m*******r
发帖数: 595 | 1 第一胎时一切都好，这是第二胎，和第一胎间隔2年，我今年33岁，本以为会像第一胎
一样一切都好，从6周起开始咳嗽，没吃药一直在扛，7周多开始呼吸困难，去local
walking clinic被告知可能是过敏引起的哮喘，开了inhaler，用了两天不起作用。再
两天后终于和ob的护士说上话，被要求去ER，这时已经伴有左肋骨疼痛，ER一个经验很
丰富的医生立马判断是blood clot，当晚所做的chest x-ray和肺部VQ scan确诊了我的
两个肺都有blood clot，左肋骨疼痛大概5天后消失，同时我每天用luvonox （blood
thinner)两次。
1个月后突然我的右肋骨开始疼，我又去了ER，再次做了chest x-ray和肺部VQ scan，
结果发现两肺的blood clot几乎没变，医生们只知道和我说再等几个月，却解释不了为
什么右肋骨突然会疼。
请版上牛人看看我的情况，给点建议，此外我在纽约周围，请推荐pulmonary embolism
方面的专家，先谢过了！ |
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g*2
发帖数: 658 | 2 刚刚把堆积了几个星期的nejm翻看了一下，居然在11月底的那期case discussion就是
讲得这个病
http://www.nejm.org/doi/full/10.1056/NEJMcpc1103565
Case 36-2011 — A 93-Year-Old Woman with Shortness of Breath and Chest Pain
Presentation of Case
Dr. Pooja Agrawal (Emergency Medicine): A 93-year-old woman was seen in the
emergency department at this hospital because of chest pain and shortness of
breath.
The patient had been in her usual state of health, with hypertension and
chronic renal insufficiency, until the morning of admission, wh... 阅读全帖 |
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发帖数: 1 | 3 日本七十年的复仇之路 (1)
在具体谈到这个主题之前，或许有必要讨论一下仇恨这个问题。我是能理解人类的仇恨
。这世界有三种力量可以支持一个人承受所不能忍受的折磨。一种是爱的力量，一种是
恨的力量，一种是信仰的力量。
即使象我这种看破红尘之人，在他们24小时折磨之下，我心中也会不时泛起恨意。所以
，我是能理解人类的那份绝望，特别是看到你的亲人被无辜地夺取生命，你的家园被毁
，你的同族被屠杀的时候。
所以，如果一个印第安人，因为自己的种族被白人完全地屠杀而走向复仇之路，我完全
可以理解。那么日本人因为被原子弹摧毁，战败而走向复仇之路，这种感情，我也是可
以理解。可以理解，不等于说我会和这种仇恨的力量和解而纵容它，让它危害人类。
多数人的感情，不管爱也好，恨也好，都是和自己命运相连，而不能把自己的遭遇放在
历史的环境下，做客观的判断，理性的判断。其实我觉得中国发言人，这句话说的比较
好。固然广岛值得纪念，但南京更不应忘怀。在我们回顾历史的时候，我们不能有选择
性记忆。日本民族的问题就是把自己民族的利益过分的强调，而忽视其他民族正当的权
益。难道日本民族感到了生存危机，就可以去屠杀其他民族？ ... 阅读全帖 |
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f******I
发帖数: 769 | 4
was
to
20 cm is pretty big of size, just asked urologist here, he said the biggest
he ever took out was 22cm, said if there was bleeding, embolization is often
used, but it hurts really bad, there sill be very much necrotic tissues,
also depends on what they use to embolize it, if it's alcohol, he can still
go for surgery, but if they put in metal coils it'd be difficult to cut
through, the other thing he said was that sometime it will throw off clots
and that's the worst and he had to call in |
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c********e
发帖数: 496 | 5 I really could not tell you go or not to go,
if I know the risk is super high, I will say NO.
if everything will be safe for sure, yes,
but for your case, it is really hard to tell. In such case, the physicians
provide information and you have to make the decision yourself.
but what I can tell is the major risk of PRV is high viscosity and embolism
accordingly. While long trip by air is another risk for embolus, it is not
rare to find pulmonary embolism after flight trip in western country, whic |
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l********y
发帖数: 2295 | 8 this is from uptodate. I think for lone AF pt, they do need rate or rhythm
control beside aspirin as anticoagulation. -- I saw this q this morning, it
only addressed which anticoagulation is the best but did not touch the q if
this pt need rate/rhythm control.
