESTINAL

• RINOSINUZITA ALERGICA PERSISTENTA

•


•

90.0.11 08:9, :

• Gran#=1'.% *10!"L Gran$=0 $ HCT=/.& $ HGB=16. (!) L+,-#=0.8 *10!"L L+,-$=&./ $ MCH='1.' -( MCHC='.% (!) MCV=6.1 2L M3)#=0.% *10!"L M3)$=/.6 $ MPV=8.& 2L PCT=0.1&

$ P45=1&. $ PLT='0 *10!"L RBC=&.16 10*10!"L R45CV=1&

$ R45S4=&.1 2 5BC=1&. *10!"L VSH 71=' ,, VSH 7=6/,, ALAT=8 U!L ASAT=8 U!L B33r9:3na ;<;aa=1.' ,(!)

Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na=1/ U!L G3@,3=101 ,(!)

L4H=1'% U!L Pr<;3n ;<;a=%.1 ,(!) Ur='1 ,(!) I)n;323@ara @9 ;r9>

a; PCR=->; /8 ,(!

90.0.11 11:17 :

• B33r9:3na )3r@;a=0.8 ,(!)

0.08.11 08:21 :

• S-9;a Fr<;39 BAAR A=NEGATIV NR.REG./1/!06.0.011

0.08.11 08:97 :


06.08.11 07:96 :

• S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a

Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ M9@<-9r9n;

• A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 10!@a,-

• C9 -3;3a >@9a,<a> 10&!@a,- ,a@r<2a(

• F3:r3na -r?n; 2<ra :a@;r3ana -<3,<r2a

• S@<r ) @a3;a;

07.08.11 08:10 :

• Gran#=6.6 *10!"L Gran$=%/.6 $ HCT=// $ HGB=1/.1 (!)

L+,-#=1.6 *10!"L L+,-$=18 $ MCH='1. -( MCHC=' (!) MCV=%.6 2L M3)#=0.6 *10!"L M3)$=%./ $ MPV=8./ 2L PCT=0.186

$ P45=16.1 $ PLT= *10!"L RBC=/.&1 10*10!"L R45

125

7/24/2019 69625104-epicrize


CV=1&.6 $ R45S4=&'.6 2 5BC=8.8 *10!"L I)n;323@ara @9 ;r9> a;

PCR=n(a;3

07.08.11 11:0, :


•

• PFR%08% 43>29n@;3 n;3a;<r3 <:>;r9@;3 ,3;a >ra @an;3;a;3a >3 [email protected],a r)9> @9 &$.

•

• ECG RS 100!,3n P -9,<nar BR4 ,3n<r 3n@ar@ar :3n;r3@9ara 3>@, 3n2r<

a;raa.

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

•

126

7/24/2019 69625104-epicrize


•

•

•

•

•

• TU BRONHOPULMONAR LIS 7CARCINOM SCUAMOS NEJERATINIZAT.

• BPOC MO4ERAT IN EACERBARE.

• ANEMIE SECUN4ARA.•


• 1,.08.11 07:1, : Gran#='. *10!"L Gran$=%8.8 $ HCT='1./ $ HGB=10

(!) L+,-#=0.8 *10!"L L+,-$=1&.& $ MCH=& -( MCHC='1.8

(!) MCV=%8.6 2L M3)#=0. *10!"L M3)$=&.% $ MPV=. 2L PCT=0.1&% $ P45=16.6 $ PLT=1%1 *10!"L RBC=/ 10*10!"L R45

CV=1/.% $ R45S4=/'.1 2 5BC=/. *10!"L VSH 71=&% ,, VSH

7=8 ,, ALAT=1& U!L ASAT=1 U!L B33r9:3na ;<;aa=0.& ,(!) C<>;r<=180 ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na='& U!L

GGT=// U!L G3@,3=8' ,(!) L4H=/% U!L Pr<;3n ;<;a=6.1

,(!) Ur=&/ ,(!)

• 1,.08.11 10:0, : Ta:<9 >an(3n=PMN = %

• EO = 1/

• BA =

• L = 1

• MO =

• 4>@r3r M3@r<@3; 3-<@r<,.H,a;33 3n 23>3@9r3.

•

• R43 stand. )A)>n 3n;r>;3;3a a@@n;9a; :a?a :3a;ra 33 23:r<?a;3 a>@n>3<na;3 @9

@a@323@ar3 <-a@3;a; 3ara >;an(a 29 )3,3;a;a ra;3 <,<(na.

• )3R/710,9;19.08.2011: )329n@;3 n;3a;<r3 <:>;r9@;3a ,<)ra;a 3n ;<; ar:<r :r<n>3@a.

R)9@ra VEMS @9 %$.

• !" toracic/2,.0.2011 +tanescu 4. A;a>a; @<-3

• 3ibrobron?oscopie /19,6;19.08.2011 dr +imon $. a;a>a; @<-3

• CV ,<:3 ;ra 3:ra -3n;n ;raa ar(3; >-r >;an(a. Ar:<r :r<n>3@ )r-;

3:ra. C<,-r>39n ;r3n>@a >3 3n23;ra;3 ) ,9@<a>a n<-a?3@a BPS ,)3a >3

an;r3<r. Pr<@> -r<32ra;3 3n23;ra;3 >;n<?an; :r LIS @9 >;n<?a a-r<a- @<,-;a.P3n;n 3n;r<:ar >;( ar(3; 3n23;ra;. B<->3.

• Rezultat anatomopatologic /266;1.08.2011 dr a?arie ".: @ar@3n<, >@9a,<>

nra;3n3?a; @9 a;3-33 ,ar@a;.

•

• E)-!R-A

• Pa@3n; 3n ar>;a ) 60 an3 2<>; 29,a;<r a ->; '0 PA 2ara an;@)n; -r><na

-a;<<(3@ >,n323@a;3 > 3n;rna?a -n;r9 ;9> 3n3;3a 3r3;a;3a 9;r3<r @9 -@;<ra;3

,9@<a>a ,<-;3?33 3n @an;3a; ,3@a >@a)r -<n)raa )3>-n a 2<r; ,)39 a>;n<

127

7/24/2019 69625104-epicrize


a)3na,3 2a;3(a:33;a; >@a)ra ;<ran;3 a 2<r; )9rr3 ;<ra@3@ -<>;r3<ar )

3n;n>3;a; @r>@9;a >3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r 3n;rnar33.

• O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; >3 ,9@<a> -a3)D

-9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;ra TA=

1'0!%0,,H( AV= % :a;a3! ,3n9;D a:)<,3na >n>3:33;a; )9rr<a>a a -a-ara

-r<29n)a 3n 3-<@<n)r9 )r-;.• B3<<(3@ >)r. 3n2a,a;<r 7VSH a@@ra; >)r an,3@ L4H 9><r @r>@9;. PFR )329n@;3

n;3a;<r3 <:>;r9@;3a ,<)ra;a 3n ;<; ar:<r :r<n>3@a. r)9@ra VEMS @9 %$.

Ra)3<(ra23a -9,<nara 3)n;3a?a <-a@3;a; 3ara >;an(a 29 )3,3;a;a ra;3

<,<(na @ r3)3@a >9>-3@39na 9n93 -r<@> -r<32ra;3 a a@>; n3 ,<;3 -n;r9 @ar> 3n)3@a 2@;9ara 9n93 CT ;<ra@3@ >3 a 9n3 23:r<:r<n<>@<-33. CT 9 ;<ra@3@ @<n23r,a

>9>-3@39na ) ;9 :r<n<-9,<nar. F3:r<:r<n<>@<-3a )>@r3 -r@> -r<32ra;3

3n23;ra;3 >;n?an; :r LIS @9 >;n?a a-r<a- @<,-;a.


• A 9r,a; ;ra;a,n; an;3:3<;3@7A,<3-9> 2! ?3 ,<>;a;3@ an;3;9>3 an;3;r,3@

an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a;

;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.• S ;rna?a @9 r@<,an)ar3

•

•

•

•

• r(3, a3,n;ar @33:ra; @a<r3@D

• ;ra;a,n; ,)3@a,n;<> an;3a(3@ a n<3D

• -r?n;ara a IOCN -n;r9 ;ra;a,n; ) >-@3a3;a; @<n2<r, -r<(ra,ar33 7 )r. U)ra

A.

•

• BOALA PULMONARA CRONICA OBSTRUCTIVA S4T II GOL4 IN

EACERBARE.

• INSUFICIENTA REPIRATORIE CRONICA ACUTIZATA.

• TBC PULMONAR SECUN4AR FIBRONO4ULAR IN ANTECE4ENTE.

• AMPUTATIE ANTEPICIOR 4REPT.•

•


• 18.08.11 08:00 : Gran#='.6 *10!"L Gran$=6. $ HCT=/1.8 $ HGB=1'.%

(!) L+,-#=1.& *10!"L L+,-$=&.& $ MCH='1.1 -( MCHC='.%

(!) MCV=& 2L M3)#=0.% *10!"L M3)$=1.' $ MPV=8. 2L

PCT=0./' $ P45=1&. $ PLT=%/ *10!"L RBC=/./ 10*10!"L R45CV=1&. $ R45S4=&.8 2 5BC=&.8 *10!"L VSH 71=' ,,

VSH 7=& ,,

• 18.08.11 08:01/,991;18.08.2011 : S-9;a Fr<;39 BAAR A=NEGATIV



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• 18.08.11 08:02 :S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n ,3@r<:3<@n<?a

<r<2ar3n(3ana. S-9;a Ea,n ,3@<<(3@=Can)3)a >-- 8 UFC!-a@a S-9;a

Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ M9@<3)

• A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 10&!@a,-

• C9 -3;3a >@9a,<a> 10&!@a,-

• F3:r3na -r?n; 2<ra :a@;r3ana -<3,<r2a rar 32,3@3n

• S@<r ) @a3;a; 1

• 18.08.11 10:18 : Ta:<9 >an(3n=PMN = &6

• EO = 8

• BA =

• L = '0

• MO = 6

• 4>@r3r

• R(r ;<ra@3@a 33 @<n(>;33D ,9;3- <-a@3;a;3 n<)9ar >3 3nar )3>,3na; 3n a,:33

@a,-3 -9,<nar3D )>n 3n;r>;3;3a a@@n;9a; :3a;ra• )3R/21.08.2011: )3>29n@;3 n;3a;<r3 ,3;a r>;r93@;3a ,<)ra;a <:>;r9@;3a

,<)ra;a 3n >(,n; @n;ra >3 >ra 3n -r32r3. r)9@ra VEMS @9 &$

#P$%R$&A:

• Pa@3n; 3n ar>;a ) && an3 29,a;<r an3<> @9n<>@9; @9 TBC -9,<nar 3n an;@)n;

> -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> @9 -@;<ra;3 ,9@<-9r9n;a

)3>-n a 2<r;9r3 ,<)ra; a>;n<a)3na,3 3na-;;n;a >@a)r -<n)raa ;ran>-3ra;33 -r)<,3nn; n<@;9rn )9rr3 ;<ra@3@ n>3>;,a;3?a; >3,-;<, a@r:a; 3n 9;3,a

>a-;a,ana an;r3<r 3n;rnar33.

• O:3@;3 a 3n;rnar -a@3n; a2:r3 @9 >;ara (nraa ,)39 9><r 3n29n;a;a

;(9,n; ;ran>-3ra;Dan-9;a;3 an;-3@3<r )r-; -9,<nar ;<ra@ a>;n3@ MV 3na>-r3;@9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;ra >3 23n >3:3an; )3>,3na; 3n a,:33

@a,-3 -9,<nar3. B3<<(3@ >)r. 3n2a,a;<r 9><r. Ra)3<(ra23a -9,<nara 3)n;3a?a

,9;3- <-a@3;a;3 n<)9ar >3 3nar )3>,3na; 3n a,:33 @a,-3 -9,<nar3. E ) >-9;a -n;r9 B >; n(a;3 a ,3@r<>@<-3 @9;9r3 233n) 3n 9@r9.

• PFR)3>29n@;3 n;3a;<r3 ,3;a r>;r93@;3a ,<)ra;a <:>;r9@;3a ,<)ra;a 3n >(,n;

@n;ra >3 >ra 3n -r32r3D r)9@ra VEMS @9 &$


• A 9r,a; ;ra;a,n; an;3:3<;3@7A,<3-9> 2!?3 an;3,3@<;3@ an;3;9>3 HHC AINS

an;3;r,3@ an;3a(3@ r3)ra;ar r<:<ran; 3;a,3n -@;<ran;

:r<n<)3a;a;<r!@<r;3?<n3@ 3naa;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;.

- @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.• S ;rna?a @9 r@<,an)ar3

• R@<,an)ar3

• r(3, a3,n;a @33:a; @a<r3@D

• 2<r; 23?3@ 3n 3,3+;a ;<ra:33;a;33D

• ;ra;a,n; @9 VENTOLIN 100 ,3@r<(ra, -922 a n<3

• CLENIL ET &0 ,@( -929r3!?3D

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• IPRAVENT ' -92!?3D

• >a 3:ra; R- @<,-n>a;a -; < 9na >r3a CSBE nr '06'1'

• r3n )9-a r?9;a9 @9;9r3<r -n;r9 BJD


• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

• • NEOPLASM ME4IASTINO PULMNAR 4REPT CARCINOM CU CELULE MICI T/N'M07

STA4IUL IV A

• PNEUMONIE LI4

• FIBROZA PULMONARA 4IFUZA POST TBC

• VALVULOPATIE AORTICA 4EGENERATIVA

• CIC SILENTIOASA

• BLOC BIFASCICULAR

• ANEMIE POLICARENTIALA

•


19.08.11 07:,0 :• Gran#=&.1 *10!"L Gran$=%.' $ HCT='.' $ HGB=1'. (!)

L+,-#=1./ *10!"L L+,-$=1. $ MCH=. -( MCHC=''.& (!) MCV=8%.' 2L M3)#=0.6 *10!"L M3)$=8.& $ MPV=%. 2L PCT=0.1&&

$ P45=1&. $ PLT=1% *10!"L RBC=/.&1 10*10!"L R45

CV=1'.6 $ R45S4=//.% 2 5BC=%.1 *10!"L VSH 71=&0 ,, VSH7=100 ,, ALAT=1' U!L ASAT= U!L Cra;3n3na=1 ,(!) F<>2a;a?a

a@a3na=1'& U!L G3@,3=66 ,(!) Pr<;3n ;<;a=%.8 ,(!) Ur=6'

,(!) I)n;323@ara @9 ;r9> a; ASLO=>9: 00 UI!, I)n;323@ara @9 ;r9>a; PCR== 6 ,(!

1,.08.11 08:09 :

• Pr<;3n9r3=0.16 ($<

1.08.11 0:6 :

• S-9;a Fr<;39 BAAR A=NEGATIV /'0!1&.0.011

•

• CT ;<ra@ F3:r<?a -9,<nara ,a>3a )329?a :3a;raa @9 a>-@; 3n Q2a(9r ) ,3rQ

>9:-9ra :9 ) ,23?, >9:-9ra @a ,a3 ,ar ) & @, )3a,;r9 >3;9a;a -<>;r<

:a?a. C<@;3 -9raa ,3@a )r @<a?<na;a @9 9n n<)9 -9,<nar -r32r3@ a)3a@n; 3n

LI4 aa)n '0,,. Ma>a TU ) %.8/./ @, @n;ra;a - BLI4 ;3n>a 3n ,)3a>;3n9 -<>;r3<r -ana a ><2a( r;r<@ar)3a@ @9 3n@9)ra AP )r. M9;3- a)n<a-;33 ) -ana a

'./ @, )3a, r;r<@ar3na >3 >9:@ar3na -r@9, >3 3n >-a;39 -ara;raa 3n2r3<r )r a;

) -ana a @, )3a, -ara;raa )rr. P 2a;a ;rna a @r<>3 3>;a a)n<-a;33 @9 )3a,,a 3ar 3n FAP ) .& @, )3a,. F3@a;9 ar )3,>n39n3 >3 >;r9@;9ra n<r,a. N9 >

@<n>;a;a ,<)323@ar3 :33ar >a9 -<r;a. C<@3>;9 n9 >; <@93;. Gan) SR ) a>-@;

n<r,a. R3n3@33 :3a;ra a9 )3,n>39n3 >3 3n)3@ @<r;3@a n<r,a. TU BLI4 T/N'M0 - 2<n) ) 23:r<?a -9,<nara ,a>3a >3 @<@;3 -9raa )ra-;a. 74r. G9;;,an

• ECG RS %!,3n BR4 ,aK<r P -9,<nar BAS.

• Ea,n :r<n<<(3@ C<,-r>39n ;r3n>@a >3 3n23;rar a ,9@<a>3 -r;93 -<>;r3<r

a ;ra3 a-r< @, )a>9-ra -3n;n93 ;raa @9 r)9@ra 9,n993 ;ra3 a-r<

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•

•

•

•

•

•

• ASTM BRONSIC PERSISTENT PARTIAL CONTOLAT IN EACERBARE.

• INSUFICIENTA RESPIRATORIE ACUTA.•


• 1,.08.11 07:11 :Gran#=6./ *10!"L Gran$=& $ HCT=/8 $ HGB=16 (!)

L+,-#='.6 *10!"L L+,-$='' $ MCH='0.' -( MCHC=''.' (!)

MCV=1 2L M3)#=0.8 *10!"L M3)$=8 $ MPV=%.8 2L PCT=0.0& $ P45=1&. $ PLT=6/ *10!"L RBC=&.8 10*10!"L R45CV=1'.6 $

R45S4=/6. 2 5BC=10.8 *10!"L VSH 71=' ,, VSH 7=% ,,

ALAT=1% U!L ASAT=1' U!L B33r9:3na ;<;aa=0.% ,(!) C<>;r<=16

,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=1' U!L GGT=1/ U!L G3@,3=66 ,(!) L4H=/0 U!L Pr<;3n ;<;a=%. ,(!) Tr3(3@r3)=8

,(!) Ur=6 ,(!) S-9;aC9;3ar :a@;r33 ar<:=Gr,n3 )3n

,3@r<:3<@n<?a <r<2ar3n(3ana. S-9;a Ea,n ,3@<<(3@=Can)3)a >-- UFC!-a@a S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@ M9@<-9r9n;

• A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,-

• C9 -3;3a >@9a,<a> 10&!@a,-

• F3:r3na -r?n; 2<ra :a@;r3ana -<3,<r2a 9r3

• S@<r ) @a3;a;

• )3R /96,0,;19.08.2011: )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a >ra :>;r9@;3a

>ra 3n ;<; ar:<r :r<n>3@. VEMS 1 3;r9.

Rgr toracica: 33 @<n(>;3 )>n 3n;r>;3;3a a@@n;9a; :3a;ra. Fara ?39n3 a@;3

TBC -9r<-9,<nar.•

• E)-!R-A:

• Pa@3n; 3n ar>;a ) 6' an3 2<>; 29,a;<r@9n<>@9; 3n an;@)n; @9 A>;, :r<n>3@ a2a;

>9: ;ra;a,n; @9 Sr;3) &0!&00 ,3@r<(ra, 1 -92! ?3 > 3n;rna?a -n;r9 ;9> @9-@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r;9r3 ,3@3 a>;n<a)3na,3 2a;3(a:33;a;

;ran>-3ra;33 2r3><an >3,-;<, a@r:a; 3n 9;3, ' ?3 an;r3<r 3n;rnar33.

• O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; ;ran>-3ra;D

-9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3 >3:3an; )3>,3na; 3n a,:33 @a,-3

-9,<nar3 >3 ra9r3 @r-3;an; :a?a :3a;raD TA= 10!%0 ,,H( AV= %6 :a;a3! ,3n9;.• B3<<(3@ >)r. 3n2a,a;<r 9><r. Ra)3<(ra23a -9,<nara )>@r3 33 @<n(>;3 )>n

3n;r>;3;3a a@@n;9a; :3a;ra 2ara a 3)n;3a ?39n3 a@;3 TBC -9r<-9,<nar.PFR

)3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a >ra :>;r9@;3a >ra 3n ;<; ar:<r :r<n>3@3ar VEMS 1 3;r9.

• In 9r,a ana,n?3 a a,n993 @3n3@ >3 - :a?a )a;<r -ara@3n3@ >a >;a:33;

)3a(n<>;3@9 ) ,a3 >9>.

• A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> 2!?3 an;3;9>3 HHC AINS an;3;r,3@

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an;3a(3@ r3)ra;ar r<:<ran; 3;a,3n -@;<ran; :r<n<)3a;a;<r!@<r;3?<n3@

3naa;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ @9 <9;3 2a<ra:3a.

• S ;rna?a a,3<ra; @9 r@<,an)ar3

• r(3, a3,n;ar @33:ra; @a<r3@D

• 3;ara 2a@;<r3<r ar(n3D

• a@@3nar an;3(r3-aa an9aaD• ;ra;a,n; ,)3@a,n;<> @9 SERETI4E &0!&00 ,3@r<(ra, 1 -92!?3

• VENTOLIN 100 ,3@r<(ra, -929r3 a n<3D

• TAVANIC &00 ,3@r<(ra, 1 @-r!?3 7% ?3D

• ER4OME4 '00 ,3@r<(ra, 1 @-r! ?3 7% ?3D

• >a 3:ra; R- @<,-n>a;a >r3a CSBE nr. '06'1/ '06'1&


• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

01.0.2011TU BRONHOPULMONARA LSS T/N'M1 7BIOPSII IN LUCRU.PNEUMONIE LSS.

METASTAZE SUPRARENALIENE.

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULARMO4ERAT.

Rgr toracica: 3n;r>;3;39 na@@n;9a; -<r)<,3nan; a n39 @a,-993 -9,<nar )ra-;<-a@3;a;

29 )3,3;a;a 3n<,<(na @ <@9-a 1!' ,3K<@3 a @a,-993 -9,<nar >;an(.