In general, patients with lone AF, who by definition are less than 60 years
of age, have a low risk of clinical embolization.
MANAGEMENT — Management issues in patients with lone AF include identifying
possible reversible diseases, the mos... 阅读全帖 |
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m**********d
发帖数: 137 | 9 接下来面了一个家门口的pg，这次风格迥异
9个candidates一起面，4个AMG （其中2个申prelim），4个印度人（1个女的年纪比较
大，另外3个应该是fresh grad）
这次跟3个faculty member面。第一个是PD，她人很和蔼，上来便问我在extern期间学
到了啥，有啥interesting patient，我很从容地讲了一些自己的经历和体会。然后她
问我free clinic的Dr.C and Dr. P (他们都认识，且Dr.P是他们pg的previous pd)，
”they have put in a lot of good words about you”，我的天，看来平时积累人品
真的很重要，我没主动请人家帮忙，人家竟然也说了些我的好话，真是阿弥陀佛。然后
她问我有啥question。面试其间我着重强调了，自己在local，非常想留在这里，对他
们pg也是仰慕已久，感觉PD很positive，“definitely, we are going to highly
consider you”。跟PD过招，这次没给自己留太大的遗憾。
第二面是跟ass... 阅读全帖 |
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R****8
发帖数: 43 | 11 看好了一个房子，感觉小区后院房子都不错，好不容易抢到了，在做home inspection
的时候听broker说seller唯一的女儿在8年前出去玩突然pulmonary embolism去世了，
去世当然在医院，不是在家里。听到这个消息打心里为这对老夫妇感到伤心，转念一想
，这样的房子算凶宅吗？ |
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h***a
发帖数: 97 | 12 【 以下文字转载自 Family 讨论区,原文如下 】
发信人: touchsoul (雕Ψ), 信区: Family
标 题: Re: 脑血栓英文是什么？
发信站: The unknown SPACE (Sun Apr 27 20:33:19 2003), 转信
stroke.
embolism |
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f******I
发帖数: 769 | 13
at this stage, there is really not much you could do for the damages already
done(within 3 hrs you can get iv tpa, within 6 hrs you can get intra-
arterial tpa),
so you kind of in the secondary prevention phase, she is at high risk for
recurrent stroke, her doctors need to find the cause of the stroke and treat
risk factors,
if it's thrombotic, you treat hypertension, diabetes, hyperlipidemia, modify
life style, aspirin or aggrenox or plavix,
if it's embolic, need to locate the source of emboli |
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f******I
发帖数: 769 | 14
some
on
big
spleen
can't tell much with very limited information you provided, the type of
liver cancer and whether is hepatic primary or metastatic would be helpful,
assume he had hepatocellular carcinoma from hep C, and maybe he had upper gi
bleed from either esophageal or gastric varices from portal hypertension
from cirrhosis from hep C, the outlook is not very good,
if it's metastatic disease with solitary hepatic mets sometimes they could
consider chemo embolization, |
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t******f
发帖数: 955 | 15 大家来到美国生病看病容易遇到不少困难，其中比较突出的一个就是语言障碍。有
些病症不会描述，有些在国内吃的比较有效的药，不知道英文的药名是什么，还有
就是这里医生说的病名不能立刻反应出来是什么。在整理以前贴子的时候，发现有
很多人问关于病名，药名和病症描述的英文的，也有很多热心有相关经历以及学医
药的网友，积极回答。我决定一边整理老贴子，一边把这些中英文翻译的贴子集中
编辑，方便大家查询。
为了让这些参与了翻译的网友的付出更有意义，我把他们的网名也列在上面，另外
就是希望有英文问题的朋友先查询一下已经收入的名词（web下面页面搜索一下），
看看是不是已经有了；如果没有就在这个主题下面，修改题目提出问题，然后有了
答案后我进一步编辑收入。
先将目前收入的一些贴出来，希望有专业知识或者相关经历的网友校对一下。随着
整理，我还会继续增加本帖内容的，也会修改由网友提出并大家确认的更加准确的
说法和翻译的。
=============================================================
urus (伊壁鸠鲁) 颈椎突出 ... 阅读全帖 |
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f******I
发帖数: 769 | 16
if it's lacunar infarct, control blood pressure, diabetes, high cholesterol,
quit smoking, lacunes are rarely caused by embolic or carotid disease |
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f******I
发帖数: 769 | 17
bronchiectasis is treated as part of COPD,
surgery is only reserved for local disease and recurrent infections
unresponsive to antibiotics, and reccurent massive bleeding, if your
relative is not a good surgical candidate, another option is bronchial
artery embolization, which might help for bleeding problem,
long term wise, mainly supportive, avoid smoking/second hand smoking, good
nutrition, bronchial hygiene(you can try nebulzed mucolytics, chest
physiotherapy and postural drainage), bronchi |
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t****y
发帖数: 576 | 18 医生说是stage 2,血管瘤在皮下，现在由于血压太大，已经开始掉皮了
美国的医生建议embolization,alcohol或者oxyn
国内好像还有中医的疗法，不知道效果如何？
对于，血管瘤，大家建议在美国治疗还是回国内？ |
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f******I
发帖数: 769 | 19