!" toracic /2.07.2011 dr 4uttmna " (Atasat copie

Ea,3nara a 2<>; 2@;9a;a 3n 3n@3)n; a3a @<r<na >3 >a(3;a. R?9;a; F<r,a;39n ;9 ) % @, )3a,;r9 @n;ra;a - BLSS ;3n>a -<>;r3<r -ana a >@3?9ra

<:3@a @9 3n@9)ra AP >;an(a >3 3na?3 FAP. ,<)323@ar3 -ra;@;a;3@ 3n LSS @9 r)9@ra

ara;33 <:ar. A)n<-a;33 FAP ) -ana a 18 ,, )3a,;r9 -r@ar3na ) 1& ,, )3a,;r9 >3 -ara;raa 3n2 )ra-;a ) 1% ,,.

N9 > @<n>;a;a a>-@; ) @<@;3 -9raa.

N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@3@. F3@a;9 ar )3,n>39n3 >3 >;r9@;9ra n<r,a7 @9 9n @3>; ) 1.& @, )3a,;r9. N9 > @<n>;a;a

,<)323@ar3 :33ar >a9 -<r;a

C<@3>;9 n9 >; <@93;.

Gan) SR @9 9n n<)9 ) ' @, )3a,;r9. R3n3@33 :3a;ra a9 )3,n>39n3 >3 >;r9@;9ra n<r,a.

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C<n@9?3 T9 BLSS T/N'M1

3ibrobron?oscopie/1121;2.07.2011 a;a>a; @<-3

CV ,<:3 Tra 3:ra - a-r<3,a;3 / @, a-<3 3-ra>@9ar3?a;3 >3 -a@ar) a: (a:93.P3n;n ;raa ar(3; an;r3<r. In23;ra;3 nr(9a;a ) ,9@<a>a BP4 BPS LIS. Pr<@>

-r<32ra;3 3n23;ra;3 >;n<?an; :r >(,n; a-3@< )<r>a @9,n. B3<->3.

)3R/6880;2.07.2011: )3>29n@;3 n;3a;<r3 <:>;r9@;39a 9><ara 3n -r32r3. R)9@raVEMS @9 1/$.

E)-!R-A

B<na 3n ar>;a )% an3 29,a;<r a ->; &0 PA @9n<>@9; 3n an;@)n; @9 HTA> -r?3n;a -n;r9 )9rr ;<ra@3@a -r)<,3nan; n<@;9rna ;9> @9 -@;<ra;3 ,9@<a>a )3>-n a 2<r;

,)39 >@a)ra ;<ran;3 a 2<r; a>;n<a)3na,3 3na-;;n;a >@a)r -<n)raa7 a-r<3,a;3

10 ( 3n 9n3 >3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;aD -9,<nar MV 3na>-r3; @9 -3r -r9n(3; :3a;ra Ta= 1/0!80 ,,H( AV= %8 :a;a3! ,3n9;.

Ra)3<(ra23a -9,<nara )>@r3 <-a@3;a; 29 )3,3;a;a 3n<,<(na @ <@9-a 1!' ,3K<@3 a

@a,-993 -9,<nar >;an( r3)3@an) >9>-3@39na 9n93 -r<@> -r<32ra;3 a n39 @a,-93

-9,<nar >;an( ,<;3 -n;r9 @ar > 3n)3@a 2@;9ara CT ;<ra@ >3 23:r<:r<n<>@<-3. CT;<ra@3@ )>@r3 T9 BLSS T/N'M1 @9 ,;a>;a? >9-rarna 3ar 23:r<:r<n<>@<-3a 3)n;3a?a

-r<@> -r<32ra;3 3n23;ra;3 >;n<?an; :r >(,n; a-3@< )<r>a @9,n @<n23r,an)>9>-3@39na.

PFR )3>29n@;3 n;3a;<r3 <:>;r9@;39a 9><ara 3n -r32r3.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.A 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r

-a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.


r(3, a3,n;ar @33:ra; @a<r3@D

;ra;a,n; @9 an;3a(3@ a n<3D

-r?n;ara a IOCN C9K @<n2<r, -r<(ra,ar33.PNEUMONIE INTERSTITIALA ATIPICA TRENANTAFIBROZA PULMONARA 4IFUZA INCIPIENTA

COR4 PULMONAR CRONIC STA4IUL II

CICIVS CRONICA 4E EFORT NHA II!III

BR4 MAOR REUMATISM CRONIC 4EGENERATIV CU RA4ICULALGII

HTAE STA4IUL IIB

4IABET ZAHARAT TIP II CU REGIM ALIMENTAR


06.07.11 08:2 : Gran#=&.8 *10!"L Gran$=%1.' $ HCT='8 $ HGB=1.1 (!) L+,-#=1.

*10!"L L+,-$=. $ MCH=.% -( MCHC='1.8 (!) MCV='.& 2L

M3)#=0.& *10!"L M3)$=&.8 $ MPV=8./ 2L PCT=0.8/ $ P45=16 $ PLT='' *10!"L RBC=/.0% 10*10!"L R45CV=1/.1 $ R45S4=/8 2

5BC=8. *10!"L VSH 71=0 ,, VSH 7=&0 ,, ALAT=1/ U!L ASAT=11

U!L Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=18 U!L GGT=/ U!L

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G3@,3=1' ,(!) L4H='' U!L Pr<;3n ;<;a=%.1 ,(!) Ur=6 ,(!)

I)n;323@ara @9 ;r9> a; PCR=n(a;3

07.07.11 07:92 :

4;@;ara 3)ra;3<r ) @ar:<n 7Z=n( 4;@;ara 9@<@3;<r 7P=n( 4;@;ara

-r<;3n<r 7A=n(

E<4/06.07.2011:RITM SINUSAL AV=&8!MIN BR4 ,aK<r P -9,<narD 1'.0%.011 a>-@;a>,ana;<r @9 @ -r@)n; AV=%!,3n

R= )#*$%&AR 3n;r>;3;39 -9,<nar a@@n;9a;.C<r) ,ar3; (ra) II.

)3R VALORI NORMALE

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BOALA PULMONARA CRONICA OBSRUCTIVA ST4 II GOL4 IN EACERBARE.

COLECTIE PLEURALA STANGA IN CANTITATE MO4ERATA.ASCITA IN AB4OMENUL SUPERIOR CU NO4ULI TISULARI INTRAPERITONEALI.

HIPERTNSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULAR INALT.CAR4IOPATIE ISCHEMICA CRONICA.

INSUFICINTA CAR4IACA CONGESTIVA CLASA NHA II.OBEZITATE GR4. II.

COARTROZA BILATERALA.

ALERGIE LA )E&-!-*-&A.


0,.07.11 : L3@3) -9ra Ea,n @3;<<(3@=PMN = $ L3,2<@3; = % $ C9 ,?<;3a= 0 $ C9 a;3-3@ = 6 $ 3?<a; >3 3n -a@ar) @9 :a?<233a @3;<-a>,3 an3?<@ar3<?a

,3;<? ra;3 2r@n; ,a;33 L3@3) -9ra G9@<?a=110 ,(!) L3@3) -9ra

L4H=6&' U!L L3@3) -9ra Pr<;3n=/.& (!) L3@3) -9n@;3 N9,. ,n;=000,.07.11 : L. -9ra @9;3ar :a@;r33 ar<:=N9 >a9 )?<;a; (r,n3. L. -9ra Ea,n ,3@<<(3@=N9 >a9 )?<;a; 29n(3. L. -9ra 2r<;39 Gra,=23:r3na

0,.07.11/ NR.REG.9208;0.07.2011 : L. -9ra Fr<;39 -;. )@rar BAAR=NEGATIV

0.07.11 :VSH 71='8 ,, VSH 7=%8 ,, ALAT=1% U!L ASAT=' U!L B33r9:3na ;<;aa=0.6 ,(!) C<>;r<=160 ,(!) Cra;3n3na=1.0 ,(!) F<>2a;a?a

a@a3na='8 U!L GGT=11' U!L G3@,3= ,(!) L4H=6&8 U!L Pr<;3n

;<;a=6.% ,(!) Ur=/0 ,(!)

06.07.11 : Gran#=& *10!"L Gran$=%'.1 $ HCT='6.% $ HGB=11./ (!)

L+,-#=1. *10!"L L+,-$=1%. $ MCH=8. -( MCHC='1 (!)

MCV='.' 2L M3)#=0.6 *10!"L M3)$= $ MPV=%.8 2L PCT=0.'68 $

P45=1&. $ PLT=/%' *10!"L RBC='./ 10*10!"L R45CV=1/. $ R45S4=&1.1 2 5BC=6.8 *10!"L

06.07.11:

Ta:<9 >an(3n=PMN = 66EO = !

BA =

L = 6MO = 6

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4>@r3r !

&%= % --)

E<4: R> AV= %0 :;a3! ,3nD a RS a '0 (ra)D 2ara ,<)323@ar3 ) 2a?a ;r,3naa.

)3R: )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a 9><ara <:>;r9@;3a ,<)ra;a >(,n; @n;ra >3

>ra 3n -r32r3. r)9@ra VEMS @9 /'$.

R(r ;<ra@3@a <-a@3;a; @ <@9-a 1! 3n2r3<ra a ,3;<ra@93 >;an(.!" toracic/0,.07.2011 dr 4uttman ".: In LSS 3>;a < :an)a ) a;@;a?3 -9,<nara

-a@a;a - >@3?9ra <:3@a )ar 2ara 3?9a3?ara 9n3 <:>;a@< ) ara;3. In LSS 3>;a )

a>,na >3 ,<)323@ar3 ) a<3;a )32?a 9)a;3a. C<@;3 -9raa >;an(a ,<)ra;a@<a?<na;a. Fara @ar)3<,(a3. N9 > @<n>;a;a ,<)323@ar3 ;9,<ra >a9 a)n<-a;3@ ,)3a>;3n<

-9,<nar. Fra@9r3 @3 ) r@9r3 @<>;a an;r<a;ra >;an( - (r3aK9 3n2r3<r. A>@3;a

-r3-a;3@a >3 -r3>-n3@a @9 3n2a,a;3 -r3;<naa >3 @a;a 3,a(3n3 n<)9ar 3n;ra-r3;<na

) -ana a 1 @, )3a,;r9 ) ;3<<(3 (r9 ) -r@3?a;. F3@a;9 ar )3,n>39n3 >3 >;r9@;9ran<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar >a9 -<r;a. Gan) SR ) a>-@; n<r,a.

C<n@9?3 A;@;a?3 3n :an)a >3 a<3;a 9)a;3a LSS. C<@;3 -9raa >;an(a ,<)ra;a.

A>@3;a 3n a:)<,n9 >9-r3<r @9 n<)993 ;3>9ar3 3n;ra-r3;<na3.

3ibrobron?oscopia/101; 0,.07.2011 dr +imon $.: ;raa 3:ra. P3n;n ;raa n<r,a. N9@<a>a -a3)a @9 a>-@; ) :r<n>3;a a;r<23@a. N9 >9n; >,n n<-a?3@.

E)-!R-A:

Pa@3n;a 3n ar>;a ) %1 an3 ar(3@a a )E&!-*-&A @9n<>@9;a @9 an;@)n;

-9,<nar7 BPOC a2a; >9: ;ra;a,n; @9 S+,:3@<r; '0! ,3@r(ra, 1 -92!?3 Vn;<3n 100,3@r<(ra, -929r3 a n<3 @ar)3<a>@9ar7HTA ICC CI ,;a:<3@ 7O:?3;a; >3

<>;<ra;3@9ar 7C<ar;r<?a :3a;ra > 3n;rn?a -n;r9 ,<)323@ara >;ar33 (nra ;9> >a@a

)3>-n a 2<r; ,3@ 3n3;3a >3 a-<3 )3>-n ) r-a9> a>;n3 2a;3(a:33;a; >@a)ra ;<ran;3 a

2<r; 2:ra7'8.8 (ra) C 2r3><an ;ran>-3ra;33 (r;9r3 3n><;3 ) ar>a;9r3 a3,n;ar >3,-;<,a@r:a; 3n 9;3,a >a-;a,ana an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar -a@3n;a >9-ra-<n)raa @9 >;ara (nraa ,<)323@a;a ;(9,n; >3

,9@<a> -a3)D ), ,<)ra; (a,:3r :3a;raD -9,<nar ,a;3;a; 3n 1! 3n2r3<ara a,3;<ra@93 >;an( @9 MV a:<3; a a@>; n3 ra9r3 @r-3;an; :a?a )r-; Sa; O= 6 $D

TA= 1/0! 80,,HGD AV= 8/ :a;a3! ,3n9;.

B3<9,<ra >)r. 3n2a,a;<r7VSH a@@ra; >)r an,3@ GGT >3 L4H @r>@9;. Ea,n93@3)993 -9ra -n;r9 BJ >; n(a;3 a ,3@r<>@-3. PFR )3>29n@;3 ,3;a r>;r3@;3 9><ara

<:>;r9@;3 ,<)ra;a >(,n; @n;ra >3 >ra 3n -r32r3. Ra)3<(ra23a -9,<nara 3)n;3a?a

@<@;3 -9raa >;an(a. P -ar@9r>9 3n;rnar33 >a 2@;9a; ;r3 ;<ra@<@n;?a @9 a@9ara a

a-r<3,a;3 1%00 , 3@3) -9ra a 23@ar ;<ra@<@n;?a. Pn;r9 a @99) -r?n;a 9n93 -r<@> -r<32ra;3 a n3 :r<n<-9,<nar >a 2@;9a; CT ;<ra@3@ >3 23:r<:r<n<>@<-3. CT

;<ra@3@ )>@r3 ;@;a?3 3n :an)a >3 a<3;a 9)a;3a LSSD @<@;3 -9raa >;an(a ,<)ra;a

3ar a n3 a:)<,3na a>@3;a 3n a:)<,n9 >9-r3<r @9 n<)993 ;3>9ar3 3n;ra-r3;<na3.La23:r<:r<n<>@<-3 > 3)n;3a?a < ,9@<a>a :r<n>3@a @9 a>-@; ) :r<n>3;a a;r<23@a 2ara a >

3)n;3a 2<r,a;39n3 ;9,<ra a n3 :r<n<-9,<nar.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.A 9r,a; ;ra;a,n; an;3:3<;3@ 7C2<r; 1 (!?3 an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r

-r<;@;<r -a;3@ -r<;@;<r (a>;r3@ an;3@<a(9an; 3nK@;a:3 a @<n;3n9a; ;ra;. - @ar 3 9r,a

a,:9a;<r @9 <9;3 2a<ra:3a.


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1,.07.11 07:22 :

Gran#=6./ *10!"L Gran$=%'.1 $ HCT=/0.& $ HGB=1.& (!) L+,-#=1.%*10!"L L+,-$=1 $ MCH='.8 -( MCHC='0.8 (!) MCV=106.' 2L

M3)#=0.6 *10!"L M3)$=%. $ MPV=8.8 2L PCT=0.161 $ P45=1&.% $

PLT=18' *10!"L RBC='.81 10*10!"L R45CV=1&.' $ R45S4=&.1 2 5BC=8.% *10!"L VSH 71=/' ,, VSH 7=81 ,, ALAT='' U!L

ASAT=& U!L Cra;3n3na=0.% ,(!) F<>2a;a?a a@a3na=1&' U!L G3@,3=86 ,(!)

L4H='/1 U!L Pr<;3n ;<;a=%.8 ,(!) Ur= ,(!)

1,.07.11 07:2, :

S-9;a Fr<;39 BAAR A=NEGATIV ''6&!1/.0%.011 S-9;a Fr<;39 BAAR


1,.07.11 07:27 :

S-9;aC9;3ar :a@;r33 ar<:=Ha,<-39> >-- S-9;a Fr<;39 Gra,=A>-@;

,a@r<>@<-3@ M9@<-9r9n;

A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,- ,a@r<2a(D C9 -3;3a >@9a,<a>10&!@a,- D F3:r3na -r?n; & @<@<:a@33 (ra, n(a;33!@a,- 68 @<@3 (ra, -<?3;33!@a,-

3n )3-< an;9r3 >@9r; >3 (ra,?3.S@<r ) @a3;a;

18.07.11 19:92 :

An;3:3<(ra,a ar<:3=AMPICILINA 7O,n3-rn P<3@33n S AMPICILINA SULBACTAM 7Una>+n S

AMOICILINA AC. CLAVULANIC 7A9(,n;3n S

BISEPTOL 7Ta(r,3n S MEROPENEM 7Mr<n, S CIPROFLOACIN7C3-r3n<E9@3-r3n S CLARITROMICINA 7Ja@3) S CLORAMFENICOL 7Br3@;3n

S CEFACLOR 7C@<r S

CEFOTAIM 7Ca2<ran S CEFTRIAON 7R<@-3n S TETRACICLINA 7A@r<,3@3n R CEFUROIM AETIL S MOIFLOACINA S CEFTIBUTEN S



R43 )#*$%&AR: A>-@; >9-r-<?a:3 a,3nar3<r an;r3<ar ,23?, 23:r<?a r;ra@;3aLS :3a;ra -r)<,nan; >;an(a.

E<4: R> AV= 0!,3n. In@ar@ar VS. P9r3 -9,<nar.

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r(3, a3,n;ar 3-<><)a;D 3-<3-3)3@ 3-<(9@3)3@D >@a)ra 3n (r9;a;D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

;ra;a,n; ,)3@a,n;<> @9 SMBICORT '0! ,3@r<(ra, 1 -92!?3

VENTOLIN 100 ,3@r<(ra, -929r3 a n<3. 9r,a?a ;ra;a,n;9 @ar3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>;D

3n;rnara 3n S-3;a9 CFR @<n2<r, 3n;(r33 @9 )<,n9 )r. R)n3@ N3@<a.

BOALA PULMONARA CRONICA OBSTRUCTIVA S4T II GOL4 IN EACERBARE.

PNEUNONIE LI4.

COLECTIE PLEURALA BILATERALA IN CANTITATE MICA.COR4 PULMOAR CRONIC 4ECOMPENSAT.


MO4ERAT.CAR4IOPATIE ISCHEMICA ANGINA PECTORALA 4E EFORT.

INSUFICIENTA CAR4IACA CONGESTIVA CLASA NHA III.

BOALA 4E NO4 SINUSALD S4R BRA4I TAHI.ANEMIE.

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29.06.11 07:09 : Gran#=' *10!"L Gran$=&8.& $ HCT=8.% $ HGB=.8 (!) L+,-#=1.8 *10!"L L+,-$=''. $ MCH='6./ -( MCHC='/.1 (!)

MCV=106.8 2L M3)#=0./ *10!"L M3)$=%.6 $ MPV=%.% 2L PCT=0.68 $

P45=1&.& $ PLT='/ *10!"L RBC=.6 10*10!"L R45CV=1/.% $ R45S4=&. 2 5BC=&. *10!"L VSH 71=/ ,, VSH 7=&& ,, ALAT=10

U!L ASAT=10 U!L B33r9:3na ;<;aa=0./ ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a

a@a3na=1'' U!L GGT=1& U!L G3@,3=%' ,(!) Pr<;3n ;<;a=&. ,(!) Ur=&1 ,(!)

29.06.11 10'1 Ta:<9 >an(3n=PMN =&8

EO = /

BA =L = '/

MO = /

4>@r3rAn3?<@3;<?a n<r,<,a@r<@3;ara. Rar n9;r<23 3-r>(,n;a;.'.06.11 11/1 L4H=% U!L

'.06.11 1''' C<<ra;3 P;. r;3@9<@3;=/ $<

)3R: )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;aD <:>;r9@;3a >ra 3n ;<; ar:<r :r<n>3@ ,a3 a@@n;9a;a 3n -r32r3. VEMS 1 3;r9.

Rgr toracica: 4>n 3n;r>;3;3a a@@n;9a; )329? :3a;ra -r)<,3nn; 3n2r3<r )r-;D

,3@r<<-a@3;a;3 3nara :a?a )ra-;D <-a@323ra >3n9>9r3<r @<>;<)3a2ra(,a;3@ :3a;ra

-r)<,3nn; @ >;an(D @<r) (<:a ,ar3;D @a@323@ar3 3ar :3a;ra >3 3n2ra3ar ,9;3-D a3n@3)n;a )3n -r<23 <-a@3;a; ) 3n;n>3;a; 3@3)3ana a n39 >3n9>993 @<>;<)3a2ra(,a;3@

-<>;r3<r >3 an;r3<r. >@3?9r3;a <r3?<n;aa >3 >@3?9r3;a <:3@a.

!onsult cardiologic:

E@<@ar)3<(ra23 A< a 3n = D A< a>@= '6D AS= /6D V4= 10 VS= &&!'6D >-;!--1/!1/D FE=

/8$

C<n@9?3 HVS 43>29n@;3 )3>;<3@a 9><ara.4(. F3:r3a;3 a;r3aa. In>923@3n;a @ar)3a@a (<:aa.

R@<,an)ar3 43(<3n 0.& ,( 1! ?3 & ?3 - >a-;a,ana @9 -a9?a K<3 >3 )9,3n3@a.

A>-n;r %& ,( 1 @-r!?3D

439r &0 ,( 1 @-r! ?3D O3@ar) /0 ,( 1 @-r! ?3D

E)-!R-A:

Pa@3n; 3n ar>;a ) 80 ) an3 2<>; 29,a;<r7/0 PA @9n<>@9; @9 an;@)n; @ar)3<a>@9ar

7HTA CIC :<aa ) n<) >3n9>aD >)r :ra) ;a3D CPC >3 -9,<nar 7BPOC a2a; >9:

;ra;a,n; @9 Sr;3) &0! &00 ,3@r<(ra, 1 -92 !?3 > 3n;rna?a -n;r9 ;9> @9 -@;<ra;3

,9@<-9r9n;a 3n @an;3;a; ,<)ra;a )3>-n a 2<r;9r3 ,3n3, 2a;3(a:33;a; a>;n<a)3na,3;ran>-3ra;33 ), 3,-<r;an; a n39 ,,:r<r 3n2r3<ar :3a;ra >@a)r -<n)raa7'(

3n a-r '9n3 >3,-;<, @ >a9 3n>;aa; @9 < >a-;a,ana an;r3<r 3n;rnar33 )ar >a9 a@9;3?a; 3n9;3,3 / <r.