need to rule out embolic source, at least need a TEE, transesophageal
echocardiogram |
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f******I
发帖数: 769 | 20
you did not provide enough information,
generally speaking, the 5 major life threatening chest pain related
diagnosis are
aortic disection,
ruptured esophagus,
pneumothorax,
pulmonary embolism,
myocardial infarction,
of the five conditions, aortic disection and ruptured esophagus, patients
mostly die within a couple hours before they had time to reach emergency
room, |
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y*****g
发帖数: 193 | 21 If you have insurance, find a doctor to order
chest x-ray to evaluate pulmonary insufficency.
CT-Scan with IV contrast to rule out pulmonary embolism.
2D-echo to evaluate Left ventricle ejection fraction.
blood test: proheart, BNP something like that.
Either way, your friend need to see a doctor (pulmonology or cardiology). |
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x*******a
发帖数: 11067 | 22 上AMAZON,查anti-embolism stocking. 我给我家人买过 TED 牌子的.
我不知道那个graduate compression,但是Amazon上好象你也可以查到. |
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f******I
发帖数: 769 | 23
elevated AFP in patient with chronic hep b infection is concerning for
hepatocellular carcinoma, he might need a liver ultrasound, normally they
say if AFP is high the lesion should be more than 1cm, if there is any
lesions found on ultrasound, he'd need biopsy, then depends on the result
and number of lesions he might be suitable for chemo-embolization and
transplant,
don't know if his interferon was standard or pegylated, if he failed
pegylated INFa, then he might need to be switched to antiv |
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g***r
发帖数: 285 | 24
interesting, when the term of ablation mentioned, either radiofrequency
abalation, to me, it means to apply a probe that emmits heat to burn the
tissue, or cryoabaltion, the probe that emeits cold or whatever to freeze
the tissue; either case you have to place the probe directly into the tumor,
which has to be invasive, though less so comparing a lobectomy,
even in chemo-embolization, like they do for liver mets, you still have to
insert the catheter through the tumor site to deliver chemo agen |
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g***r
发帖数: 285 | 25
you have to tell me what is 丘脑? is it thalamus?
if it is, it's most likely lacunar infarct, which often occurs in internal
capsule,
most of lacunar infarct is due to small vessel disease with risk factors
such as hypertension, diabetes, hyperlipidemia and such, though very small
percentage of it could be from embolic source,
i see she is taking plavix, depends on which neurologist you are talking to,
either plavix or aggrenox will be fine, which is a step up above aspirin,
if she starts having |
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g*****j
发帖数: 1211 | 26 I believe you are talking about pulmonary embolism. The filter is not in
the lung, but in the IVC (inferior vena cava) - a major vein that drains the
lower part of body.
It basically is caused by blood clots formed in vein dislodge into and block
blood vessels in the lung. Any lung tissue with a discontinued blood
supply irreversibly die. There is very few effective treatment at this
point since the damage is already done. What need to be done is to
stabilize the patient, find out the root |
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m*****e
发帖数: 292 | 27 You should check the details of this case more carefully before you made
your conclusion. If you were a physician, you will treat the patient before
pulmonary embolism occurs, as she already had signs and symptoms of blood clots.
patients,
last
any
's |
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c********e
发帖数: 496 | 28 Multaq or others similar, be very careful to use them,
They are good for control Af, but many side effects like hypo/
hyperthyroidism, pulmonary problem. And it is very hard to stop it.
on the other hand, try to find out what is causing the Af, some of them is
curable.
ablation is another option.