O:3@;3a 3n;rnar >;ar (nraa 3n29n;a;aD ;(9,n; a n39 ,,:r993 >9-r3<r )r-;

-r?3n;a 9n ,an(3<, @<n(n3;aD ), 3,-<r;an; a n39 ,:. 3n2r3<ar :3a;raD ;>9;

@<nK9n@;3<a)3-<> >a: r-r?n;a;D -9,<nar MV 3na>-r3; @9 ?3n( 3n -3r -r9n(3;ra9r3 >3:3an; )3>,3na; 3n 1! 3n2r3<ar a a,:3<r @a,-3 -9,<narD a):<,3na a n39

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2an@993 )r-; -r?3n;a rn3 3n(3naa ) )3,n>39n3 ) a-r<3,a;3 /& @, )3a,;r9

nr)9@;3:3a n)9rr<a>a 2ara ;9:9rar3 ) ;ran?3; 3n;>;3na.

B3<<(3@ an,3 ,<)ra;a n<r,<@r<,a ,a@r<@3;araD 3-<-r<;3n,3D 9><ara r;n;3 a?<;a;a.R PA 4>n 3n;r>;3;3a a@@n;9a; )329? :3a;ra -r)<,3nn; 3n2r3<rD <-a@323ra >3n9>9r3<r

@<>;<)3a2ra(,a;3@ :3a;ra -r)<,3nn; @ >;an(D @<r) (<:a ,ar3;D @a@323@ar3 3ar

:3a;ra >3 3n2ra3ar ,9;3-D a 3n@3)n;a )3n -r<23 <-a@3;a; ) 3n;n>3;a; 3@3)3ana an39 >3n9>993 @<>;<)3a2ra(,a;3@ -<>;r3<r >3 an;r3<r. >@3?9r3;a <r3?<n;aa >3 >@3?9r3;a <:3@a.

PFR= 43>29n@;3 n;3a;<r3 ,3;a. r>;r3@;3a ,<)ra;a <:>;r9@;3a >ra >(,n; @n;ra ,a3

a@@n;9a; 3n -r32r3 r)9@ra VEMS @9 6$. VEMS >9: 1.P :a?a a,n993 @3n3@ ra)3<<(3@ PFR >3 :3<9,<ra > >9>;3n )3a(n><;3@9 ) ,a3 >9>.

P -ar@9r>9 3n;rnar33 -a@3n;9 a )?<;a; -3><a) ) @<n>;3-a;3 @ar >a9 r,3> )9-a

a),3n3>;rara ) U3 ) -ara23na >3 >9-<?3;<ar @9 (3@r3na. A 9r,a; ;ra;a,n; an;3:3<;3@ 7C2<r;

1(!?3 @<r;3?<n3@7HHC100,( an;3a(3@ an;3-3r;3@ )39r;3@ an;3@<a(9an; 3nK@;a:3 @9a,3<rara >;ar33 (nra >3 <9;3 @3n3@a 2a<ra:3a.


r(3, a3,n;ar 3-<><)a;D 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

;ra;a,n; ,)3@a,n;<> @9 Sr;3) &0!&00 ,3@r<(ra, 1 -92!?3D ;ra;a,n; -n;r9 -a;<<(3a @ar)3<<(3@a -r>@r3> ) @a;r ,)3@9 >-@3a3>;

43(<3n 0.& ,( 1! ?3 & ?3 - >a-;a,ana @9 -a9?a K<3 >3 )9,3n3@a.

A>-n;r %& ,( 1 @-r!?3D 439r &0 ,( 1 @-r! ?3D

O3@ar) /0 ,( 1 @-r! ?3D


)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.TU ME4IASTINALA CU 4ETERMINARI SECUN4ARE PULMONARE.

TU BRONHOPULMONARA LI4.

BPOC ST4 II GOL4 IN EACERBARE.COLECTIE PLEURALA BILATERALA.

ANEMIE SECUN4ARA.


21.07.11 12:18 : Fr<;39 :r<n>3@ Ea,n @3;<<(3@= & PMN ,a@r<2a( ! @a,-. >@<r . E< =

0. Fr@n; @9 -3;3a :r<n>3@.

22.07.11 07:,, : Gran#=%.& *10!"L Gran$=%/.' $ HCT='.8 $ HGB=1 (!)

L+,-#=1. *10!"L L+,-$=1. $ MCH=&.& -( MCHC='0.1 (!)

MCV=8/.% 2L M3)#=0.% *10!"L M3)$=6.& $ MPV=%.1 2L PCT=0.' $

P45=1&.& $ PLT=''% *10!"L RBC=/.%0 10*10!"L R45CV=16 $ R45S4=/8.% 2 5BC=10.1 *10!"L VSH 71='% ,, VSH 7=8 ,, ALAT=8

U!L ASAT=1 U!L B33r9:3na ;<;aa=0./ ,(!) Cra;3n3na=1. ,(!) F<>2a;a?a

a@a3na=/1 U!L G3@,3=1/& ,(!) L4H=% U!L Pr<;3n ;<;a=%. ,(!) Ur=' ,(!)RGF stand. PA- desen interstitial accentuat bilateral8 largire mdiastinala8 opacitate lu delmitata imomogenaL6$.#%G- &S. A(? <5 batai/ minut, a' I&S la J grade

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PFR- disfunctie ventilarie mi'ta, restrictie moderata, obstructie moderata pe tot arborele bronsic.&educerea (%)S cu +%* toracic -Atasat copie;oncluzie- Tu mediastinala cu determinari secundare pulmonare. Fibrobronhoscopie "1102/21.07.2011+ dr i)on - atasat copie;( mobile, trahee libera, pintene traheal normal. Arborele bronsic stang liber. !& primitiva dr. LS$, L)libere. Stenoza concentrica a br segment L6$ prin hipertrofie de pliuri si compresiune e'trinseca datade lichid.

#P$%R$&A- !olnav in varsta de 1 ani, fumator, a peste 5 "A, fara antecedente personale patologice

semnificativ ,se prezinta pentru modificarea starii generale, dispnee la efort mediu, scadera tolerantei laefort, inaptetenta, scadere ponderala, dureri retrosternala si la nivelul membrului superior drept, simptomee'acerbate in ultimele saptamani anterior internarii.7biectiv - la internare2 starea generala mediu modificata, tegumente palide, p'()onar 2 )( abolit labaza hemitoracelui drept8 TA? 13/>mm0D8 A(? <> batai/ minut.!iologic- sdr. inflamator (S0 acceleara, leucocitoza, sdr anemic, glicemie usor crescuta.&adiografia pulmonara largire mdiastinala8 opacitate lu delmitata imomogena L6$ ce ridica suspiciune aunuiprocs proliferaiv la nivel pulmonar si mediastinal. Se indica efcuarea ;T toarce si a fibrobronhoscopiei.;T toracic descrie Tu mediastinala cu determinari secundare pulmonare iar fibrobronhoscopiaevidentiaza Stenoza concentrica a br segment L6$ prin hipertrofie de pliuri si compresiune e'trinseca."#&- disfunctie ventilarie mi'ta, restrictie moderata, obstructie moderata pe tot arborele bronsic,reducerea (%)S cu +"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

A urmat tratament antibiotic, antitermic, antialgic, e'pectorant, bronhodilatator, protector hepatic, protector gastric, a continuat trat. pe care il urma ambulator, cu evolutie favorabila.Se e'terneaza cu recomandarile2

;ra;a,n; @9 an;3a(3@ a n<3D

-r?n;ara 3n >r3@39 IOCN @<<n2<r, -r<(ra,ar33 >3 3n;(r33 @9 )<,n9 )r U)ra A.TU BRONHOPULMONAR LS4 7TU BP4 T/N'M0 71 SR.

ABCES PULMONAR SECUN4AR 4REPT.

COLECTIE PLEURALA 4REAPTA.

BPOC ST4 III GOL4 IN EACERBARE.METASTAZE PE GLAN4A SUPRARENALA 4REAPTA.

INSUFICIENTA CAR4IACA CONGESTIVA CLASA NHA II!II. FIA PERMANENTA.

4IABET ZAHARAT TIP CONTOLAT CU ANTI4IABETICE ORALE.


19.07.11 07:06 :Gran#=&. *10!"L Gran$=%/.8 $ HCT=/6./ $ HGB=1/.'

(!) L+,-#=1.' *10!"L L+,-$=16.' $ MCH=./ -( MCHC='0.8 (!) MCV=&.8 2L M3)#=0.% *10!"L M3)$=8. $ MPV=.& 2L PCT=0.16 $

P45=1&. $ PLT=8 *10!"L RBC=/.8& 10*10!"L R45CV=1/.' $ R45S4=&1.1 2 5BC=%. *10!"L VSH 71=8 ,, VSH 7=6 ,, ALAT= U!L

ASAT=1' U!L B33r9:3na ;<;aa=0.% ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?aa@a3na=1&0 U!L GGT='6 U!L G3@,3=1/& ,(!) L4H=%8 U!L Pr<;3n

;<;a=6./ ,(!) Tr3(3@r3)=1'& ,(!) Ur='6 ,(!)

19.07.11/9962;1,.07.2011 : L. -9ra Fr<;39 -;. )@rar BAAR=NEGATIV

19.07.11 12:1 : L. -9ra @9;3ar :a@;r33 ar<:=N9 >a9 )?<;a; (r,n3.

L. -9ra Ea,n ,3@<<(3@=N9 >a9 )?<;a; 29n(3.

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L. -9ra 2r<;39 Gra,=F3:r3na rar 9@<@3; rar ,a;33

19.07.11 12:6 : L3@3) -9ra Ea,n @3;<<(3@=-= %.8 7 @<n;a@; @9 ar9 C<<ra;3a

MGG PMN = /$ E< = $ L+= 8/ $ @9 ,?<;3a =10$ 3?<a; >3 rar 3n -a@ar),3;<? ra;3 2r@n; ,a;33 L3@3) -9ra G9@<?a=1/ ,(!) L3@3) -9ra

L4H='// U!L L3@3) -9ra Pr<;3n='. (!)

R43 stand. @<r) (<:a ,ar3; 2a>@ - )3a2ra(,. <-a@3;a; @ <@9-a '!/ )3n @a,-9 -9,<nar )r-;@9 n3 3)r<ar3@.

E!4( F3A @9 AV ,)3.

!" toracic/22.07.2011 dr 4uttman ". A;a>a; @<-3C<n@9?3 T9 BP4 T/N'M0 71 SR

3ibrobron?oscopie /1079;1.07.2011 dr. +imon $. a;a>a; @<-3

CV ,<:3 ;ra 3:ra - a-r<3,a;3 & @, a-<3 3n23;ra;3 nr(9a;a n<-a?3@a )

,9@<a>a.P-3n;n ;raa >-r )ra-;a. Pr<@> -r<32ra;3 -<3:9rK<na; BP4 :r LS4 :r3n;,)3ara @9 <:>;r9@;3 a-r<a- ;<;aa >3 n@r<?a 3n >9-ra2a;a.

Rezutlat anatomo(patologic /2179;18.07.2011 dr a?arie ": @ar@3n<, >@9a,<>

nra;3n3?a;.

)3R/68726;1.07.20110( )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a>(,n; @n;ra >3 >ra 3n -r32r3. R)9@ra VEMS @9 &$.

E)-!R-A

B<na 3n ar>;a ) &% an3 2<>; 29,a;<r a / PA @9n<>@9; @9 an;@)n; -r><na -a;<<(3@@ar3<a>@9ar 7F3A -r,ann;a ICC ,;a:<3@ 7 4Z ;3- II> -r?3n;a -n;r9 ,<)323@ara

>;ar33 (nra ;9> @9 -@;<ra;3 3n3;3a ,9@<a>a 9;r3<r ,9@<-9r9n;a )3>-n a 2<r; ,3@

a,;3 3-<;3,3 ;ran>-3ra;33 @2aa>;n<a)3na,3 2a;3(a:33;a; )9rr3 ;<ra@3@),

(a,:3r ,3n3, >3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r 3n;rnar33. Pn;r9 a@>;>3,-;<, -a@3n;9 a 2<>; 3n;rna; >3 3n S-3;a;9 H9)3n 9n) a 2<>; )3a(n<>;3@a; @9 a:@>

-9,<nar >@9n)ar >3 @<@;3 -9raa )ra-;a 9;r3<r 233n) 3n)r9,a; >-r @3n3@a n<a>;ra -n;r9

@<n;3n9ara 3n>;3(a;33<r.O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; @3an<;3<@ ), (a,:3r

,<)ra; -9,<nar ;<ra@ ,23?,a;<> ,a;3;a; 3n 1! 3n2r3<ara a ,3;<ra@93 )r-; @9

a:<3r MV a a@>; n3D ra9r3 @r-3;an; 3n 1! >9-r3<ara a ,3;<ra@93 )r-; >3 :a?a >;an(DTA= 1'0!80,,H(D AV= 80 :a;a3! ,3n9;.

B3<9,<ra VSH 9><r a@@ra; 3-<-r<;3n,3D (3@,3 9><r @r>@9;a. Ea, BJ )3n 3@3)9

-9ra >; BAAR n(a;3 a ,3@r<>@<-3 @9;9r3 233n) 3n [email protected])3<(ra23a -9,<nara 3)n;3a?a <-a@3;a; @ <@9-a '!/ )3n @a,-9 -9,<nar )r-; @9 n3

3)r<ar3@ @ r3)3@a >9>-3@39n 9n93 a:@> -9,<nar >@9n)ar @ar a n@>3;a; 3n>;3(a;33

>9-3,n;ar. > 2@;9a?a CT ;<ra@ >3 23:r<:r<n<>@<-3.

CT ;<ra@3@ 3)n;3a?a T9 BP4 T/N'M0 71 SR >3 23:r<:r<n<>@<-3a )>@r3 Pr<@> -r<32ra;3 -<3:9rK<na; BP4 :r LS4 :r 3n;,)3ara @9 <:>;r9@;3 a-r<a- ;<;aa >3 n@r<?a 3n

>9-ra2a;a.

PFR )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n; @n;ra >3>ra 3n -r32r3


A 9r,a; ;ra;a,n; an;3:3<;3@ 7C3n)a,3@3na/1!?3 @3-r3n< 12!?3 a-<3 a,<3-9> '1.(!?3 >3(n;a,3@3na 12!?3 HHC an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@

-r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.


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r(3, a3,n;ar 3-<><)a; 3-<(9@3)3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D ;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->!?3

VENTOLIN 100 ,3@r<(ra, -929r3 a n<3

an;3a(3@ a n<3. @<n;3n9a ;ra;a,n;9 @ar)3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>;D

@<n;3n9a ;ra;a,n;9 )3a:;<<(3@D

> -r?3n;a a IOCN C9K @<n2<r, -r<(ra,ar33 >3 3n;(r33 @9 )<,n9 )r U)raBRON$*A %RON$%A A%*$&A*A*B% P3ONARA F$BRO&A*A #*$NA B$3A*#RA3+ PR#O. 3A N$. 3OB$3ORP.%P% %OP#NA*#*$3$ %RON$%*ABAG$ %RON$%*3B. # P#RONA3$*A*# $N*AB$3 #O*$ONA3 # *$P $P3$

R. AN#$# OARAAnalize de laborator:

27.06.11 07:9, :

5BC=6. *10!"L L+,-#=* 1. *10!"L M3)#=0./ *10!"L Gran#=&.' *10!"L

L+,-$=* 16.% $ M3)$=6.% $ Gran$=* %6.6 $ HGB=* 1' (!) RBC=* '.6

10*10!"L HCT=* '8.% $ MCV=* 10%.% 2L MCH=* '6.1 -( MCHC=''.& (!) R45CV=* 1&./ $ R45S4=* 60.6 2 PLT=/0 *10!"L MPV=* %./ 2L

P45=1&.8 $ PCT=0.1%% $ VSH 71=& ,, VSH 7=1/ ,, ALAT=8 U!L

ASAT=1/ U!L B33r9:3na ;<;aa=0.' ,(!) Cra;3n3na=0.6 ,(!) F<>2a;a?aa@a3na=11% U!L GGT=1 U!L G3@,3=% ,(!) L4H=8 U!L Pr<;3n

;<;a=* &. ,(!) Ur= ,(!)

RGF stand. PA-opacitati de intensitate costala si supracostala, prezente bilateral, cu diam. de apro'. 1 cm.,desen interstitial accentuat bazal bilateral, hili fibrozati, ascensionati, cu calcificari. Aspectul radiologic esteidentic cu cel prezent in radiografii anterioare din *

#%G- &S. 6ncarcare ($.

PFR - obstructie medie in periferie. (%)S in limite normale.

#P$%R$&A- !olnav in varsta de 5> ani, mare fumator, "A, cunoscut cu bronsita cronica, cu

supraimnfectii fercvente, T!; pulmonara fibrozata e'tinsa bilateral, predom. la niv. lobilor sup., ;";

compensat, etilism cr., tabagism cr., tulb. de personalitate instabil emotional de tip impulsiv, sdr. anemie cr , se prezinta pentru modificarea starii generale, tuse, dispnee la efort mediu, astenie, febra, inaptetenta,transpiratii predominent nocturne, simptome e'acerbate in ultimele saptamani anterior internarii.Obiecti - la internare2 starea generala mediu modificata, transpiratii nocturne8 p'()onar 2 torace normalconformat, )( inasprit, diminuat cu e'pir prelungit.Bio(o,ic- usoara anemieRadio,ra8ia p'()onara -evidentiaza sechele post T!, aspectul fiind nemodificat in ultimii ani.PFR- obstructie medie in periferie. (%)S in limite normale

"e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

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A urmat tratament antibiotic #ortum, antitermic, antialgic, antiinflamator,antitusiv, rehidratare, vit !1, vit!, cu evolutie favorabila.Se e'terneaza cu recomandarile2

-control pneumologic peste luni, cu bilet de trimitere de la medical de familie si dovada de asiguratcupon de pensie din ultimele 3 luni calendaristice-consult cardiologic

BOALA PULMONARA CRONICA OBSTRUCTIVA ST4 III GOL4 IN EACERBARE.INSUFICIENTA RESPIRATORIE CRONICA ACUTIZA.

TUMORA BRONHOPULMONARA NECONFIRMATA.

CON4ROM LA EMERGENTA BR LSS.

MALFORMATII ARTERIO VENOASE PULMONARE LI4.


2,.06.11 0:2 : Gran#=6.8 *10!"L Gran$=%1. $ HCT=/1. $ HGB=1'.6

(!) L+,-#=1.8 *10!"L L+,-$=18./ $ MCH='0.& -( MCHC='' (!)

MCV=.6 2L M3)#=1 *10!"L M3)$=10./ $ MPV=8.1 2L PCT=0.11 $

P45=1&.' $ PLT='% *10!"L RBC=/./& 10*10!"L R45CV=1& $ R45S4=&1.% 2 5BC=.6 *10!"L VSH 71=1 ,, VSH 7='6 ,, ALAT=10

U!L ASAT=10 U!L B33r9:3na ;<;aa=1.0 ,(!) C<>;r<=1'1 ,(!)

Cra;3n3na=0.% ,(!) F<>2a;a?a a@a3na=&8 U!L GGT='% U!L G3@,3=8,(!) L4H='0 U!L Pr<;3n ;<;a=%. ,(!) Tr3(3@r3)=61 ,(!) Ur='%

,(!)

2,.06.11 0:9 /'06!%.06.011: S-9;a Fr<;39 BAAR A=NEGATIV S-9;a Fr<;39 BAAR B=NEGATIV


A+"R#): P= %.'/D -CO= &.D P<= 81.D Sa;O= &.$

Rgr toracica: <-a@3;a; -ara;raaa )ra-;aD <-a@3;a; 3n;r@3)<3ara )ra-;aD ar(3ra

,ar(3n33 @<r)993 7 @<,-ara;3 @9R(r ;<ra@3@a 2@;9a;a 3n 9r,a @9 an3. B9a ) ,23?r,

-r?n;a. P r(r ;<ra@3@a ) -r<23 > 3)n;3a?a < <-a@3;a; ra;3 :3n )3,3;a;a LS4.

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)3R/728; 2,.06.2011: )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a >raD <:>;r9@;3a >ra -

;<; ar:<r :r<n>3@ ,a3 a@@n;9a;a 3n -r32r3. VEMS= 1 3;r9

3ibrobron?oscopia/87;2,.06.2011 dr. +imon $.: ;raa 3:ra. P3n;n ;raa n<r,a.Ar:<r :r<n>3@ :3a;ra 3:r. M<)323@ar3 ) >;a;3@a :r<n>3@a @9 >@r;33 ,9@<-9r9n;.

A>-@; ) :r<n>3;a @r<n3@a a@9;3?a;a. C<n)r<, a ,r(n;a :r LS>. An<,a3 ) )33?39n

:r<n>3@a LS4.!" "%RA!E /2,.06.2011 dr !otoz A.: >)r ) 9n-r a<ara @9 :r<n<(ra,a ar3@a a

n39 LS4 - 2<n)9 9n<r ,<)323@ar3 >@ar 23:r<;3@ r;ra@;3 a@@n;9a; @ar <@9-a

3n;r LS4 2ara > -<a;a 3)n;3a @r; - >@;39n3 na;3 r< ,a>a ;9,<raa. S@3?9ra<r3?<n;aa @a; >3 1! @ran3aa a >@3?9r33 <:3@ >9n; @<n >-r LS4. C<r)9 >3 ,n;

,)3a>;3n993 >9n; )-a>a; >-r )ra-;aD ,<)ra;a a>@n>3<nar a ,3)3a2ra(,993 )r-;.

La n39 LI4 > 3)n;3a )<9a ;ra3@; a>@9ar )3a;a; >9(>;3 -n;r9 ,a2<r,a;3

ar;r3<n<a>a -9,<nara 9na @9 ar>ar 3n VCI 3n >(,n;9 >9-ra-a;[email protected]<r) @9 @a3;a;3 )r-; n)3a;a;.

Fara ?39n3 2<@a -9r<-9,<nar >;an(3.

a)n<-a;33 ,)3a>;3na @a;3a (( -ara;raa3 )r-; ) 1' 1% )3a,;r9. Fara @<@;33

3@3)3n -9ra. F3a@a; @9 )3,n>39n3 n<r,a >3 >;r9@;9ra <,<(na - >@;39n3 na;3.Gan) >9-rarna @9 )3,n>39n3 n<r,a.

C<n@9?3 M<)323@ar3 23:r<;3@ a@@n;9a; r;ra@;3 a LS4 2ara >a -9;, @9) @r;3>;n;a 9n3 2<r,a;39n3 T9 3n @<n)3;33 9n3 a,3nar3 C; na;3. S9>-3@39n ) MAV

-9,<nar LI4 > r@<,na)a an(3< CT -9,<nar.

EPICRIZA

Pa@3n; 3n ar>;a ) 61 an3 2<>; 29,a;<r a '0PA @9n<>@9; @9 an;@)n; -9,<nar 7BPOC

TBC -9,<nar @ar)3<a>@9ar 7F9;r a;r3a In>923@3n;a ;r3@9>-3)3ana(r II In>92@3n;a

,3;raa (r II. CPC )3(>;3 7H-a;3;a ;<3@a >3 9r<<(3@ 7A)n<, ) -r<>;a;a > 3n;rna?a -n;r9 ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r;9r3 ,3@3 >3 ,<)ra; 2a;3(a:33;a;

a>;n<a)3na,3 ;ran>-3ra;33 n<@;9rn >3,-;<,a;<<(3 a@@n;9a;a @9 a-r<3,a;3 >a-;a,an3

an;r3<r 3n;rnar33.O:3@;3 a 3n;rnar >;ar (nraa ,)39 3n29n;a;aD ;(9,n; >3 ,9@<a> -a3)D -9,<nar

M 3na>-r3; :3a;ra ,a3 )3,3n9a; a n39 ,3;<ra@93 )r-;D TA= 110!6& ,,H(D AV= 80

:a;a3! ,3n9;.B3<9,<ra >)r 3n2a,a;<r 7VSH a@@ra; 9><r >)r an,3@. PFR )3>29n@;3 n;3a;<r3 ,3;a

r>;r3@;3a >raD <:>;r9@;3a >ra - ;<; ar:<r :r<n>3@ ,a3 a@@n;9a;a 3n -r32r3D

VEMS= 1 3;r9.R(r ;<ra@3@a PA 3)n;3a?a <-a@3;a; -ara;raaa )ra-;aD <-a@3;a;

3n;r@3)<3ara )ra-;aD ar(3ra ,ar(3n33 @<r)993 7 @<,-ara;3 @9 r(r ;<ra@3@a 2@;9a;a 3n9r,a @9 an3D :9a ) ,23?r, -r?n;a. P r(r ;<ra@3@a ) -r<23 > 3)n;3a?a < <-a@3;a;

ra;3 :3n )3,3;a;a LS4. > r3)3@a >9>-3@39na -r?n;3 9n93 -r<@> -r<32ra;3 LS4 ,<;3

-n;r9 @ar > 2r@;9a?a C; ;<ra@ >3 23:r<:r<n<>@<-3. CT9 ;<ra@3@ 3)n;3a?a ,<)323@ar323:r<;3@ a@@n;9a; r;ra@;3 a LS4 2ara a -9;a @9) @r; 3>;n;a 9n3 2<r,a;39n3 T9 3n

@<n)3;33 9n3 a,3nar3 C; na;3D>9>-3@39n ) MAV -9,<nar LI4.

FB )>@r3 a n39 :r<n>33<r a>-@; ) :r<n>3;a @r<n3@a a@9;3?a;aD an<,a33 ) )33?39n :r<n>3@a LS4 >3 -r?n;a a n39 ,r(n;3 :r a 9n93 @<n)r<,. Aan) 3n )r >9>-3@39na

9n93 -r<@> -r<32ra;3 -<9,<nar > r@<,an)a 3n@r@ara @<n23r,ar33 a@>;3 >9>-3@39n3. S

r@<,an)a 2@;9ara 9n93 @<(ra233 ;<ra@3@ -n;r9 < n;9aa -9n@;3 ;ran>;<ra@3a@ 3ar 3n

146

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7/24/2019 69625104-epicrize


Pa@3n; 3n ar>;a ) %1 ) an3 29,a;<r a & PA <-ra; 3n 9r,a @9 8 an3 -n;9 ;9,<ra <><a>a )

r:<r) @<>;a >;an( @9n<>@9; @9 an;@)n; -9,<nar 7BPOC 2<r,a >ra >9: ;ra;a,n; @9

S-3r3a 18 ,3@r<(ra, 1 @->!?3 >3 Sr;3) &0!&00 1 -92!?3 @ar)3<a>@9ar 7 C<r) -9,<nar @r<n3@ @<,-n>a; C3 HTA > 3n;rna?a -n;r9 )3>-n a 2<r;9r3 ,3@3 ;9> @9 -@;<ra;3

,9@<-9r9n;a 2a;3(a:33;a; >@a)ra ;<ran;3 a 2<r; a>;n<a)3na,3 ;ran>-3ra;33

3na-;n;a >3,-;<,a;<<(3 a@@n;9a;a 3n 9;3,3 >a-;a,an3 an;3<r 3n;rnar33.O:3@;3 a 3n;rnar >;ar (nnraa ,)39 3n29n;a;a >9:-<n)ra ;(9,n; @3an<;3@

@3@a;r3@ -<>; <-ra;<r3 3-<@<n)r9 >3 2an@ >;an( @9 n;ra;3D -9,<nar MV 3na>-r3; @9 -3r

-r9n(3; ra9r3 >3:3an; )3>,3na; ra9r3 @r-3;an; :a?a :3a;ra 23n ra9r3 >3:3an;)3>,3na; 3n a,:33 @a,-3 -9,<nar3.D TA= 100!60,,H(D AV= 6 :a;a3! ,3n9;.

B3<9,<ra >)r. 3n2a,a;<r 7VSH 9><r a@@ra; >)r. an,3@. PFR )3>29n@;3 ,3;a r>;r3@;3a

>ra <:>;r9@;3a >ra - ;<; ar:<r :r<n>3@D VEMS1 3;r9. Ra)3<(ra23a ;<ra@3@a

3)n;3a?a )>n 3n;r>;3;3a 3n2ra3ar :3a;. a@@n;9a;D :9;<n a<r;3@ @a@323@a;D <-a@3;a;3 3nar>@arD 33 23:r<>3 a>@n>3<na;3 @9 @a@323@ar3.

In 9r,a ana,n?3 a a,n993 @3n3@ >3 -ara@3n3@ > >;a:3>; )3a(n<>;3@9 ) ,a3 >9>.

P -ar@9r>9 3n;rnar33 a 9r,a; ;ra;a,n; an;3:3<;3@ 7 A,<3-9> 1. ( '1 (!?3 -@;<ran;

:r<n<)3a;a;<r. HHC a n<3,3<233n an;33n2a,a;<r an;3a(3@ @9 <9;3 2a<ra:3a)3>-na >a a,3<ra; 3ar ;9> a r,3>.

S ;rn?a @9 r@<,an)ar3

r(3, a3,n;ar 3-<><)a; >3 @33:ra; @a<r3@D rn9n;ara a 29,a;D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

;ra;a,n; ,)3@a,n;<> @9 SIRIVA 18 ,3@r<(ra, 1 @->! ?3D SERETI4E &0! &0 ,3@r<(ra, 1 -92! ?3D


>a 3:ra; r;;a @<,-n>a;a -n;r9 < 9na >r3a nr. D @<n;3n9ara ;ra;a,n;993 @ar)3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>D

@<n>9 @ar)3<<(3@D


,<n3;<r3?ar -r3n ,)3@9 ) 2a,33.PNEUMONIE LS4.

TUBERCULOZA PULMONARA SECUN4ARA NO4ULAR. INFILTRATIV L4 BAAR

NEGATIV LA MICROSOPIE CULTURI IN LUCRU CAZ NOU AFLATA SUB SCHEMA I4E TRATAMENT.

INFECTIE URINARA OASA.

S4R HEPATOCITOLIZA.


1,.07.11 07:9, : ALAT=1'0 U!L ASAT=1 U!L B33r9:3na ;<;aa=0./ ,(!) C<>;r<=1'8 ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=11 U!L GGT=8

U!L G3@,3=81 ,(!) L4H=/08 U!L Pr<;3n ;<;a=%.' ,(!) Tr3(3@r3)=66

,(!) Ur=1 ,(!)

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1,.07.11 /9977;1.07.2011 : S-9;a Fr<;39 BAAR A=NEGATIV S-9;a Fr<;39 BAAR

B=NEGATIV

1,.07.11 08:20 :VSH 71=&/ ,, VSH 7= ,,

1,.07.11 10:20 :Ta:<9 >an(3n=PMN = &/

EO =/

BA =L = 8

MO = /

4>@r3r

1.07.11 07:0, : 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n( 4;@;ara 9@<@3;<r 7P=-<?3;3

4;@;ara -r<;3n<r 7A=-<?3;3 S)3,n; 9r3nar='0/0 9@<@3;!@ 68 @.

-3;3a -a;!@' ,a;33 )@<!@rar 9r3,9@9> 2. :a@;r3ana

18.07.11 07:0 :ALAT=11& U!L ASAT=86 U!L B33r9:3na ;<;aa=0./ ,(!) Cra;3n3na=0. ,(!) Pr<;3n ;<;a=%.0 ,(!) Ur=1 ,(!)

22.07.11 07:,0 : Ca@39 ;<;a=./ ,(!) Ma(n?39=.0 ,(!)

R4R toracica: 33 @<n(>;33 )>n 3n;r>;3;3a a@@n;9a :3a;raD ,9;3- <-a@3;a;3 n<)9ar

>3 3nar 9n @9 ?<n ) 3-r;ran>-arn;a @ >@;a?a -r; -r<-r39 )3>,3na; a n39,3;<ra@93 )ra-;.

E<4: R> AV= %& :a;a3! ,3n9;D a RS a 0 (ra) 2ara ,<)323@ar3 3>@,< ?3<na.

E)-!R-A:

Pa@3n;a 3n ar>;a ) 1an3 n29,a;<rar 2ara APP >,n323@a;3 > 3n;rna?a -n;r9 ;9>

>a@a a>;n<a)3na,3)3>-n a 2<r; ,)39,ar 2a;3(a:33;a; 3na-;n;a >@a)r -<n)raa 7 a-r<3,a;3 & ( 3n 9n3 2:ra 7'. (ra) C 2r3><an ;ran>-3ra;33 -r)<,3nn;

n<@;9rn K9n(3 ;<ra@3@ an;r3<r @9 3ra)3r -<>;r3<ara a,;3 @2a >3,-;<, a@r:a;

3n 9;3,a >a-;a,ana an;r3<r 3n;rnar33. O:3@;3 a 3n;rnar -a@3n;a >9:2:r3a @9 >;ar(nraa 3n29n;a;a ;(9,n; ;ran>-3ra; 3,:a >a:9raaD -9,<nar ;<ra@ a>;n3@ MV

3na>-r3; :a?a :3a;ra 2ara ra9r3 >9-raa)a9(a;D TA= 100!60,,H(D AV= %/ :a;a3! ,3n9;.

B3<<(3@ >)r. 3n2a,a;<r7 VSH a@@ra; >)r ) -a;<@3;<3?a. a,n9 >9,ar a 9r3n33)n;3a?a 9@<@3;9r3 >3 -r<;3n9r3 9><ara.

R(2 ;<ra@3@a 3)n;3a?a ?39n3 ,a3 -r<:a:3 >-@323@ 3ar a,n9. >-9;3 >; BAAR n(a;3

a M 7C 3n 9@r9. 4a;<r3;a 2a-;993 @a @a r(r ;<ra@3@a 3)n;3a?a ?39n3 ,a3 -r<:a:3 >-@323@

> )3@9;a @a?9 3n C<,3>3a ) TBC >3 > <;ara>; 3n3;3ra ;ra;a,n;993 TSS 3n >@,a I %!%HR @->!?3 Z '@-r.?3 E ' @-r!?3.

In3;3a >a a),3n3>;ra; ;ra-3 an;3:3<;3@a n>-@323@a C3-r3n< 1 2!?3/ ?3 9;r3<r B3>-;<

@-r!?3 9;r3<r >a a),3n3>;ra; TSS 3n >@,a HRZE %!% HR @->!?3 Z '@-r.?3 E '@-r!?3. 3ar a><@3a; >a a),3n3>;ra; 3;. B6 -r<;@;<r (a>;r3@ -r<;@;<r -a;3@ an;33>;a,3n3@

an;3;r,@ an;33n2a,a;<r >3 ) r@33:rar 3)r<@;r<3;3@a. P -ar@9r>9 3n;rnar33 -a@3n;a a

-r?n;a; r9-;3 @9;ana;a r3;,a;<a>a -r9r3(3n<a>a -r)<,3nan; a n39 2;3 3n;r-r;a;a @a

233n) ra@;3 ar(3@a a a),3n3>;rara ) C3-r3n< ,<;3 -n;r9 @ar > >3>;a?a ;ra-3a @9C3-r3n<.

T<ran;a a ;ra;. a 2<>; :9na > ;rna?a a,3<ra; @9 3n)3@a;33

r(3, a3,n;ar @33:ra; @a<r3@D

,<n3;<r3?ara 29n@;33 -a;3@D

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@<n>9; (a>;r<n;r<<(3@D

!ontinatea "++ in sc?ema 'RE 7;7 pana la "2: 'GR( 2 cps;ziC )$( 9 cpr;ziC E$B( 9

cpr;ziC apoi 'R 9;7 pana la "6 sub control prin A".

A><@3a; > a a),3n3>;ra 3; B6 -r<;@;<r (a>;r3@ -r<;@;<r -a;3@D

r3n a @<n;r< ->; 1 9naD

,<n3;<r3?ar -r3n 4AT Mara,9r>.

)&E#$%&-E *- "RE&A&"A

3-BR%A )#*$%&ARA *-

)A'-)*E#R-"A )%+"ER%BAA*A +- *A"ER%"%RA!-!A REA)"A

RE"RA!"-*A.

'E)A"%$E4A*-E /5

Analize de laborator:2.07.11 08:2 :

5BC=6./ *10!"L L+,-#= *10!"L M3)#=0.& *10!"L Gran#='. *10!"L

L+,-$='0. $ M3)$=%.8 $ Gran$=61.' $ HGB=1&.1 (!) RBC=/.&810*10!"L HCT=/%.' $ MCV=* 10'.' 2L MCH='. -( MCHC='1. (!)

R45CV=1'. $ R45S4=&'.& 2 PLT=16' *10!"L MPV=.1 2L P45=1&.

$ PCT=0.1/8 $ VSH 71=/ ,, VSH 7=8 ,,

RGF stand. PA-opacitati reticulo-nodulare de intensitate costala bazal dr., hili fibrozati cu calcificari.

%* toracic -Atasat copiePFR- !"92"/ 1.09.2011- obstructie usoara in periferie

#P$%R$&A- !olnav in varsta de ani, fumator, "A?, fara A"" semnificative, se prezinta pentru

evaluare clinico-biologica in conditiile in care de apro'imativ luni prezinta episoade frecvente de tuseseaca, uneori tuse cu e'pectoratie mucopurulenta, dureri toracice cu caracter de intepatura la nivelultoracelui anterior si posterior, transpiratii, astenie, adinamie8 simptome se e'acerbeaza in ultimele zileanterior internarii. 6n data de 5.5.11 a efectuat consult pneumologic cand pe radiografia toracica sedeceleaza opacitate bazala dr. si se recomanda tratament antibiotic si simptomatice. "acientul sisteazadin propria initiativa administrarea medicatiei dupa zile. Simptomatologia persista8 pacientul seinterneaza pentru diagnostic si tratament de specialitate.7biectiv - la internare2 starea generala usor modificata, transpiratii nocturne8 p'()onar 2 torace astenic,)( diminuat si raluri subcrepitante la nivelul hemitoracelui drept bazal.&adiografia pulmonara -evidentiaza opacitati bazale drept cu aspect mai probabil de fibroza, dar. pt. ca sepun probleme de dgn. diferential se recomanda ;T toracic.;T toracic- descrie modificari de pahipleurita postero-bazala si latero-toracica dreapta cu aspecte defibroza pulmonara adiacenta si hepatomegalie."e baza datelor clinice si paraclinice s-a stabilit diagnosticul de mai sus.

A urmat tratament antibiotic, antitermic, antialgic, e'pectorant, cu evolutie favorabila. Se e'terneaza curecomadarile2

Reco)andari-consult gestroenterologic hepatomegalieF

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B)%! A!#"-A" +". -- 4%*

)&E#$%&-E -&"ER+"-"-A*A

!%R )#*$%&AR !R%&-! !%$)E&+A"

-!! &>'A --'"AE +". -- R-+! A-"-%&A* $E-#

AR-"$-E E="RA+-+"%*-!A E&"R-!#*ARA

%BE-"A"E $%RB-A A&%$ E )R%+"A"A +%&A" #RE"R%(E-!A*

+R. )%+""R%$B%"-! $B. -&3. B-*A"ERA*

-&+#3-!-E&"A E&%A+A !R%&-!A

$A* )ER3%RA&+ )*A&"AR +"4. )%+""RA#$A"-!


27.06.11 07:,1 :

5BC=&.6 *10!"L L+,-#=* 1./ *10!"L M3)#=0.& *10!"L Gran#='.% *10!"L L+,-$=&.1 $ M3)$=8. Gran$=66.% HGB=* 11.% (!) RBC=* /.1& 10*10!"L HCT=* '&.'

$ MCV=8&. 2L MCH=8.1 -( MCHC=''.1 (!) R45CV=1/./ $ R45S4=/&.% 2PLT='% *10!"L MPV=. 2L P45=16 $ PCT=0.18 $D

Ta:<9 >an(3n=PMN = %0 EO = 6 BA = L = MO = . 4>@r3r ,a;33 3n 23>3@9r3. VSH71=% ,, VSH 7=&& ,, ALAT=11 U!L ASAT=8 U!L B33r9:3na ;<;aa=0.' ,(!)

F<>2a;a?a a@a3na=1/ U!L GGT=1/ U!L G3@,3= ,(!) L4H='6/ U!L Pr<;3n

;<;a=6.% ,(!) Cra;3n3na=0.8 ,(!) Ur='8 ,(!). SO=8$.

27.06.11 07:,2 :

S-9;a Fr<;39 BAARA=NEGATIV '0%0!%.06.011 S-9;a Fr<;39 BAARB=NEGATIVS-9;a Fr<;39 BAARC=NEGATIV

R43 stand. )A)>n 3n;r>;3;3a a@@n;9a; :3a;ra 33 23:r<?a;3 a>@n>3<na;3 ,ar3;3 @9@a@323@ar3 @<r) (<:a ,ar3;.

)3R 68962( )3>29n@;3 n;3a;<r3 <:>;r9@;3a 9><ara - :r<n33 ,ar3 >3 ,3@3. . R)9@ra

VEMS @9 /0$.

E)-!R-A B<na 3n ar>;a ) &/ an3 29,a;<r 0 PA @9n<>@9; @9 BPOC >;a)39 II GOL4CPC HTAE >;a)39 II r3>@ ,)39 <:?3;a; ,<r:3)a ar3;,3 ;ra>3>;<3@a n;r3@9ara

3n>923@3n;a n<a>a @r<n3@a a)n<, ) -r<>;a;a >3n)r<, -<>;;r<,:<;3@ ,,:r >9-r3<ar

:3a;ra a2a; >9: ;ra;a,n; @9 439r &0,( 101;:!?3 C<r)ar<n 00,( 100;:!?3. F9r<>,3)

/0,( 1;: a ?3 Tr<,:<>;<- 1!00;:!?3 > -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra 2:ra7;='8' (ra) C>39> ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r; ,)39 ;ran>-3ra;33

-r)<,3nn; n<@;9rn )9rr3 ;<ra@3@ >3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa 9><r a;ra;a ;(9,n; -a3) <:?3;a; (r. III

;ran>-3ra;33 n<@;9rnD pulmonar: ;<ra@ (<:9<> MV 3na>-r3; :3a;ra ra9r3 @r-3;an; :a?a

:3a;ra.

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7/24/2019 69625104-epicrize


B3<<(3@ an,3 9><ara ,a;33 3n 23>3@9r3 3n ;a:<9 >an(3n. Ea,n9 :a@;r3<<(3@ -n;r9

BJ )3n >-9;a ra a:>n;a BAAR 7C 3n 9@r9.

Ra)3<(ra23a -9,<nara >;an). PA)>n 3n;r>;3;3a a@@n;9a; :3a;ra 33 23:r<?a;3a>@n>3<na;3 ,ar3;3 @9 @a@323@ar3 @<r) (<:a ,ar3;.

PFR ( )3>29n@;3 n;3a;<r3 <:>;r9@;3a 9><ara - :r<n33 ,ar3 >3 ,3@3. . R)9@ra VEMS @9

/0$.P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.

P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@ an;3;r,3@ an;3a(3@ an;3,;3@

-r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.S ;rna?a @9 r@<,an)ar3

;ra;a,n; @9 S-3r3a 1@-?>!?3 sau I-ran; ' -922!?3

Vn;<3n -922 a n<3

ra9ar cardiologica urologica @<n;3n9ara ;ra;a,n;993 r@<,an)a; ) @a;r ,)3@9

>-@3a3>;

)3>-n>ar3?ar -n9,<<(3@a ->; ' 9n3 @9 :3; ) ;r3,3;r ) a ,)3@a ) 2a,33 >3

)<a)a ) a>3(9ra; 7@9-<n ) -n>3 )3n 9;3, ' 9n3 @an)ar3>;3@

BRONSIECTAZII SUPRAINFECTATE.

PNEUMONIE LIS.

FIBROZA PULMONARA 4IFUZA I4IOPATICA.

HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULARMO4ERAT.

CAR4IOPATIE ISCHEMCA ANGINA PECTORALA 4E EFORT.

AVC ISCHEMIC IN ANTECE4ENTE.