Another important point is the prevention of embolism, as stated above by
banzhu. |
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s********l
发帖数: 1195 | 29 谢谢您的指点
我回去再和家长商量一下
唉
embolism
which |
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c********e
发帖数: 496 | 30 I do think what you are telling is kind of misunderstanding of what you were
told.
DVT is curable for sure, chemotherapy is not indicated, unless there is
malignancy (pancreatic cancer may be accompanied with migrating embolism). |
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c********e
发帖数: 496 | 31 heparin, thrombolytic, warfarin, are all involved in the treatment of
Pulmonary Embolism, Nothing special, just different indications. |
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c***n
发帖数: 921 | 32 弹力袜子英文文好像是 Anti-Embolism Stockings吧？
和 compression stocking 一回事么 |
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c***n
发帖数: 921 | 33 弹力袜子英文文好像是 Anti-Embolism Stockings吧？
和 compression stocking 一回事么 |
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h**a
发帖数: 108 | 34 被告知肺部有血栓但是不是大问题，但是看到以下的医院的CT报告又觉得比医生说的要
严重一些，不知哪位能帮忙解读一下。万分感谢
Findings: There is significant thrombus within the right lower lobe
pulmonary artery, which distends the artery somewhat and is nearly occlusive
. There are several vessels distal to this, which also appear to contain
thrombus. Contrast does, however, pass beyond this into the more distal
branches. There is what appears to be peripheral consolidation, which has a
lobulated,slightly ill-defined contour, which could represent focal
infa... 阅读全帖 |
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c********e
发帖数: 496 | 35 first, I guess this is a spiral CT report, is that right? regular CT plays
no role in the Tx of PE.
pulmonary embolism sounds horrible, actually it is not uncommon though,
while most of the cases shows no symptoms, until a major vessel is blocked.
If you are free of symptom, all you should do is to figure out the source of
the embolus, especially rule out DVT, the most common one, a Doppler may
help with it.
If you have SOB, tarchycardia, or chest pain, stay in the ER, heparin (
preferred) or LM... 阅读全帖 |
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a**********2
发帖数: 3726 | 37 Large artery low flow TIA usually lasts minutes to hours.
Embolic TIA usually lasts hours.
is
the |
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l*h
发帖数: 4124 | 38 I don't question the diagnosis of HCC, but the pathology report is of very
low quality, and I don't understand the treatment strategy either.
1. there is no description of microscopic findings, there is no way to tell
if the histological grading is correct or wrong. it seems almost all
pathologists in China have the magic power to give an unequivocal diagnosis
on everything.
2. stomach stromal tumor is rare, spleen stromal tumor is extremely rare. i
simply cannot believe all three tumors occur a... 阅读全帖 |
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s*****9
发帖数: 255 | 39 我孕39周，因为娃偏小，曾经在31周和35周娃低于10%被怀疑胎盘吸收有问题，虽然38
周B超娃已经长到了28%，也被安排了下周二催产。
OB说因为我现在还基本没开指，会先上一个促开指的药，叫作misoprostol，等开指到
一定程度再上pitocin。
结果我查了两种药物，这个叫作misoprostol的在FDA只批了可以抗肠胃溃疡的，没有批
催产的，而且在FDA网站上有这么一段话：
A major adverse effect of the obstetrical use of misoprostol is uterine
tachysystole which may progress to uterine tetany with marked impairment of
uteroplacental blood flow, uterine rupture (requiring surgical repair,
hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism and
lead to a... 阅读全帖 |
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s*****9
发帖数: 255 | 40 我孕39周，因为娃偏小，曾经在31周和35周娃低于10%被怀疑胎盘吸收有问题，虽然38
周B超娃已经长到了28%，也被安排了下周二催产。