90.06.11/9172;90.06.2011 :S-9;a Fr<;39 BAAR A=NEGATIVFr<;39 BAAR B=NEGATIV

Fr<;39 BAAR C=NEGATIV

90.06.11 07:27 : Gran#=/.8 *10!"L Gran$=&.8 $ HCT=/0 $ HGB=1.8 (!) L+,-#='.& *10!"L L+,-$='. $ MCH=.8 -( MCHC=' (!)

MCV='./ 2L M3)#=0.% *10!"L M3)$=8 $ MPV=6.% 2L PCT=0.1/ $

P45=1&.' $ PLT='0 *10!"L RBC=/. 10*10!"L R45CV=1'.& $ R45S4=/6.' 2 5BC= *10!"L VSH 71=6& ,, VSH 7=10 ,, ALAT= U!L

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ASAT=1 U!L B33r9:3na ;<;aa=0./ ,(!) Cra;3n3na=0.% ,(!) F<>2a;a?a

a@a3na=180 U!L G3@,3=0 ,(!) L4H='1 U!L Pr<;3n ;<;a=8. ,(!)

Ur='1 ,(!)

0,.07.11 12:0 : LaaK :r<n>3<<a<ar E. @3;<<(3@=Nr. ;<;a @9 = /8 1000000 !

,3@r<3;r9. Ma@r<2a( = %/.%&$ L3,2<@3; = 1%& $ PMN = &$ E<?3n<23 = 1&$

0,.07.11 12:2 :A>-3ra; :r<n>3@ C9;9r3 ar<:=N9 >a9 )?<;a; (r,n3. A>-3ra; :r<n>3@ Fr<;39 Gra,=Fr<;39 a@9ar.

07.07.11 0:0, :Gran#=/.& *10!"L Gran$=&&. $ HCT='%.6 $ HGB=11.8 (!)

L+,-#='.1 *10!"L L+,-$='8./ $ MCH=. -( MCHC='1.' (!) MCV='.1 2L M3)#=0.& *10!"L M3)$=&.% $ MPV=6.8 2L PCT=0.1% $

P45=1&./ $ PLT=6/ *10!"L RBC=/.0/ 10*10!"L R45CV=1'.6 $ R45

S4=/6.' 2 5BC=8.1 *10!"L

3R = -<?3;3 7Y. )!R -<?3;3a 7 A+*%= /00! UL

)3R/967,;28.06.2011: d3>29n@;3 n;3a;<r3 ,3;a r>;r3@;a ,<)ra;a <:>;r9@;3a 9><ara 3n

;<; ar:<r :r<n>3@. r)9@ra VEMS @9 '/$.

Rgr toracica: ,9;3- ,3@r<<-a@3;a;3 n<)9ar >3 3nar )3>,3na; 3n a,:33 @a,-3 -9,<nar3D

<-a@3;a; -ara@ar)3a@a >;an(a ra;3 <,(naD33 @<n(>;33.E<4: R> AV= 60 :a;a3! ,3n9;D a r> a 0 (ra)D 2ara ,)23@ar3 3>@,< ?3<na.

!" toracic /01.07.2011 dr +tanescu 4.: - 2<n)9 9n3 23:r<? -9,<nar )329? )ar 3n;n>

:3a;ra a-ar ,)323@ar3 3,-<r;an; :r<n>3@;a;3@ @9 -r3:r<n>3;a >3 :r<n>3@;a?33 :a?a

:3a;ra ,a3 ;3n> 3n >;an(a 9n) a-ar >3 9n a>-@; ) >9-ra3n2@;3.2ara @<@;33 3@3)3n.M)3a>;3n 2ara ,a> (an(3<nar >,n323@a;3 )3,n>3<na. Hrn3 3a;aa ,3n3,a. Pr;

;<ra@3@ 2ara ,<)32@ar3 )n>3;,;r3@. a3ar n9 a-ar ,a> (a(3<nar >,n323@a;3 )3,n>3<na.

F3@a; >-3na r3n3@3 :3a;ra >3 (a) SR 2ara ?39n3 2<@a.

C<n@9?3 a>-@; CT ) :r<n>@;a?33 :3a;ra >9-ar3n2@;a;a 3n >;an(a. Hrn3 3a;aa ,3n3,a.

3ibrobron?oscopia/1019;0,.2011 dr +imon $.: ;raa 3:ra. P3n;n ;raa n<r,a.

Ar:<r :r<n>3@ :3a;ra 3:r. S@r;33 ,9@<-9r9n; :r L3n(9ara 7 :rn>3@;a?33>9-ra3n2@;a;.

*aa bron?oaleolar:( a;a>a; @<-3 3,2<@3;<?a >3 <?3n<233

E)-!R-A:

Pa@3n;a 3n ar>;a ) 6 an3 n29,a;<ar @9n<>@9;a @9 an;@)n; -r><na

@ar)3<a>@9ar7HTA CIC> 3n;rna?a -n;r9 ,<)323@ara >;ar33 (nra ;9> @9-@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r; ,3@ a>;n<a)3na,3 2a;3(a:33;a; >@a)ra

;<ran;3 a 2<r; ;ran>-3ra;33 >3,-;<, a@r:a; 3n 9;3,a >a-;a,ana an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; @<r)<an ar3@<a> a

n39 ,,:r<r 3n2r3<ar :3a;raD -9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3@r-3;an; :a?a >;anD TA= 1'0!%0 ,H(D AV= %/ :a;a3! ,3n9;.

B3<<(3@ >)r. 3n2a,a;<r 7VSH ,9; a@@ra; PCR -<?3;3aD FR -<?3;3. Ea,n9 >-9;3 -n;r9 BJ >; n(a;3 a ,3@r<>@<-3 @9;9r3 233n) 3n 9@r9. PFR )3>29n@;3 ,3;a r>;r3@;3

,<)ra;a <:>;r9@;3 9><ara 3n;<; ar:<r :r<n>3@.

Ra)3<(ra23a -9,<nara 3)n;3a?a ,9;3- ,3@r<<-a@3;a;3 n<)9ar >3 3nar )3>,3na; 3n

a,:33 @a,-3 -9,<nar3D <-a@3;a; -ara@ar)3a@a >;an(a ra;3 <,(na. S r3)3@a >9>-3@39na 9n3TBC -9,<nar @ar a 2<>; 3n23r,a;a -r3n a,n9 >-9;3 -n;r9 BJ BAAR n(a;3 a

153

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,3@r<>@<-3 @9;9r3 3n 9@r9. Sa 2@;9a; CT ;<ra@ >3 23:r<:r<n<>@<-3 -n;r9 a @9)

-r?n;a 9n93 -r<@> -r<32ra;3 :r<n<-9,<nar.CT ;<ra@3@ 3)n;3a?a :r<n>@;a?33 :3a;ra

@9 >9-ar3n2@;3 -r),3nan; :a?a >a;n(. F3:r<:r<n<>@<-3a )>@r3 a>-@; ) :r<n>3@;a?33>9-ra3n2@;a;. In aaK9 :r<n<a<ar > 3)n;3a?a 3,2<@3;<?a >3 <?3n<233. Aan) 3n

)r a>-@;9 ra)3<<(3@ a,3nar3 ) a:<ra;<r7FR -<?3;3 PCR -<?3;3a >3 r?9;a;9

)>@r3> )3n aaK9 :r<n<a<ar > r3)3@a >9>-3@39na 9n3 :<3 ) >3>;,D > r@<;?a -r<:) >an( -n;r9 3,9n<<(3 -n;r9 a 3n23r,a >a9 @<n23r,a -r?n;a 9n3 :<3 ) >3>;,.


A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> '1 2!?3 Gn;a,3@3na 80 ,( 12!?3 an;3;r,3@an;3a(3@ -@;<ran; an;33n2ana;<r 3;a,3n -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a;

;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 2a<ra:3a.


r(3, a3,n;ar 3-<><)a; >3 @33:ra; @a<r3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

;ra;a,n; ,)3@a,n;<> @9 TAVANIC &00 ,( 1 @-r!?3 7% ?3D ER4OME4 '00,( 1 @->!?3 7% ?3D

3n )9-a r?9;a;9 ana3?<r a2a; 3n 9@r9D

r3n a @<n;r< ->; 6 9n3 3n a:>n;a a@r:ar3<rD )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

PNEUMONIE INTERSTITIALA.


TBC PULMONAR SECUN4AR FIBRON4ULAR LS BILATERAL M4R CU REZISTENTAPRIMARA BAAR NEGATIV LA MICROSCOPIE CULTURI IN LUCRU.

COR4 PULMONAR CRONIC.

4ESHI4RATARE.


1,.07.11 07:,0 : Gran#=/.& *10!"L Gran$=61. $ HCT=/. $ HGB=1&.' (!) L+,-#=. *10!"L L+,-$=.8 $ MCH=' -( MCHC='0.6 (!)

MCV=10/.6 2L M3)#=0.6 *10!"L M3)$=8.' $ MPV=%. 2L PCT=0.'0/ $

P45=1&.' $ PLT='8& *10!"L RBC=/.%8 10*10!"L R45CV=1/. $ R45

S4=&6.% 2 5BC=%.' *10!"L VSH 71=& ,, VSH 7=1' ,, ALAT='& U!L ASAT='6 U!L B33r9:3na ;<;aa=1.8 ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a

a@a3na=1'% U!L GGT=/ U!L G3@,3=100 ,(!) L4H='& U!L Pr<;3n

;<;a=%./ ,(!) Tr3(3@r3)=&& ,(!) Ur='/ ,(!)

1,.07.11 11:21 : B33r9:3na )3r@;a=0. ,(!)

Examne sputa: /9978;1.07.2011: BAAR A n(a;3D

BAAR B n(a; @9;9r3 3n 9@r9.

)3R: )3>9n@;3 n;3a;<r3 ,3;a r>;r3@;3a 9><ara <:>;r9@;3a ,)3 3n ;<; ar:<r :r<n>3@,a3 a@@n;9a;a 3n -r32r3. R)9@ra VEMS @9 & $.

Rgr toracica /,986,987;1,.07.2011: ,9;3- <-a@3;a;3 ,3@r<n<)9ar 23:r<@a@ar >3 <-a@3;a;3

3nar )3>,3na; 3n;r>@a-9<r;:ra a-3@a )ar >3 3n2ra3ar :3a;ra a>-@; >@ar.

E<4: R> AV= %& :a;a3! ,3n9; a RS a &0 (ra) 2ara ,<)323@ar3 ) 2a?a ;r,3naa.

E)-!R-A:

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Pa@3n; 3n ar>;a ) &6 an3 29,a;<r a /0PA @9n<>@9; @9 an;@)n; -r><na -a;<<(3@

-9,<nar 7TBC -9,<nar >@9n)ar M4R @9 r?3>;n;a -r3,ara > 3n;rna?a -n;r9 ;9> >a@a

3n3;3a 9;r3<r @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r; ,)39 a>;n<a)3na,32a;3(a:33;a; >@a)ra ;<ran;3 a 2<r; 3na-;;n;a ;ran>-3ra;33 -r)<,3nn; n<@;9rn

>3,-;<, a@r:a; 3n 9;3, )<9a >a-;a,an3 an;r3<r 3n;rnar33. S3,-;<,a;<<(3a -r?n;a;a

) @a;r -a@3n; r3)3@a >9>-3@39na r@;3ar33 TBC -9,<nar.O:3@;3 a 3n;rnar -a@3n; a2:r3 @9 >;ara (nraa 9><r 3n29n;a;a ;(9,n; 9>@a; -39

;(9,n;ar -r>3>;n; ;an(3@;a?33 2a@3aD -9,<nar ;<ra@ @32<;3@ MV 3na>-r3; @9 -3r

-r9n(3; ra9r3 @r-3;an; 3n 1! 3n2r3<ar a a,:3<r @a,-3 -9,<nar3 >3 rar >3:3an; TA=1'0!80,,H( AV= %8 :a;a3! ,3n9;.

B3<9,<ra >)r 3n2a,a;<r 7VSH a@@ra; >)r an,3@ BT >3 B4 9><r @r>@9;a. PFR )3>9n@;3

n;3a;<r3 ,3;a r>;r3@;3a 9><ara <:>;r9@;3a ,)3 3n ;<; ar:<r :r<n>3@ ,a3 a@@n;9a;a 3n

-r32r3. Ra)3<(ra23a -9,<nara 3)n;3a?a ,9;3- <-a@3;a;3 ,3@r<n<)9ar 23:r<@a@ar >3<-a@3;a;3 3nar )3>,3na; 3n;r>@a-9<r;:ra a-3@a )ar >3 3n2ra3ar :3a;ra. S r3)3@a

>9>-3@39na ra@;3ar33 ;9:r@9<?3 -9,<nar ,<;3 -n;r9 @ar > 2@;9a?a a,n9 B a

>-9;3. Ea,n9 >-9;3 -n;r9 BJ >; BAAR n(a;3 a ,3@r<>@<-3 @9;9r3 233n) 3n 9@r9.

Pn;r9 a @9) @9 @r;3;9)3n ra@;3ara T9:r@9<?3 -9,<nar ;r:93 >a a>;-;a, r?9;a;9@9;9r3<r BJ.

In 9r,a ana,n?3 a a,n993 @3n3@ >3 - :a?a )a;<r -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ),a3 >9>.

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:r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3n >3 ) r@33:rar3)r<@;r<3;3@a @9 <9;3 2a<ra:3a.


r(3, a3,n;ar @33:ra; @a<r3@D rn9n;ara a 29,a;D


(3,na>;3@a r>-3ra;<r3 @9 @r>;ra ;<ran;3 a 2<r;D ;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->!?3D

VENTOLIN 100 ,3@r<(ra, -929r3 a n<3.

r3n )9-a r?9;a;9 @9;9r3<r BJ ->; 9n3D

,<n3;<r3?ara PFR a ' 9n3D r3n a @<n;r< ->; 6 9n3 3n a:>n;a a@r:ar3<rD

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

BOALA PULMONARA CRONICA OBSTRUCTIVA ST4 II GLO4 IN EACERBARE.TBC PULMONAR SECUN4AR FIBRONO4ULAR LS BAAR NEGATIV LA


ANEMIE SECUN4ARA.

4ESHI4RATARE.


12.07.11 08:1, : Gran#='.6 *10!"L Gran$=&.' $ HCT=/1. $ HGB=1'. (!) L+,-#=1. *10!"L L+,-$='1. $ MCH='0./ -( MCHC='1.& (!)

MCV=6.6 2L M3)#=0.6 *10!"L M3)$=.& $ MPV= 2L PCT=0.1/ $

P45=1&. $ PLT='8 *10!"L RBC=/.'/ 10*10!"L R45CV=1/./ $ R45S4=&1. 2 5BC=6.1 *10!"L VSH 71=& ,, VSH 7=/ ,, ALAT=8 U!L

155

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ASAT=1% U!L B33r9:3na ;<;aa=0.' ,(!) Cra;3n3na=1.0 ,(!) F<>2a;a?a

a@a3na=1& U!L GGT=1 U!L G3@,3=8% ,(!) Pr<;3n ;<;a=%./ ,(!)

Ur='1 ,(!)

19.07.11 0:, /99,;19.07.2011:S-9;a Fr<;39 BAAR A=NEGATIV


S-9;a Fr<;39 BAAR C=NEGATIVR43 stand. )A)>n 3n;r>;3;3a a@@n;9a; :3a;ra 33 @<n(>;3<na;3 <-a@3;a;3 3nar ) 3n;n>3;a;

@<>;aa -r)<,3nan; 3n2ra3ar :3a;ra. A>@n>3<nar )3a2ra(,a;3@a.

E!4 RS AV= 6/ :a;a3! ,3nD a RS a 0 (ra) 2ara ,<)32@ar3 3>@,<?3<na.

)3R/6826;0,.07.2011 )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3a

,<)ra;a >(,n; @n;ra >3 >ra 3n -r32r3. R)9@ra VEMS @9 &0$.

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7Pr<;?a @<<2,9raa )ra-;a> 3n;rna?a -n;r9 >9>-3@39na ra@;3ar3 TBC -9,<nar. La3nrnar -a@3n;9 -r?n;a ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r;9r3 ,<)ra;

a>;n<a)3,an3 2a;3(a:33;a; >@a)ra ;<rn;3 a 2<r; 3na-;;n;a >@a)r -<n)raa

;ran>-3ra;33 -r)<,3nan; n<@;9rn >3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; ;ran>-3ra;D -9,<nar ;<ra@

a>;n3@ MV 3na>-r3; @9 -3r -r9n(3; ra9r3 r<n2an; )3>,3na; 3n a,:33 @a,-3 -9,<nar3ra9r3 @r-3;an; :a?a :3a;raD TA= 1'0!80,,H(D AV= %0 :a;a3! ,3n9;.

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r>;r3@;3a ,<)ra;a <:>;r9@;3a ,<)ra;a >(,n; @n;ra >3 >ra 3n -r32r3D r)9@ra

VEMS @9 &0$.Ra)3<(ra23a -9,<nara 3)n;3?a <-a@3;a;3 3nar ) 3n;n>3;a; @<>;aa -r)<,3nan; 3n2ra3ar

:3a;ra >3 a>@n>3<nar )3a2ra(,a;3@a @a @ r3)3@a >9>-3@39na 9n3 ra@;3ar3 TBC -9,<nar. S

2@;9a?a a,n9 BJ a >-9;3 -n;r9 @9)ra ra@;3ar33 TBC -9,<nar. Ea,n9 >-9;3 -n;r9 BJ >; n(a;3 @9;9r3 233n) 3n [email protected];r9 a a3r,a @9 @r;3;9)3n @a n9 >; ra@;3ar TBC

-9,<nara ;r:93 >a a>;-;a, r?9;a;9 @9;9r3<r BJ.

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A 9r,a; ;ra;a,n; an;3:3<;3@7C3-r3n< 1 2!?3HHC an;33n2a,a;<r an;3a(3@ -@;<ran;

:r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3n >3 ) r@33:rar3)r<@;r<3;3@a @9 <9;3 2a<ra:3a.


r(3, a3,n;ar @33:ra; @a<r3@D rn9n;ara a 29,a;D

a@@3nar an;3(r3-aa an9aaD ;ra;a,n; ,)3@a,n;<> @9 SPIRIVA 18 ,3@r<(ra, 1 @->!?3D SERETI4E &0!&0 ,3@r<(ra, 1 -92! ?3D


>a 3:ra; r;-a -; < 9na >r3a CSBB nr. '%/%/6. r3n )9-a r?9;a;9 @9;9r3<r BJ.


)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

156

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BPOC ST4 II GOL4

TBC PULMONAR SECUN4AR FIBRONO4ULAR BAAR NEGTIV LA MICROSCOPIE

CULTURI IN LUCRU.ANENIE SECUN4ARA.


27.07.11 08:9 :Gran#='.% *10!"L Gran$=6 $ HCT='8. $ HGB=1.& (!)

L+,-#=1.' *10!"L L+,-$=/.' $ MCH='1.8 -( MCHC='.% (!)

MCV=%.' 2L M3)#=0.' *10!"L M3)$=6.% $ MPV=8.1 2L PCT=0.11 $ P45=1&.% $ PLT=61 *10!"L RBC='.' 10*10!"L R45CV=1/ $ R45

S4=/.6 2 5BC=&.' *10!"L VSH 71=1 ,, VSH 7='/ ,, ALAT=8 U!L

ASAT=10 U!L B33r9:3na ;<;aa=0.% ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a

a@a3na=110 U!L G3@,3=1 ,(!) L4H=' U!L Pr<;3n ;<;a=%. ,(!) Ur=16 ,(!)

28.07.11 11:09 /&R.RE4.90;28.07.2011 : S-9;a Fr<;39 BAAR A=NEGATIV


)3R/727;26.07.2011: )3>29n@;3 ;3a;<r3 <:>;r9@;3a ,)3 - :r<n>3 ,ar3 >3 >ra -

:r<n>33 ,3@3. R)9@ra n;3a;33 ,a3, @9 /& $.

Rgr toracica /1029;26.07.2011: <-a@3;a3 23:r<n<)9ar :3a;ra LS 7 a>-@; >@ar . L<:3;ar;ra@;3a LSS

EPICRIZA

Pa@3n; 3n ar>;a ) /% an3 @9n<>@9; 3n an;@)n; @9 TBC -9,<nar 700 > -r?3n;a 3n>3@39 n<>;r9 -n;r9 ;9> @9 -@;<ra;3 @9 >;r39r3 >an(3n<n; 7 a23r,a;3 a>;n3 a)3na,3

>3 )3>-n -r)<,3<nan; -3ra;<r3 a 9n -a@3n; @9n<>@9; @9 BPOC. <:3@;3 a 3n;rnar

-9,<nar MV @9 -3r -r9n(3; rar ra9r3 :r<n>3@ )3>,3na;. Ra)3<<(3@ ?39n3 TBC2:r<n<)9ar :3a;ra -ar >;a33?a;. Ba@;r3<<(3@ a,n9 >-9;3 r-;a; >; BAAR

n(a;3 @9;r3 3n 9@r9. P -ar@9r>9 3n;rnar33 >-9; ,<-;<3@ n9 >a9 ,a3 r-;a; 3ar a

a,n9 <ra<2ar3n(3an > @<n>;a;a >an(rar3 a (3n(33<r @ar ar 23 -9;9; 3n)9@ 3n r<ar 3n -r33n;a ,<-;3?33<r ,a;3na. Ea,3nar3 ) a:<ra;<r 3)n;3a?a 9n >)r an,3@ @ar ar

-3@a >;ara ) a>;n3 >3 a)3na,3 )>@r3>a ) @a;r -a@3n;D >)r an,3@ @ar ;r:93 @<r@;a;.

PFR 3)n;3a?a )3>29n@;3 ;3a;<r3 <:>;r9@;3a ,)3 - :r<n>3 ,ar3 >3 >ra - :r<n>33

,3@3 @9 r)9@ra n;3a;33 ,a3, @9 /& $.In 9r,a ana,n?3 a a,n993 @3n3@ >3 -ara@3n3@ > >;a:3>; )3a(n<>;3@9 ) ,a3 >9>.

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r(3, a3,n;ar @3:ra; @a<r3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

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Vn;<3n -929r3 a n<3D

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r3n a @<n;r< ->; ' 9n3 3n a:>n;a a@r:ar3<rD

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B)%! A!#"-A" 3%R$A +EERA.

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"B! )#*$%&AR 3-BR%A" *+ B-*A"ERA*.

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'") +E!#&ARA.

!%R )#*$%&AR !R%&-! E!%$)E&+A".

)%*-) E !%ARA %!A*A %)ERA" -& A&"E!EE&"E.


0,.07.11 08:0 : Gran#=&.' *10!"L Gran$=%0. $ HCT=&.' $ HGB=1&.6 (!)

L+,-#=1.& *10!"L L+,-$=1.8 $ MCH=.1 -( MCHC=.8 (!)

MCV=%.6 2L M3)#=0.8 *10!"L M3)$=10 $ MPV=8.' 2L PCT=0. $ P45=1&.% $ PLT=68 *10!"L RBC=&.'6 10*10!"L R45CV=16.8 $ R45

S4=&.1 2 5BC=%.6 *10!"L VSH 71=1 ,, VSH 7=' ,, ALAT=1/ U!L ASAT= U!L B33r9:3na ;<;aa=1.1 ,(!) C<>;r<=116 ,(!) Cra;3n3na=0.%

,(!) F<>2a;a?a a@a3na=11/ U!L GGT=8 U!L G3@,3=%% ,(!) L4H=&%U!L Pr<;3n ;<;a=6.% ,(!) Tr3(3@r3)=/' ,(!) Ur=1& ,(!)

06.07.11 07:28 : Gran#=&.6 *10!"L Gran$=%1 $ HCT=&1.8 $ HGB=1&.% (!)

L+,-#=1.& *10!"L L+,-$=1. $ MCH=. -( MCHC='0.' (!) MCV=6.8 2L M3)#=0.8 *10!"L M3)$=.8 $ MPV=%.' 2L PCT=0.1/ $

P45=1&.' $ PLT=66 *10!"L RBC=&.'6 10*10!"L R45CV=1&.% $ R45

S4=&6.% 2 5BC=%. *10!"L

0.07.11 07:20 : 4;@;ara 3)ra;3<r ) @ar:<n 7Z=n( 4;@;ara 9@<@3;<r 7P=n(

4;@;ara -r<;3n<r 7A=n(

A+)R#):0,.07.2011: -= %.6D -O= 68,,H(D -CO= %/.,,H(D Sa;O= 0$ 0%.0%.011 -= %.'/D P<= 60./ ,,H(D -CO= 66.8 ,,H( Sa; O= 8. $

R43 stand. )A(<-a@3;a;3 r;3@9<n<)9ar ) 3n;n>3;a; @<>;aa >3 >9-ra@<>;aa )3>,3an;

:3a;ra -r)<,. a n3. LS :3a;ra 9n @9 ?<n ) 3-r;ran>-arn;a @ar >@3;a?a -r;

-r<-r39D )>n 3n;r>;3;3a a@@n;9a; :a?a :3a;ra 33 23:r<?a;3 a>@n>3<na;3 @9 @a@323@ar3.

E!4 RS AV= %& :a;a3! ,3n9;D HBAS HA4 9n) T n(a;3 V1V6.

)3R/6876;06.07.2011 )3>29n@;3 n;3a;<r3 ,3;a >ra - ;<; ar:<r :r<n>3@. VEMS

1.CT ;<ra@ 706.0%.011 )r G9;;,an T. a;a>a; @<-3.

C<n@9?3 F3:r<?a -9,<nara >;a;3<nara @9 :9 ) ,23?,. HTP. Fara a>-@; ) TU

:r<n<-9,<nara.

E)-!R-A:

Pa@3n; 3n ar>;a ) 60 an3 2<>; ,ar 29,a;<r a ->; &0 PA @9n<>@9; an;@)n; -r><na

-a;<<(3@ BPOC 2<r,a >ra @9 ;ra;a,n; 3n@<n>;an; In>923@3n;a r>-3ra;r3 @r<n3@a TBC -9,. 3n APP 711 -<3- CV )r. <-ra; 3n 00 @9 )3>2<n3 r>;an;a CPC ICC NHA II!III

HTA a2a; >9: ;ra;a,n; @ar)3<<(3@ > 3n;rna?a ) 9r(n;a -r9a; )3n >r3@39 UPU -n;r9

,<)323@ara >;ar33 (nra )3>-n @9 <r;<-n ;9> @9 -@;ra;3 ,9@<-9r9n;aK9n(3

158

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;<ra@3@ -<>;r3<r @2a a>;n<a)3na,3 2a;3(a:33;a; >@a)ra ;<ran;3 a 2<r; ;ran>-3ra;33

2r3><an >3,-;<, a@r:a; 3n 9;3, ?3 an;r3<r 3n;rnar33.

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-r9n(3; ra9r3 r<n2an; )3>,na; 3n a,:33 @a,-3 -9,nar3 ra9r3 @r-3;an; 3n 1! 3n2r3<ar

a a,:3<r @a,-3 -9,<nar3 Sa; O= 8$D TA= 110!60,,H( AV= 108 :a;a3! ,3n9;Da:)<,3na >n>3:33;a; )9rr<a>a a -a-ara -r<29n)a 3n ;aK9 >9-r3<r.

B3<9,<ra L4H @r>@9; 2ara a; ,<)323@ar3 >,n323@a;3. ASTRUP a@3)<?a r>-3ra;<r3

)@<,-n>a;a. PFR )3>29n@;3 n;3a;<r3 ,3;a >ra - ;<; ar:<r :r<n>3@. VEMS 13;r9.Ra)3<(ra23a -9,<nara 3)n;3a?a ,9;3- <-a@3;a;3 r;3@9<n<)9ar ) 3n;n>3;a; @<>;aa >3

>9-ra@<>;aa )3>,3an; :3a;ra -r)<,. a n3. LS :3a;ra 9n @9 ?<n ) 3-r;ran>-arn;a

@ar >@3;a?a -r; -r<-r39. S 2@;9a?a CT ;<ra@ @ar )>@r3 F3:r<?a -9,<nara )329?a >3

HTP 2ara a 3)n;3a a>-@; ) -r<@> -r<32ra; a n3 -9,<nar.In 9r,a ana,n?3 a a,n993 @3n3@ >3 a )a;<r -ara@3n3@ >a >;a:33; )(n. ) ,a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@7A,<3-9> '1 2!?3 >3 Gn;a,3@3na 12!?3 8 ?3 a-<3 C3-r3n<

1 2!?3 HHC an;3;r,3@ an;3a(3@ an;33n2a,a;<r -@;<ran; :r<n<)3a;a;<r an;3,3@<;3@

)39r;3@ -r<;@;<r (a>;r3@ 3;a,3n >3 ) r@33:rar 3)r<@;r<3;3@a @9 <9;3 2a<ra:3a.S ;rna?a @9 r@<,an)ar3

r(3, a3,n;ar 3-<><)a; >3 @33:ra; @a<r3@D

@r>;ra ;r-;a;a a ;<ran;3 a 2<r;D

a@@3nar an;3(r3-aa an9aaD ;ra;a,n; ,)3@a,n;> @9 IPRAVENT ' -929r3!?3

VENTOLIN 100 ,3@r<(ra, ' -929r3!?3

CLENIL ET -929r3!?3D >a 3:ra; R- @<,-n>a;a -; < 9na >r3a CSBB nr.........

3n)3@a;3 ) 3(n<;ra-3 a )<,3@339 3;r3 <3(n! <ra 10 <r!?3D

r3n a @<n;r< ->; ' 9n3 3n a:>n;a a@r:ar3<rD )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

PNEUMONIE LIS.

TBC PULMONAR SECUN4AR FIBRONO4ULAR BAAR NEGATIV LA MICROSCOPIECULTURI IN LUCRU.

CAN4I4OZA OROFARINGIANA.

4ESHI4RATARE.


07.07.11 08:,9 : Gran#=%. *10!"L Gran$=%0.8 $ HCT=/.8 $ HGB=1'.6 (!)

L+,-#=.6 *10!"L L+,-$='.& $ MCH='/. -( MCHC='1.% (!) MCV=108 2L M3)#=0.6 *10!"L M3)$=&.% $ MPV=%./ 2L PCT=0./16 $

P45=1&.& $ PLT=&6' *10!"L RBC='.% 10*10!"L R45CV=1'. $ R45

S4=&/.' 2 5BC=11.1 *10!"L VSH 71=11 ,, VSH 7='1 ,, ALAT='0U!L ASAT='0 U!L B33r9:3na ;<;aa=0. ,(!) C<>;r<=161 ,(!)

Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=1/6 U!L GGT=0 U!L G3@,3=101 ,(!)

L4H='8& U!L Pr<;3n ;<;a=%.1 ,(!) Tr3(3@r3)=6 ,(!) Ur=8 ,(!)

07.07.11 11:08 : Ta:<9 >an(3n=PMN = %

159

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7/24/2019 69625104-epicrize


HIPERTENSIUNE ARTERIALA ESENTILA ST4.II CU RISC CAR4IOVASCULAR

MO4ERAT.

CAR4IOPATIE ISCHEMICA ANGINA PECTORALA 4E EFORT.INSUFICIENTA CAR4IACA CONGESTIVA CLASA NHA II.

4ISLIPI4EMIE.

OBEZITATE GRA4UL II.


2.06.11 08:,1 : Gran#=&./ *10!"L Gran$=&&.1 $ HCT='./ $ HGB=1'.1 (!)

L+,-#='.& *10!"L L+,-$='6.1 $ MCH=% -( MCHC=''. (!)

MCV=81.6 2L M3)#=0. *10!"L M3)$=8.8 $ MPV=8. 2L PCT=0. $ P45=1&.& $ PLT='&% *10!"L RBC=/.8/ 10*10!"L R45CV=1'.1 $ R45

S4=/1. 2 5BC=.8 *10!"L VSH 71='1 ,, VSH 7=6 ,, ALAT=1/

U!L ASAT=10 U!L B33r9:3na ;<;aa=0.' ,(!) C<>;r<=66 ,(!) Cra;3n3na=0.6 ,(!) F<>2a;a?a a@a3na=1/ U!L GGT=18 U!L G3@,3=%8 ,(!)

Pr<;3n ;<;a=6.8 ,(!) Tr3(3@r3)=1'% ,(!) Ur=' ,(!)

R43 stand. )A @<r) (<:a ,ar3; 2a>@ - )3a2ra(, D )>n 3n;r>;3;3a a@@n;9a; :a?a :3a;ra 33

23:r<?a;3 a>@n>3<na;3 @9 @a@323@ar3.

E!4 R> AV= %& :a;a3! ,3n9; a RS a '0 (ra)D 2ara ,<)323@ar3 3>@,<?3<na.

)3R 766/&! %.06.011 )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3 ,<)ra;a

>(,n; @n;ra >3 >ra 3n -r32r3. R)9@ra VEMS @9 /6$

E)-!R-A

Pa@3n;a 3n ar>;a ) &0 an3 n29,a;<ar @9n<>@9;a @9 an;@)n; -r><na -9,<nar

7A>;,n :r<n>3@ -ar;3a @<n;<a;a2a; >9: ;ra;a,n; @9 S;) &0! &00 ,3@r<(ra, 1 -922! ?3 >3

Vn;33n 100 ,3@r<(ra, -929r3 a n<3 @ar)3<a>@9ar 7HTA ICC CI n)<@r3n 7 >)rC9>3n( 3a;r<(n> -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> @9 -@;<ra;3 ,9@<a>a

)3>-n a 2<r; ,)39! ,3@ a>;n3 2a;3(a:33;a >@a)ra ;<ran;3 a 2<r; >3,-;<,a@r:a; 3n 9;3,a >a-;a,ana an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar -a@3n;a >9-ra-<n)raa @9 >;ara (nraa ,)39 ,<)323@a;a ;(9,n;

;ran>-3ra;D -9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3 >3:3an; >3 r<n2an; )3>,3na; 3n

a,:33 @a,-3 -9,<nar3 ra9r3 @r-3;an; :a?a :3a;raD Ta=1/0!80,,H( AV= 8 :a;a3! ,3n9;.B3<<(3@ >)r. 3n2a,a;<r 7VSH a@@ra; 3-r@<>;r<,3. PFR )3>29n@;3 n;3a;<r3

,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3 ,<)ra;a >(,n; @n;ra >3 >ra 3n -r32r3.

R)9@ra VEMS @9 /6$Ra)3<(ra23a -9,<nara 3)n;3a?a @<r) (<:a ,ar3; 2a>@ - )3a2ra(, D )>n 3n;r>;3;3a a@@n;9a;

:a?a :3a;ra 33 23:r<?a;3 a>@n>3<na;3 @9 @a@323@ar3. P r(r ;<ra@3@a n9 > 3)n;a?a n<)99 -9,<nar a?9; 3n an;@)n; - CT9 ;<ra@[email protected] :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.

A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,3-9> 1. (!?3 an;3;r,3@ an;3a(3@ -@;<ran;

:r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ a @<n;3n9a; ;ra;. - @ar 3 9r,a a,:9a;<r@9 <9;3 2a<ra:3a.


161

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r(3 a3,n;ar 3-<><)a;D 3-<@a<r3@D 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

;ra;a,n; ,)3@a,n;<> @9 Sr;3) &0! &00 ,3@r<(ra, 1 -92 !?3D

Vn;<3n 100 ,3@r<(ra, -99r3 a n<3D >a :ra; R- -n;r9 < 9na Sr3a CSBB. nr '%/%/&8D

@<n;3n9ara ;ra;a,n;993 @ar)3<<(3@ >3 n)<@r3n<<(3@ -r>@r3> ) @a;r ,)@33 >-@3a3>;3D

r3n a @<n;r< ->; ' 9n3 7>3 -n;r9 ,n3;<r3?ara 3n <9;3 a n<)993 -9,<narD )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33D

PNEUMONIE LIS.

BOALA PULMONARA CRONICA OBSTRCTIVA ST4 II GOL4 IN EACERBARE.

BRONSIECTAZII SUPRAINFECTATEANEMIE SECUN4ARA.

STENOZA AORTICA ME4IE.

INSUFICIENTA TRICUSPI4IANA GR4 II.ETILISM CRONIC.

CONSILIEREA ABAN4ONULUI FUMATULUI CONSUMULUI CRONIC 4E ALCOOL


06.07.11 07:2 :Gran#=' *10!"L Gran$=&'./ $ HCT=/1.1 $ HGB=1'.1 (!)

L+,-#=.1 *10!"L L+,-$='%.& $ MCH=''.6 -( MCHC='1.8 (!) MCV=10&.% 2L M3)#=0.& *10!"L M3)$=.1 $ MPV=%./ 2L PCT=0.1% $

P45=1&.' $ PLT=6% *10!"L RBC='.8 10*10!"L R45CV=1'.' $ R45

S4=&1. 2 5BC=&.6 *10!"L VSH 71=1% ,, VSH 7=/' ,, ALAT=1/U!L ASAT=/ U!L B33r9:3na ;<;aa=0.6 ,(!) Cra;3n3na=0.8 ,(!) F<>2a;a?a

a@a3na=18' U!L GGT= U!L G3@,3=8& ,(!) L4H=//1 U!L Pr<;3n

;<;a=6./ ,(!) Ur=1 ,(!))3R/66117 ;06.07.2011: )3>29n@;3 n;3a;<r3 ,a r>;r3@;3a 9><ara <:>;r9@;3a ,<)ra;a 3n;<; ar:<r :r<n>3@ ,a3 a@@n;9a;a 3n -r32r3. R)9@ra VEMS @9 '$.

EJG R> AV= %& :a;a3! ,3n a RS a 80 (ra) 2ara ,<)323@ar3 3>@,<?3<na.

Rgr toracica: 33 @<n(>;33 )>n 3n;r>;3;3a a@@n;9a; -r),3nan; 3n2ra3ar :3a;raD M9;3-<-a@3;a;3 n<)9ar >3 3nar ,a3 a@@n;9a; 3n2ra3ar a n39 @a,-993 -9,<nar >;an(D

,9;3- <-a@3;a;3 n<)9ar3n23;ra;3 )3>,3na; -r)<,3nan; :a?a @ <@9-a >3n9>9 @<>;<

)3a2ra(,a;3@ )r-;.

E)-!R-A:

Pa@3n; 3n ar>;a ) 61 ) an3 2<>; 29,a;<r7/0PA @9n<>@9; @9 an;@)n; -r><na -a;<<(3

-9,<nar 7BPOC ,<)ra; Br<n>3@;a?33 @ar)3<a>@9ar 7S;n<?a A< ,)3 3n>923@3n;a;r3@9>-3)3ana (r) II > -r?3n;a -n;r9 ;9> 3n3;3a >a@a 9;r3<r @9 -@;<ra;3 ,9@<

-9r9n;a 3n @an;3;a; ,<)ra;a 3na-;n;a )3>-n a 2<r;9r3 ,<)ra; 3n><,n3 ;ran>-3ra;33

)9rr ;<ra@3@a -<>;r3<ara a>;n<a)3na,3 2a;3(a:33;a; >@a)ra ;<ran;3 2<r;>3,-;<, @ar >a9 3n>;aa; @9 a-r<3,a;3 ' ?3 an;r3<r 3n;rnar33.

O:3@;3a 3n;rnar >;ar (nraa ,<)ra;a;ra;aD ;(9,n; >3 ,9@<a> 9><r -a3)D a

n39 a-ara;993 r>-3ra;<r > )@a?a ,9r,9r ?3@9ar 3na>-r3; :3a;ra ra9r3 @r-3;an;

162

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:a?a :3a;raD a n39 a-ara;993 )3(>;3 > <:3@;3a?a 23@a; a ' @, >9: r:<r)D TA=

11&!80,,H(D AV= %8 :a;a3! ,3n9;.

B3<9,<ra >3n)r<, 3n2aa,;<r 7VSH a@@ra;D an,3 >@9n)ara 9><ara 3-<-r<;3n,3.PFR )3>29n@;3 n;3a;<r3 ,a r>;r3@;3a 9><ara <:>;r9@;3a ,<)ra;a 3n ;<; ar:<r :r<n>3@

,a3 a@@n;9a;a 3n -r32r3D r)9@ra VEMS @9 '$

R(r ;<ra@3@a 3)n;3a?a ,9;3- <-a@3;a;3 n<)9ar >3 3nar ,a3 a@@n;9a; 3n2ra3ar an39 @a,-993 -9,<nar >;an(D ,9;3- <-a@3;a;3 n<)9ar3n23;ra;3 )3>,3na; -r)<,3nan;

:a?a @ <@9-a >3n9>9 @<>;<)3a2ra(,a;3@ )r-;.

P :a?a a,n993 @3n3@ ra)3<<(3@ :3<9,<ra >3 :a@;r3<<(3@ > >9>;3n )3a(n<>;3@9 ) ,a3>9>.

P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7A,<3 -9> 9;r3<r

C3-r<2<a@3na @<r;3?<n3@ 3;a,3n7B1 B6 an;3;9;3 an;3-3r;3@ an;3a(3@

-a;<-r<;@;<ar (a>;r<-r<;@;<ar an;3@<a(9an; 3nK@;a:3 @9 a,3<rara >;ar33 (nra .S ;rna?a a,3<ra; @9 r@<,a)ar3

• r(3, a3,n;ar @33:ra; @a<r3@D

• 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

• a@@3nar an;3(r3-aa an9aaD• a:an)<n9 29,a;993 @<n>9,993 ) a@<<D

• ;ra;a,n; @9 S-3r3a 18 ,3@r<(ra, 1@->!?3 6 9n3D

• Vn;<3n 100 ,3@r<(ra, -929r3 a n<3D


• )3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

PNEUMONIE INTERSTITIALA.

HEMIBLOC ANTEROSUPERIOR STANG.

ANEMIE SECUN4ARA.HIPERTENSIUNE ARTERIALA ESENTIALA ST4. II!B


20.07.11 10:28 : Gran#=/.0 *10!"L Gran$=68.% $ HCT='8.1 $ HGB=11.& (!)

L+,-#=1./ *10!"L L+,-$=&./ $ MCH=8.' -( MCHC='0.1 (!)

MCV=/. 2L M3)#=0.' *10!"L M3)$=&. $ MPV=6.% 2L PCT=0.'0% $

P45=1&.& $ PLT=/& *10!"L RBC=/.0& 10*10!"L R45CV=1/.% $ R45S4=&0./ 2 5BC=&.% *10!"L VSH 71=%0 ,, VSH 7=11& ,, ALAT=8

U!L ASAT=8 U!L B33r9:3na ;<;aa=0.6 ,(!) C<>;r<=16% ,(!)

Cra;3n3na=0. ,(!) G3@,3=10 ,(!) Pr<;3n ;<;a=%. ,(!) Tr3(3@r3)=1' ,(!) Ur=% ,(!)

E<4: AV= 80 :a;3! ,3n9;D a RS LA '0 (ra) 2ara ,<)323@ar3 3>@,<?3<na.

Rgr toracica: @<r) (<:a ,ar3; 2a>@ - )3a2ra(,D )>n 3n;r>;3;3a a@n;9a; :3a;ra -r)<,3nan; 3n2ra3ar :3a;raD 33 @<n(>;33.

)3R: 3n 3,3; n<r,a.

E)-!R-A:

Pa@3n;a 3n ar>;a ) 66 an3 29,a;<r @9n<>@9;a @9 an;@)n; -r><na -a;<<(3@

@3r9r(3@a7 3>;r@;<,3 ;<;aa >3 HTA > -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> @9

-@;<ra;3 ,<-;<3@a )3>-n a 2<r; ,)39 a>;n<a)3na,32:ra 7'8' (ra) C )9rr3

163

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;<ra@3@ a n39 9n(3993 3n2r3<r a <,-a;993 )ra-; >3,-;<, a@r:a; 3n 9;3, ?3

an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa 3n29n;a;aD ;(9,n; >3 ,9@<a> -a3) -9,<nar MV3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;ra >3 23n >3:3an; )3>,3na; 3n a,:33

@a,-3 -9,<nar3.