OB说因为我现在还基本没开指，会先上一个促开指的药，叫作misoprostol，等开指到
一定程度再上pitocin。
结果我查了两种药物，这个叫作misoprostol的在FDA只批了可以抗肠胃溃疡的，没有批
催产的，而且在FDA网站上有这么一段话：
A major adverse effect of the obstetrical use of misoprostol is uterine
tachysystole which may progress to uterine tetany with marked impairment of
uteroplacental blood flow, uterine rupture (requiring surgical repair,
hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism and
lead to a... 阅读全帖 |
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n***a
发帖数: 1373 | 41 What I can think of is to relieve coughing as much as possible. Here, they
may do embolization of the blood vessels where the bleeding it from. But I
don't know if it can work for him and whether it can be done in the hospital
where the patient is. Talk to his doctor about it. |
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s*******2
发帖数: 1182 | 42 PE 诊断明确，接下来就是要规范的治疗了。让你的PCP 推荐一个pulmonologist. |
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m*******r
发帖数: 595 | 43
谢谢回复，在住院期间见过一个年轻的pulmonologist，感觉经验很不丰富，希望版上
人能推荐个这领域的专家，谢谢 |
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m**********r
发帖数: 2099 | 44 如果孩子还怀着，你这个属于高危妊娠。如果还是家庭医生在看你，要求转给产科医生
，要求hematologist会诊，要求pulmonologist会诊。这种事情如果产妇和孩子出了问
题，我不信哪个pcp兜得住，该转诊的不转诊，纽约州medical malpractice对精神损失
费没有上限。 |
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m*******r
发帖数: 595 | 45
谢谢回复，现在怀孕13周，宝宝一切都好。我是同时在看ob/gyn和hematologist,问题
是他们谁也解释不清为什么我的右肺突然开始疼，在医院见到的唯一一个high risk ob
告诉我这可能也是正常的，让我再等几个月看看。我很需要second opinion，尤其是今
天和以前见过的一个老中医联系，中医告诉我一个极端例子，一个40多岁怀第二胎的产
妇也是有同样的问题结果死在了产床上，吓死人了！
目前我已经决定再找个high risk ob和hematologist听听他们的意见。不过，我在医院
见到的pulmonologist感觉年轻没什么经验，我想换个有经验的。如果版上有推荐的谢
谢了！
此外还有一个问题，前两天才拿到我的medical record，请大家看看我的血小板数值：
5/22 (一个月前住院当天，还没开始用blood thinner，当天之后便开始每天两次按最
高剂量用): 243,000
5/24: 267,000
5/25: 319,000
6/11: 319,000
6/20: 268,000
没有医学背景的我请问一下:我在开始用blood thinne... 阅读全帖 |
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f****o
发帖数: 2770 | 46 肺栓和血小板正不正常没有关系啊
blood thinner不是降低血小板而是inhibit clotting factor
我在想你的lovenox dose 是多少？体重多少？
还有会不会你有heparin resistance
factor III deficiency
怀孕了如果lovenox无效比较讨厌了，warfarin也不能用
肺栓还真是会死的病不弄好 |
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s*****9
发帖数: 255 | 47 我孕39周，因为娃偏小，曾经在31周和35周娃低于10%被怀疑胎盘吸收有问题，虽然38
周B超娃已经长到了28%，也被安排了下周二催产。
OB说因为我现在还基本没开指，会先上一个促开指的药，叫作misoprostol，等开指到
一定程度再上pitocin。
结果我查了两种药物，这个叫作misoprostol的在FDA只批了可以抗肠胃溃疡的，没有批
催产的，而且在FDA网站上有这么一段话：
A major adverse effect of the obstetrical use of misoprostol is uterine
tachysystole which may progress to uterine tetany with marked impairment of
uteroplacental blood flow, uterine rupture (requiring surgical repair,
hysterectomy, and/or salpingo-oophorectomy), or amniotic fluid embolism and
lead to a... 阅读全帖 |
|
e***y
发帖数: 4307 | 48 子宫肌瘤栓塞术是uterine fibroid embolization. 这个是介入放射手术，找
interventional radiology做。不过不清楚新泽西那个医生好。 |
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b****e
发帖数: 26 | 49 Some of you may know her : wanger.. She had Pulmonary Embolism (肺栓塞) attack this morning.. she is ICU and really in pain.. please help with prayers..
blessing..anything...
PE is really dangerous. 1/3 die from it.. but if she makes past 48 hours. things will be looking good for her. .. i dont know how much longer i can hold on for this..it is killing me.
== Update: She seems to be doing better now.. heart rate is around 120.. she was about 130-140 last night and have huge pain in the chest. righ |
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G*******4
发帖数: 117 | 50 Progesterone (Prometrium)在pregnancy Risk Drug Category 中属于category D,也
就是说实验证明对胎儿有风险。除非用药的利大于弊。
它的副作用包括Pulmonary Embolism，由于怀孕本身容易造成凝血，这个时候用它，增
加了可能性。
知道自己以前流产的原因么？
不能乱投医。 |
|