B3<<(3@ >)r. 3n2a,a;<r 7VSH a@@ra; >)r a,n,3@ 2ara a; ,<)323@ar3 -a;<<(3@. PFR 3n3,3; n<r,a. Ra)3<(ra23a -9,<nara 3)n;3a?a )>n 3n;r>;3;3a a@n;9a; :3a;ra

-r)<,3nan; 3n2ra3ar :3a;raD 33 @<n(>;33.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.A 9r,a; ;ra;a,n; an;3:3<;3@ ,<>;a;3@ an;3;9>3 an;3;r,3@ an;3a(3@ -r<;@;<r -a;3@

-r<;@;<r (a>;r3@ >3 3;a,3n @9 <9;3 2a<ra:3a.


r(3, a3,n;ar 3-<><)a; >3 @33:ra; @a<r3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

a@@3nar an;3(r3-aa an9aaD ;ra;a,n; ,)3@a,n;<> @9 TAVANIC &00 ,( 1 @-r!?3 7% ?3D

@<n>9; r9,a;<<(3@ >3 :an<<(3@D

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.BOALA PULMONARA CRONICA OBSTRUCTIVA ST4 II GOL4 IN EACERBARE.

COLECTIE PLEURALA STANGA.

HIPERTENSIUNE ARTERIALA ESENTIALA GR4 II CU RISC CAR4IOVASCULAR

INALT. CAR4IOPATIE ISCHEMICA CRONICA.

INSUFICIENTA CAR4IACA CLASA NHA II.

INSUFICIENTA RENALA CRONICA ACUTIZATA.ANEMIE SECUN4ARA.

A4ENOM 4E PROSTATA.


07.07.11 11:90 : L3@3) -9ra Ea,n @3;<<(3@=- = %. PMN = 6$ L+ = 80$C9 ,?<;3a = 1/$ rar ,a;33. F3:r3na -r?n;a. L3@3) -9ra G9@<?a=11

,(!) L3@3) -9ra L4H=1// U!L L3@3) -9ra Pr<;3n=1.& (!)

07.07.11 11:9, /920;0.07.2011: L. -9ra Fr<;39 -;. )@rar BAAR=NEGATIV

07.07.11 11:9 : L. -9ra @9;3ar :a@;r33 ar<:=N9 >a9 )?<;a; (r,n3. L. -9ra

Ea,n ,3@<<(3@=N9 >a9 )?<;a; 29n(3. L. -9ra 2r<;39 Gra,=F3:r3na

0.07.11 07:21 : Gran#=&./ *10!"L Gran$=%.% $ HCT='0./ $ HGB=.& (!)

L+,-#=1. *10!"L L+,-$=16.6 $ MCH=8.% -( MCHC='1. (!) MCV= 2L M3)#=0.8 *10!"L M3)$=10.% $ MPV=.1 2L PCT=0.101 $

P45=1% $ PLT=11 *10!"L RBC='.'1 10*10!"L R45CV=1/.6 $ R45

S4=&0./ 2 5BC=%./ *10!"L VSH 71=/0 ,, VSH 7=8& ,, ALAT=16U!L ASAT=8 U!L B33r9:3na ;<;aa=0.' ,(!) C<>;r<=1/6 ,(!)

Cra;3n3na=.% ,(!) F<>2a;a?a a@a3na=6& U!L GGT=&' U!L G3@,3=11/ ,(!)

L4H='/ U!L Pr<;3n ;<;a=/.6 ,(!) Tr3(3@r3)= ,(!) Ur=1%0 ,(!)

0.07.11 08:,9 : Ta:<9 >an(3n=PMN = 80

164

7/24/2019 69625104-epicrize


EO =

BA = !

L = 1MO = 6

4>@r3r an3?<@3;<?a n<r,<,3@r<@3; 3-<@r<,3 -ana a an9<@3;.

J= '.D Na= 1'8.C<a(9<(ra,a T= 1/D APTT= ./D IP 6%.D INR= 1.

1,.07.11 08:10 : L3@3) -9ra G9@<?a=1/8 ,(!) L3@3) -9ra L4H=8 U!L

L3@3) -9ra Pr<;3n=1.6 (!)Cra;3n3na='.0 ,(!) Ur=1&' ,(!)

J= /.'D Na= 1'/

R43 stand. )A @<r) (<:a ,ar3; 33 @<n(>;33)>n 3n;r>;3;3a a@@n;9a; a n39 ,3;<ra@93

)ra-;D <-a@3;a; ) 3n;n>3;a; @<>;aa 29 )3,3;a;a @ <@9-;a 1! 3n2r3<ara a ,3;<rra@93>;an(.

3ibrobron?oscopie 710&!08.0%.011 )r S3,<n M a;a>a; @<-3

CV ,<:3 ;ra 3:ra -3n;n ;raa n<r,a. N9 >9n; >,n n<-a?3@. M9@<a>a @9 a>-@;

) :r<n>3;a @r<n3@a @9 )3r;3@9<?a :r<n>3@a >3 >@r;33 >r<,9@<a>.)3R )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a 3n ;<; ar:<r

:r<n>3@ ,a3 a@@n;9a;a 3n -r32r3. R)9@ra VEMS @9 /8$.

E)-!R-A B<na 3n ar>;a ) 80 an3 2<>; 29,a;<r &' PA @9n<>@9; @9 an;@)n; -r><na -a;<<(3@ -9,<nar 7BPOC @ar)3<a>@9ar7HTA ICC CI > -r?3n;a -n;r9 ,<)323@ara

>;ar33 (nra ;9> @9 -@;<ra;3 ,9@<-9r9n;a ,<-;3?3 3n @an;3;a; ,3@a )3>-n a 2<r;

,3@ a>;n3 2a;3(a:33;a; ), (a,:3r ,<)ra; :3a;ra >3,-;<, a@r:a; 3n 9;3,

?3 an;r3<r 3n;rnar33.O:3@;3 a 3n;rnar >;ara (nraa 3n29n;a;a ;(9,n; >3 ,9@<a> -a3) ), (a,:3r

:3a;ra ,<)ra; ?39n3 a n39 (a,:3 )r-;D -9,<nar ,a;3;a; 3n 1! 3n2r3<ara a

,3;<ra@93 >;an( @9 a :<3ra MV a a@>; n3Dra9r3 @r-3;an; :a?a )r-;D TA= 1/0!80,,H(D AV= 80 :a;a3! ,3n9;D a:)<,n ,ar3; ) <9, 9><r >n>3:3 a -a-ar.

B3<<(3@ >)r. 3n2a,a;<r7VSH ,9; a@@ra; >)r an,3@ >)r ) r;n;3 a?<;a;a

3-<-r<;3n,3.PFR )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a 3n;<; ar:<r :r<n>3@ ,a3 a@@n;9a;a 3n -r32r3D r)9@ra VEMS @9 /8$.

Ra)3<(ra23a -9,<nara 3)n;3a?a <-a@3;a; ) 3n;n>3;a; @<>;aa 29 )3,3;a;a @ <@9-;a 1!

3n2r3<ara a ,3;<rra@93 >;an(.Pn;r9 a 9@3)a @a9?a ,<-;3?33 >a 2@;9a; 23:r<:r<n<>@<-3. La 23:r<:r<n<>@<-3a >

3)n;3a?a ,9@<a>a :r<n>3@a @9 a>-@; ) :r<n>3;a @r<n3@a @9 )3r;3@9<?a :r<n>3@a >3 >@r;33

>r<,9@<a>D 2ara a > 3)n;3a >,n ) -r<@> -r<32ra;3. In a@>; @<n)3;33 ,<-;3?3a

,3n3,a -r?n;a;a ) @a;r -a@3n; > -3@a @ ,a3 -r<:a:3 3n @<n;;9 9n<r ;9:9rar3 )@<a(9ar. P -ar@9r>9 3n;rnar33 >a 2@;9a; ;<ra@<@n;?a 3n >@<- ;ra-9;3@ >3 )3a(n<>;3@

a@9an)9> 3n ,<) r-)a; a-r<3,a;3 6 3;r3 3@3) >r<@3;r3n @9 @ar@;r ) ;ran>9)a;.

Ea,n9 3@3)993 -9ra -n;r9 BJ >; n(a;3.Pa@3n;9 a -r?n;a; ), (a,:3r :3a;ra @ar n9 a9 r,3> a a),3n3>;rara ) 8 23<

F9r<>,3)! ?3D a@>;a 233n) -r<:a:3 ), ) @a9?a 3-<-r<;3n,3@a.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.A 9r,a; ;ra;a,n; an;3:3<;3@7C3-r3n< 1 2! ?3 ,<>;a;3@ an;3;9>3 HHC

an;33n2a,a;<ran;3;r,3@ an;3a(3@ -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ >3 3;a,3n a @<n;3n9a;

;ra;. - @ar 3 9r,a a,:9a;<r @9 <9;3 >;a;3<nara..

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r(3, a3,n;ar 3-<><)a; @33:ra; -r<;3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D Tra;a,n; ,)3@a,n;<> @9 S-3r3a 18 ,3@r<(ra, 1 @->!?3D

@<n;3n9ara ;ra;a,n;993 @ar)3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>;D

3n;rnar 3n >r3@39 M)3@aa III @<n2<r, 3n;(r33 @9 )<a,na )r. P<K<(a C.BOALA PULMONARA CRONICA OBSTRUCTIVA MO4ERATA IN EACERBARE.

INSUFICIENTA REPIRATORIE CRONICA ACUTIZATA.


INALT.CAR4IOPATIE ISCHEMICA CRONICA.

BR4 MAOR.

4IABET ZAHARAT TIP II CU NECESAR 4E INSULINA 7TRATAMNET NOU INSTITUIT.TEREN ATOPIC. A*ER4-E *A $E-!A$E&"E: A*4%!A*$-& +- -!*%3E&A!.

!%*E!-+"-"A A!#"A.

OBEZITATE GR4 II.


06.07.11 08:00 : G3@,3 1=%& ,(!) G3@,3 ='0' ,(!) G3@,3 '='8 ,(!)

G3@,3 /='0' ,(!) G3@,3 &='&' ,(!) G3@,3 6='& ,(!)

Ana3? UPU a;a>a; @<-3.

R4R toracica: 33 @<n(>;33D )>n 3n;r>;3;39a a@@n;9a; :3a;ra.

E<4: R> AV= 0 :a;a3! ,3n. a RS a 0 (ra). BR4 ,aK<r.

!onsult c?irurgical /07.07.2011 r 3eti:

4( C<@>;3;a a@9;a.

R@<,an)ar3 an;3:3<;ra-3

an;3a(3@ an;3>-a>;@

r@33:rar 3)r3@a @;r<3;3 >r 23?3<<(3@ 7&00 , ><. R3n(r 7&00 ,D

ASTRUP > r@<na,)a ra9ar 3n )a;a ) 08.0%.011.

Reealuare c?irurgicala /0.07.2011 dr 3eti: -r<(ra,ar -n;r9 3n;rn;3 @3r9r(3@aa 3n

)a;a ) 11.0%.011.

!onsult diabetologic /07.07.2011 dre !opcea -.:

4r 4Z ;3- II

R@<,an)ar3 )3;a 1800 @a!&0 ( HC 3n>93n<;ra-3 INSUMAN BAZAL 16 UI )3,3na;a7<ra %

16 UI >ara 7 <ra 1 @9 a),3n3>;rar

>9:@9;ana;a a n9 @<a->3 2@;9ara -r<23993 (3@,3@ <ara % 1 1 3 ra9ar -n;r9 aK9>;ara )<?<r

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FIBROZA PULMONARA 4IFUZA.

ANEMIE SECUN4ARA.

INSUFICIENTA CAR4IACA CONGESTIVA CLASA NHA III.CAR4IOPATIE ISCHEMICA PRIN AFECTARE TRIVASCULARA.

INSUFICIENTA MITRALA MO4ERATA.

INSUFICIENTA TRICUSPI4IANA MO4ERATA.HTP SECUN4ARA MO4ERATA! SEVERA.

INFARCT MIOCAR4IC VECHI ANTEROINFERIOR TRATAT CONSERVATIV.

4IABET ZAHARAT TIP INSULINONECESITANT.


21.07.11 07:2, : Gran#=/.& *10!"L Gran$=&%.1 $ HCT='%.% $ HGB=11.(!) L+,-#=.8 *10!"L L+,-$='&.% $ MCH=6.% -( MCHC=.% (!)

MCV=0 2L M3)#=0.6 *10!"L M3)$=%. $ MPV=8.% 2L PCT=0.6 $

P45=1&.6 $ PLT= *10!"L RBC=/.1 10*10!"L R45CV=1&.6 $ R45S4=&0./ 2 5BC=%. *10!"L VSH 71=1 ,, VSH 7=// ,, A@3)

9r3@=6. ,(!) ALAT=8 U!L ASAT=8 U!L B33r9:3na ;<;aa=0. ,(!)

C<>;r<=16 ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a a@a3na=1'8 U!L GGT=/0

U!L G3@,3=11 ,(!) L4H=/' U!L Pr<;3n ;<;a=6.8 ,(!) Tr3(3@r3)=8 ,(!) Ur=&1 ,(!)

R43 stand. )A( @<r) (<:a ,ar3; 33 @<n(>;33D <-a@3;a;3 3ar :3a;raD <-a@3;a; 29 )3,3;a;a@ > <@a3?a?a - r(r ) -r<23 a n39 LI4. M3n3,a @<@;3 -9raa :3a;raa.

E!4 RS AV= %& :a;a! ,3n9; a RS a 0 (ra)D a>-@; ) S 3n V1 V&D 9n) T n(a;3 V'

V& 73>@,3 >9:-3@ar)3@a.

)3R/21.07.2011 )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3a ,<)ra;a <:>;r9@;3 ,<)ra;a 3n ;<;ar:<r :r<n>3@. R)9@ra VEMS @9 '$

!" toracic 2@;9a; ) @a;r >r3@39 R@9-rar C9K Fara >,n ) ) ;r<,:,:<3>, -9,<anarD a<r;a ;<ra@3@a 2ara ,<)323@ar3 ) @a3:9D a)n<-a;r33 ,9;3- @9 )3a,;r9 ) -ana a

1/ ,, 3n <Ka Bar;;3D @<@;3 -9raa :3a;raaD 23:r<?a -9,<nara :3a;raaD @<r) ,ar3; )

<9, @9 -r)<,3nn;a 3n3,33 >;an(3 >9(ran) < a9<-a;3 ,3;raa. P >@;39n3 a:)<,n993

>9-r3<r n9 > 3)n;3a?a ,<)323@ar3 -a;<<(3@ a n39 <r(an<r -arn@3,a;<a> >a9,;<r ;9:993 )3(>;3.

E)-!R-A

B<na 3n ar>;a ) &6 an3 2<>; 29,a;<r a ->; &0 PA @9n<>@9; @9 an;@)n; -r><na

-a;<<(3@ @ar)3<a>@9ar 7ICC CIC HTP IM @3 >3 ,;a:<3@ 74Z ;3- 3n>93n<n@>3;an; >; -r9a; )3n >3@39 R@9-rar 9n) a 2<>; )3a(n<>;3@a; @9 C<@;3

-9raa :3a;raa. La -r9ar - >@;3 -a@3n;9 a 2<>; >;a:3 ,<)3,na,3@. Pa@3n;9 a

-r?3n;a;D ;9> >a@a )3>-n a 2<r; ,3@ a>;n<a)3na,3 2a;3(a:33;a; >@a)ra ;<rn;3 a2<r; K9n(3 ;<ra@3@ -<>;r3<r 3na-;n;a >@a)r -<n)raa >3,-;<, a@r:a; 3n 9;3,

?3 an;r3<r 3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; >3 ,9@<a> -a3) -9,<nar

>9:,a;3;a; :a?a :3a;ra @9 MV )3,3n9a; a a@>; n3 ra9r3 @r-3;an; 3n 1! 3n2r3<ar a

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7/24/2019 69625104-epicrize


4>@r3r n<r,<!,3@r<@3; rar ,a@r<@3; 3-<@r<,3

R43 stand. PA)>n 3n;r>;3;3a a@@n;9a; :3a;ra -r)<,3nan; a n39 ,3;<ra@93 >;an( 33

@<n(>;33 <-a@3;a; ra;3 <,<(na 29 )3,3;a;a -ara@ar)3a@ )r-;.

E!4:R> AV= %& :a;a3! ,3n9; a RS a '0 (ra) 2ara ,<)323@ar3 ) 2a?a ;r,3naa.

)3R )3>29n@;3 n;3a;<r3 <>;r9@;3a 9><ara )<ar 3n >(,n;9 -r32r3@. R)9@ra VEMS @9

1&$.

E)-!R-A Pa@3n; 3n ar>;a ) / an3 29,a;<r a 16.& PA r@n; <-ra; 3n >@;3a C3r9r(;<ra@3@a -n;r9 E,-3, -9ra )r-; -<>;r<:a?a 3n@3>;a; > 3n;rna?a -n;r9 ;9> @9

-@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r; ,)39 a>;n<a)3a,3 2a;3(a:33;a; >@a)ra

;<ran;3 a 2<r; >9:2:r33;a;3 ;ran>-3ra;33 -r)<,3nn; n<@;9rn )9rr3 ;<ra@3@ a <@93n;rn;3 @3r9r(3@a >@a)r 9><ara -<n)raa. O:3@;3 a 3n;rnar >;ara (nraa ,)39

,<)323@a;a ;(9,n; >3 ,9@<a> -a3)D -9,<nar MV 3na>-r3; @9 -3r -r3n(3; :3a;ra Sa;

O= 8$D TA= 10!%0,,H(D AV= %6 :a;a3! ,3n9;

B3<<(3@ >)r. 3n2a,a;<r 7VSH ,9; a@@ra; 9@<@3;<?a >)r an,3@ GGT @r>@9; . PFR)3>29n@;3 n;3a;<r3 <>;r9@;3a 9><ara )<ar 3n >(,n;9 -r32r3@. Ra)3<(ra23a -9,<nara

3)n;3a?a <-a@3;a; ra;3 <,<(na 29 )3,3;a;a -ara@ar)3a@ )r-;.

P :a?a )a;<r @3n3@ >3 -ara@3n3@ >a >;a:33; )3a(n<>;3@9 ) ,a3 >9>.A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> '1 2!?3 >3 C3n)a,3@3na /1 2!?3 an;3;r,3@ an;3a(3@

-@;<ran; -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3n @9 <9;3 2ara:3a.


r(3, a3,n;ar @33ra; @a<r3@D

rn9n;ara a 29,a;D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D ;ra;a,; ,)3@a,n;<> @9 Taan3@ &00 ,( 1 @-r! ?3 7% ?3D 7R- >r3a CSBB nr

r3n a @<n;r< ->; < 9na 3n a:>n;a a@r:ar33<r.

)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

PNEUMONIE LI4.FIBROZA PULMONARA 4IFUZA.

4IVERTICULOZA BRONSICAINSUFICIENTA VENTRICULARA STANGA 4E EFORT.

CAR4IOPATIE ISCHEMICA ANGINA PECTORALA 4E EFORT.

ANEMIE SECUN4ARA.


1,.07.11 07:98 :Gran#=.' *10!"L Gran$=&8.% $ HCT='& $ HGB=11.' (!)

L+,-#=1.' *10!"L L+,-$='. $ MCH='.8 -( MCHC='. (!) MCV=101. 2L M3)#=0.' *10!"L M3)$=8./ $ MPV=6. 2L PCT=0.1&8 $

P45=1&.% $ PLT= *10!"L RBC='.// 10*10!"L R45CV=1/.1 $ R45S4=&1.1 2 5BC='. *10!"L VSH 71=60 ,, VSH 7=10' ,, ALAT=8U!L ASAT=8 U!L B33r9:3na ;<;aa=0.& ,(!) C<>;r<=1%% ,(!)

Cra;3n3na=1.1 ,(!) F<>2a;a?a a@a3na=01 U!L GGT=1& U!L G3@,3=88 ,(!)

L4H= U!L Pr<;3n ;<;a=%.& ,(!) Tr3(3@r3)=%1 ,(!) Ur=/6 ,(!)

1,.07.11 08:, : S-9;aC9;3ar :a@;r33 ar<:=Srra;3a >-- S-9;a Ea,n,3@<<(3@=N9 >a9 )?<;a; 29n(3. S-9;a Fr<;39 Gra,=A>-@; ,a@r<>@<-3@

-9r9n;

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A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 &!@a,-

C9 -3;3a >@9a,<a> 10!@a,-

F3:r3na -r?n; 101& @<@3 (ra, -<?3;33!@a,- 3?<a;3 >3 3n)3-< / @<@3 (ra, n(a;33 >3 :a@33 (ra, n(a;33!@a,-

S@<r ) @a3;a; '

1,.07.11 10:02 : Ta:<9 >an(3n=PMN = &/EO = 10

BA =

L = '/MO =

4>@r3r

1.07.11 11:92 /9,16;18.07.2011: A>-3ra; :r<n>3@ Fr<;39 BAAR A=NEGATIV

A>-3ra; :r<n>3@ C9;9r3 ar<:=En;r<:a@;r >-- A>-3ra; :r<n>3@ Fr<;39 Gra,=A>-@;,a@r<>@<-3@

A>-@; ,3@r<>@<-3@ C9 3n2a,a;<r33 !

C9 -3;3a >@9a,<a> >3 :r<n>3@ 10!@a,-

F3:r3na a:>n; rar3 :a@33 (ra, n(a;33S@<r ) @a3;a; !

1.07.11 12:98 :

An;3:3<(ra,a ar<:3=


. AMPICILINA 7O,n3-rn P<3@33n S '. IMIPENEM7T3na,

'. AMPICILINA SULBACTAM 7Una>+n /. JANAMICINA

7Jana,+@3n

/. AMOICILINA AC. CLAVULANIC 7A9(,n;3n S &. LINEZOLI4&. BISEPTOL 7Ta(r,3n S 6. LINCOMICINA 7L3n@<@3n



7N(ra,

8. CLARITROMICINA 7Ja@3) . NITROFURANTOIN 7Ma@r<)an;3n


7N<3@3n

10. CEFACLOR 7C@<r '1. OFLOACINA7Tar33) S

11.CEFOPERAZONASULBACTAM 7 S9-ra?<na '. OACILINA

7Pr<>;a-+n1.CEFOTAIM 7Ca2<ran S ''. PENICILINA

7Pn3@33na G

1'.CEFTAZI4IM 7F<r;9, S '/.PIPERACILINATAZOBACTAM 7Ta?<@3n S


7A@r<,3@3n 3

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1&.CEFUROIM AETIL 3 '6. TOBRAMICINA

7N:9@3n S

16.ERITROMICINA 7Er+;r<@3n '%.TICARCILINACLAVULANIC 7T3,n;3n S

1%.GENTAMICINA 7Gn;a,+@3n S '8. VANCOMICINA

7L3)[email protected] '. MOIFLOACINA S

1.AZTREONAM /0.CLIN4AMICINA

0.CEFTIBUTEN /1.CEFOITIN S1.TICARCILINA /.LEVOFLOACINA



20.07.11 12:12 :

An;3:3<(ra,a ar<:3=


. AMPICILINA 7O,n3-rn P<3@33n S '. IMIPENEM7T3na,

'. AMPICILINA SULBACTAM 7Una>+n /. JANAMICINA

7Jana,+@3n/. AMOICILINA AC. CLAVULANIC 7A9(,n;3n S &. LINEZOLI4

&. BISEPTOL 7Ta(r,3n S 6. LINCOMICINA 7L3n@<@3n



7N(ra,

8. CLARITROMICINA 7Ja@3) . NITROFURANTOIN 7Ma@r<)an;3n


7N<3@3n10. CEFACLOR 7C@<r '1. OFLOACINA

7Tar33) S

11.CEFOPERAZONASULBACTAM 7 S9-ra?<na '. OACILINA7Pr<>;a-+n

1.CEFOTAIM 7Ca2<ran S ''. PENICILINA

7Pn3@33na G

1'.CEFTAZI4IM 7F<r;9, S '/.PIPERACILINATAZOBACTAM 7Ta?<@3n S


7A@r<,3@3n S1&.CEFUROIM 7Z3na@2J29r< '6. TOBRAMICINA 7N:9@3n

S

16.ERITROMICINA 7Er+;r<@3n '%.TICARCILINACLAVULANIC 7T3,n;3n S

1%.GENTAMICINA 7Gn;a,+@3n S '8. VANCOMICINA

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18.4OICICLINA '. MOIFLOACINA S

1.AZTREONAM /0.CLIN4AMICINA

0.CEFTIBUTEN /1.CEFOITIN S1.TICARCILINA /.LEVOFLOACINA

R?9;a; >9n; -r3,a; @a3;a;3 3n ,, ?<na ) 3n3:3;3 >a9 @an;3;a;3 CMI (! S= >n>3:3D I= 3n;r,a)3arD R= r?3>;n;D N=N3n;r-r;a:3D C<n;a,3na;D

R43 stand. )A)>n 3n;r>;3;3a a@@n;9a; -r)<,3nan; 3n2ra3ar :3a;ra 33 @<n(>;33D ,9;3-<-a@3;a;3 n<)9ar ra;3 <,<(n :a?a )r-;.

E!4( RS AV= 60 :a;a3! ,3n a RS a '0 (ra) BAV (r I 9n) T 3na; VV& 2ara a;

,<)323@ar3 3>@,<?3<na.

3ibrobron?oscopie/1078;1.07.2011 dr +imon $.( a;a>a; @<-3CV ,<:3 ;ra 3:ra -3n;n ;raa n<r,a. N9 >9n; >,n n<-a?3@. ,9@<a>a ) a>-@;

:r<n>3;3@ @r<n3@. 7 )3r;3@9<?a :r<n>3@a >@r;33 >r<,9@<a>.

)3R/928;1.07.2011( )3>29n@;3 n;3a;<r3 r>;r3@;3VA ,<)ra;a. R)9@ra VEMS @9 $.

E)-!R-A( B<na 3n ar>;a ) %8 an3 n29,a;<r @9n<>@9; @9 an;@)n; -r><na -a;<<(3@ -9,<nar 7 Br<n>3;a @r ,<ra(3@a 23:r<?a -9,<nara @ar)3<a>@9ar 7IVS )

2<r; CIC > -r?3n;a -n;r9 ,<)323@ara >;ar33 (nra ;9> @9 -@;<ra;3 ,<-;<3@a

)3>-n a 2<r; ,3@ ;ran>-3ra;33 K9n(3 ;<ra@3@ -<>;r3<r a>;n<a)3na,3 2a;3(a:33;a;>@a)ra ;<ran;3 a 2<r; @2a a,;3 >3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r

3n;rnar33.

O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;a ;(9,n; -a3)D -9,<nar MV

3na>-r3; @9 -3r -r9n(3; ra9r3 r<n2an; )3>,3na; 3n a,:33 @a,-3 -9,<nar3 @r-3;an; :a?a :3a;raD TA= 1'0!%0,,H(D AV= %8 :a;a3! ,3n9;.

B3<<(3@ >)r. 3n2a,a;<r 7VSH ,9; a@@ra; >)r an,3@. PFR )3>29n@;3 n;3a;<r3 r>;r3@;3a

,<)ra;ar)9@ra VEMS @9 $. EJG BAV (r I.Ra)3<(ra23a -9,<nara )>@r3 ,9;3- <-a@3;a;3n<)9ar ra;3 <,<(n :a?a )r-;. P -ar@9r>9 3n;rnar33 -a@3n;9 a -r?n;a; ,a3 ,9; -3><a)

) ;9> @9 -@;<ra;3 ,<-;<3@a 3n @an;3;a; ,3@a 7 -r),3nan; 3n -r3,a K9,a;a; a ?33 ,<;3

-n;r9 @ar >a 3n)3@a; 2@;9ara :r<n<>@<-33. Sa 2@;9a; 23:r<:r<n<>@<-3a @ar a 3)n;3a; <,9@<a>a @9 a>-@; ) :r<n>3;a @r<n3@a 2ara a 3)n;3a >,n ) -r<@> r<32ra;3. In a@>; @<n)3;33

-r?n;a ;9>3 @9 -@;ra;3 ,<-;<3@a > -3@a 3n @<n;;r9 an;@)n;<r -r><na -a;<<(3@

a -a@3n;993 >3 3n @a)r9 @<n)3;33<r ,;< n2a<ra:3 7 @an3@9a. Mn;3<n? @a -a@3n;9 a2@;9a; 9n CT ;<ra@ 3n an;@)n; @ar a )>@r3> )<ar ,n; ) F3:r<?a -9,<nara )329?a

:3a;raa 2ara a 3)n;3a >,n ) -r<@ n<-a?3@ a n3 -9,<nar.


>9>.A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,<3-9> '1 2!?3,<>;a;3@ an;3a(3@ an;33n2a,a;<r

:r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ 3;a,3n >3 ) r@33:rar

3)r<@;r<3;3@a@9 <9;3 2a<ra:3a.S ;rna?a @9 r@<,an)ar3

r(3, a3,n;ar 3-<><)a;D 3;ara @<n)3;33<r ,;< @9 @an3@9aD

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D

;ra;a,n; ,)3@a,n;<> @9 AVELO /00 ,( 1 @-r!?3 7% ?3D

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@<n>9; @ar)3<<(3@D



FIBROZA PULMONARA 4IFUZA BILATERAL.ANEMIE SECUN4ARA.

GUTA AFLATA SUB TRATAMENT.

TBC PULMONAR SECUN4AR IN ANTECE4ENTE 700%.


11.07.11 08:1 : Gran#=1. *10!"L Gran$=''.' $ HCT=/'.8 $ HGB=1'.8

(!) L+,-#=. *10!"L L+,-$=&1.6 $ MCH='/. -( MCHC='1.& (!) MCV=111.1 2L M3)#=0.8 *10!"L M3)$=1&.1 $ MPV=%.% 2L PCT=0.1%1 $

P45=1&.' $ PLT=' *10!"L RBC='.& 10*10!"L R45CV=1&.1 $ R45

S4=&.1 2 5BC=&.6 *10!"L VSH 71=' ,, VSH 7=& ,, A@3) 9r3@=8.0/,(!) ALAT=1& U!L ASAT=1 U!L B33r9:3na ;<;aa=0. ,(!) C<>;r<=11/

,(!) Cra;3n3na=1.' ,(!) F<>2a;a?a a@a3na=1' U!L GGT=/ U!L

G3@,3=%% ,(!) Pr<;3n ;<;a=%.0 ,(!) Ur=%& ,(!)

11.07.11 11:06 : Ta:<9 >an(3n=PMN = '8$D

EO = 8$D

BA =

L = /6$DMO = 8$.

4>@r3r

12.07.11 08:00 /992;12.07.2011 :S-9;a Fr<;39 BAAR A=NEGATIV S-9;a Fr<;39 BAAR B=NEGATIV

)3R/6,66;1,.07.2011: )3>29n@;3 n;3a;<r3 ,3a; r>;r3@;3a ,<)ra;a <:>;r9@;3a

,<)ra;a 3n ;<; ar:<r :r<n>3@ ,a3 a@@n;9a;a 3n -r32r3. R)9@ra VEMS 9 /0$.EJG R> AV= 80 :a;a3! ,3n9; a R> a '0 (ra) 9n) T 3na; 3n V V/.

E)-!R-A:

Pa@3n; 3n ar>;a ) & ) an3 @9n<>@9; @9 TBC -9,<nar700% 3n>923@3n;a n<a>a ,,:r3n2r3<ar 23:r<?a -9,<nara > 3n;rna?a 3n C3n3@a ) Pn9,<<(3 a@9?an) ;9> @9

-@;<ra;3 ,9@<-9r9n;a @9 ,<-;3?3 ,3n3,a a>;n<a)3na,3 2a;3(a:33;a; )3>-n a

2<r;9r3 ,)33 >3,-;<, a@r:a; 3n 9r,a @9 < >a-;a,ana an;r3<r 3n;rnar33.O:3@;3 a 3n;rnar >;ar (nraa ,<)ra; 3n29n;a;aD ;(9,n; >3 ,9@<a> -a3)D

-9,<nar ,9r,9r ?3@9ar 3na>-r3; :3a;ra @9 -3r -r9n(3;D 23n ra9r3 :r<n>3@ )3>,3na;

3n a,:33 @a,-3 -9,<nar3D Ta= 1/0!0,,H(D AV= 88 :a;a3! ,3n9;. B3<9,<ra >)r an,3@ 9><r

a@3) 9r3@ @r>@9; GGT 9><r @r>@9; >)r ) r;n;3 a?<;a;a.PFR )3>29n@;3 n;3a;<r3 ,3a; r>;r3@;3a ,<)ra;a <:>;r9@;3a ,<)ra;a 3n ;<; ar:<r

:r<n>3@ ,a3 a@@n;9a;a 3n -r32r3.P :a?a a,n993 @3n3@ -ara@3n3@ >3 ) a:<ra;<r > >9>;3n )3a(n<>;3@9 ) ,a3 >9>.

P -ar@9r>9 3n;rnar33 -a@3n;9 a 9r,a; ;ra;a,n; an;3:3<;3@7C3-r<2<a@3@a &00 ,(!?3

an;a(3@ -r<;@;<r (a>;r3@ >3 -a;3@D a 9r,a; ;ra;a,n;9 -n;r9 (9;aD @9 a,3<rara >;ar33

(nra >3 <9;3 @3n3@a 2a<ra:3a.S ;rna?a @9 9r,a;<ar r@<,an)ar3

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r(3, a3,n;ar @33:ra; @a<r3@ 2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D


VENTOLIN 100 ,3@r<(ra, -929r3n a n<3D > 3:ra?a R- @<,-n>a;a >r3a CSBB nr.'%/%&'/.


)3>-n>ar3?ar -r3n ,)3@9 ) 2a,33.

BOALA PULMONARA CRONICA OBSTRUCTIVA ST4. II GOL4 IN EACERBARE.FIBROZA PULMONARA 4IFUZA.

ANEMIE SECUN4ARA.

HIPERTNSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULAR INALT.CAN4I4OZA OROFARINGIANA.

4IABET ZAHARAT CONTROLAT PRIN 4IETA ALIMENTARA.

OBEZITATE GR4 II

Analize de laborator:19.07.11 07:07 : Gran#='.' *10!"L Gran$=&8.% $ HCT='.' $ HGB=1.6 (!)

L+,-#=1. *10!"L L+,-$=''.1 $ MCH=.& -( MCHC=' (!) MCV=. 2L M3)#=0./ *10!"L M3)$=8. $ MPV=8 2L PCT=0.1'/ $

P45=1&.& $ PLT=168 *10!"L RBC=/.% 10*10!"L R45CV=1'./ $ R45

S4=/&.& 2 5BC=&.6 *10!"L VSH 71=16 ,, VSH 7=/& ,, ALAT=10U!L ASAT=11 U!L B33r9:3na ;<;aa=0. ,(!) C<>;r<=1/ ,(!)

Cra;3n3na=0.8 ,(!) F<>2a;a?a a@a3na=106 U!L GGT=' U!L G3@,3=110 ,(!)

L4H=% U!L Pr<;3n ;<;a=6. ,(!) Tr3(3@r3)=11 ,(!) Ur=' ,(!)

R43 stand. )A @<r) (<:a ,ar3; 2a>@ - )3a2ra(, 33 @<n(>;33D )>n 3n;r>;3;3a a@@n;9a;

:3a;ra ,3@r<<-a@3;a;3 n<)9ar >3 3nar ) 3n;n>3;a; @<>;aa :a?a :3a;ra.

E!4 RS AV= 60 :a;a3! ,3n9;D a RS a 0 (ra)D BR4 3n@<,-;D 2ara ,<)323@ar3 ) 2a?a;r,3naa.

!" toracic 71&.0.011 )r. G9;;,an T.A;a>a; @<-3

Ea,3nara a 2<>; 2@;9a;a 3n 3n@3)n; a3a @<r<na >3 >a(3;a. R?9;a; M<)323@ar3 ) >;a;3@a ;<ra@aa @9 a>-@; ) ,3n3,a 23:r<?a -9,<nara )329?a

:3a;raa.

N9 > @<n>;a;a ,<)323@ar3 ;9,<ra >a9 a)n<-a;3@ ,)3a>;3n<-9,<nar. N9 > @<n>;a;a a>-@; ) @<@;3 -9raa.

N9 > @<n>;a;a ,<)323@ar3 -ar3;a ;<ra@3@.

F3@a;9 ar )3,n>39n3 >3 >;r9@;9ra n<r,a. N9 > @<n>;a;a ,<)323@ar3 :33ar >a9

-<r;a. C<@3>;9 n9 >; <@93;.

Gan) SR ) a>-@; n<r,a.

R3n3@33 :3a;ra a9 )3,n>39n3 >3 >;r9@;9ra n<r,a.

)3R/6686;12.07.2011( )3>29n@;3 n;3a;<r3 ,3;a r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a

3n ;<; ar:<r :r<n>3@. R)9@ra VEMS @9 /$.

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E)-!R-A B<na 3n ar>;a ) && an3 n29,a;<r @9n<>@9; @9 an;@)n; -r>na

-a;<<(3@ -9,<nar 7BPOC a2a; >9: ;ra;a,n; @9 S-3r3a 18 ,3@r<(ra, 1 @->! ?3

@ar)3<a>@9ar 7HTA >3 ,;a:<3@ 74Z ;3- II @<n;r<a; -r3n )3;a O:?3;a;> 3n;rna?a -n;r9 ,<)323@ara >;ar33 (nra ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r; ,)39

a>;n<a)3na,3 2a;3(a:33;a; >@a)r ;<ran;3 a 2<r; ;ran>-3ra;33 >3,-;<, a@r:a; 3n

9;3, >a-;a,an3 an;r3<r 3n;rnar33.O:3@;3 a 3n;rnar -a@3n; >9-ra-<n)ra @9 >;ara (nraa ,)39 ,<)323@a;a ;(9,n; >3

,9@<a> -a3)D -9,<nar MV 3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;ra >3 rar

ra9r3 :r<n>3@ )3>,3na;DSa; O= 8$ 7 a -9><3,;r9 TA= 1'0!80,,H( AV= %/ :a;a3!,3n.

B3<<(3@ >)r. 3n2a,a;<r 9><r 7VSH a@@ra; >)r an,3@. PFR )3>29n@;3 n;3a;<r3 ,3;a

r>;r3@;3 ,<)ra;a <:>;r9@;3 ,<)ra;a 3n ;<; ar:<r :r<n>3@. Ra)3<(ra23a -9,<nara 3)n;3a?a

,3@r<<-a@3;a;3 n<)9ar >3 3nar ) 3n;n>3;a; @<>;aa :a?a :3a;ra @ar r3)3@a >9>-3@39na 9n<r :r<n>3@;a?33. S 2@;9a?a C; ;<ra@ @ar )>@r3 23:r<?a -9,<nara )329?a -r)<,3nan; :a?a

:3a;ra.


A 9r,a; ;ra;a,n; an;3:3<;3@ 7A,3-9> 1 2! ?3 HHC an;3;r,3@ an;3a(3@ -@;<ran; :r<n<)3a;a;<r -r<;@;<r -a;3@ -r<;@;<r (a>;r3@ > 3 an;3,3@<;3@ a @<n;3n9a; ;ra;. - @ar 3

9r,a a,:9a;<r @9 <9;3 2a<ra:3a.S ;rna?a @9 r@<,an)ar3

r(3, a3,n;ar 3-<><)a; 3-<(9@3)3@D

2<r; 23?3@ 3n 3,3;a ;<ra:33;a;33D


VENTOLIN 100 ,@r<(ra, -929r3 a n<3D >a 3:ra; R- >r3a CSBB nr '%/%&'& 7-; < 9naD

9r,a?a ;ra;a,n;9 @ar)3<<(3@ -r>@r3> ) @a;r ,)3@9 >-@3a3>;D


PNEUMONIE LIS.

BRONSIECTAZII SUPRAINFECTATE.HIPERTENSIUNE ARTERIALA ESENTIALA ST4 II CU RISC CAR4IOVASCULAR

MO4ERAT.

HIPERTIROI4ISM FARA TRATAMENT.

GUSA NO4ULARA OPERATA IN ANTECE4ENTE.


28.06.11 10:1, : Gran#=/.8 *10!"L Gran$=6/. $ HCT=/.& $ HGB=1/./

(!) L+,-#=.' *10!"L L+,-$='0. $ MCH=.' -( MCHC=''.8 (!) MCV=86.8 2L M3)#=0./ *10!"L M3)$=&.6 $ MPV=%.% 2L PCT=0. $

P45=1&.6 $ PLT=60 *10!"L RBC=/. 10*10!"L R45CV=1/ $ R45S4=//. 2 5BC=%.& *10!"L VSH 71= ,, VSH 7=&0 ,, ALAT=10

U!L ASAT= U!L B33r9:3na ;<;aa=0.' ,(!) Cra;3n3na=0. ,(!) F<>2a;a?a

a@a3na= U!L GGT=1 U!L G3@,3=% ,(!) L4H=6& U!L Pr<;3n

;<;a=%.6 ,(!) Ur=' ,(!)

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Rgr toracica: 33 @<n(>;33D )>n 3n;r>;3;3a a@@n;9a; :3a;ra -r)<,3nan; 3n2ra3arD

<-a@3;a; -ara@ar)3a@a >;an(a ) 3n;n>3;a; @<>;aa 29 )3,3;a;a.

!" torace /28.06.2011 dr +tanescu 4.: a n39 >(,n;993 10 )3n >;(. a-ar ,)323@ar3 :r<n>3@;a;3@ >9-ra3n2@;a; >3 ,3@3 ?<n ) a<3;a a)3a@n;. In r>; @a,-9r3 -9,<nar

2ara ,<)323@ar3 )n>3;<,;r3@. Fara @<@;33 3@3)3n. In -<9 3n2r3<r a 3993 >;an( a-ar <

3,a(3n ;3>9ara ) @@a '&!' ,, @n;9r -<3@3@3@ @9 @ara@;r (an(3<nar @9 @a@323@ar33n@9>. Pr; ;<ra@3@ 2ara ,<)323@ar3 )3,n>3;<,;r3@. a3ar n9 a-ar ,a> (( >,n323@a;3

)3,n>3<na. F3@a; >-3na r3n3@33 :3a;ra >3 (an) SR 2ara ?39n3 2<@a.

C<n@9?3 A>-@; CT ) :r<n>3@;a?3 >9-ra3n2@;a;a @9 a)n<-a;3 3n 39 >;an(.

E)-!R-A:

B<na 3n ar>;a ) 61 an3 29,a;<r a ->; /0PA @9n<>@9; @9 an;@)n; -r><na

-a;<<(3@ @ar)3<a>@9ar 7HTA >;) II!B n)<@r3n 7H3-r;3r<3)3>, >3 @3r9r(3@a 7G9>an<)9ara <-ra;a > 3n;rna?a -n;r9 ;9> @9 -@;<ra;3 ,9@<-9r9n;a )3>-n a 2<r;

,)39 a>;n< a)3na,3 2a;a33;a; >@a)ra ;<ran;3 a 2<r; 3na-;;n;a >@a)r -<n)raa

>3,-;<, a@r:a; 3n 9;3, >a-;a,an3 an;r3<r 3n;rnar33.O:3@;3 a 3n;rnar >;ara (nraa ,)39 ,<)323@a;aD -9,<nar ;<ra@ ,23?,a;<> MV

3na>-r3; @9 -3r -r9n(3; ra9r3 @r-3;an; :a?a :3a;raD TA= 1&0!80 ,,H(D AV= %/ :a;a3!

,3n9;.B3<<(3@ >)r. 3n2a,a;<r 7VSH 9><r a@@ra; 2ara a; ,<)23@ar3 >,n323@a;3. Ra)3<(ra23a

-9,<nara 3)n;3a?a <-a@3;a; -ara@ar)3a@a >;an(a ) 3n;n>3;a; @<>;aa 29 )3,3;a;a @ar

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