Theo dõi diễn biến và xử trí bệnh sốt xuất huyết - DG news
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Theo dõi diễn biến và xử trí bệnh sốt xuất huyết

Sốt xuất huyết hiện đang là bệnh xảy ra khá phổ biến tại một số địa phương với nhiều người mắc bệnh, với những biểu hiện lâm sàng khá đa dạng và tỷ lệ diễn biến nặng cao. Nếu không được phát hiện, chẩn đoán sớm và xử trí kịp thời sẽ dễ dẫn đến tử vong. Vì vậy không nên chủ quan khi đối diện với sốt xuất huyết vì bệnh chưa có thuốc điều trị đặc hiệu và vắc-xin phòng bệnh.

Diễn biến bệnh sốt xuất huyết

Bệnh thường khởi phát một cách đột ngột và tiến triển qua ba giai đoạn là giai đoạn sốt, giai đoạn nguy hiểm và giai đoạn hồi phục.

 

Giai đoạn nguy hiểm thường xảy ra từ ngày thứ 3 đến ngày thứ 7 sau khi bị sốt. Người bệnh có thể còn sốt hoặc đã giảm sốt và có các biểu hiện như thoát huyết tương do tăng tính thấm thành mạch thường kéo dài từ 24 – 48 giờ; tràn dịch màng phổi, mô kẽ, màng bụng, phù nề mi mắt, gan to và có thể đau. Nếu bị thoát huyết tương nhiều sẽ dẫn đến tình trạng sốc với các biểu hiện như vật vã, bứt rứt hoặc li bì, lạnh các đầu chi, da lạnh ẩm, mạch nhanh, nhỏ; huyết áp bị kẹt với hiệu số huyết áp tối đa và huyết áp tối thiểu bằng hoặc dưới 20mmHg; huyết áp bị tụt hoặc không đo được; lượng nước tiểu ít. Triệu chứng xuất huyết có thể xảy ra ở dưới da, niêm mạc và nội tạng. Dấu hiệu xuất huyết dưới da được biểu hiện với các nốt xuất huyết rải rác hoặc chấm xuất huyết thường thấy ở mặt trước hai cẳng chân và mặt trong cánh tay, bụng, đùi, mạng sườn hoặc mảng bầm tím. Dấu hiệu xuất huyết niêm mạc được biểu hiện với hiện tượng chảy máu mũi, lợi; đi tiểu ra máu, kinh nguyệt kéo dài hoặc xuất hiện kinh sớm hơn kỳ hạn. Dấu hiệu xuất huyết nội tạng có thể thấy ở hệ tiêu hóa, phổi, não; đây là dấu hiệu nặng. Ngoài ra, một số trường hợp nặng có thể có biểu hiện suy phủ tạng như viêm gan nặng, viêm não, viêm cơ tim. Những biểu hiện nặng này có thể xảy ra ở một số người bệnh không có dấu hiệu thoát huyết tương rõ hoặc không bị sốc; vì vậy trên thực tế lâm sàng cần cảnh giác. Khi xét nghiệm cận lâm sàng cho thấy dung tích hồng cầu (hematocrite) tăng so với giá trị ban đầu của người bệnh hoặc so với giá trị trung bình của dân số ở cùng lứa tuổi; số lượng tiểu cầu giảm dưới 100.000/mm3 máu, enzyme AST (aspartat transaminase), ALT (alanin transaminase) thường tăng; trong trường hợp nặng có thể có rối loạn đông máu. Siêu âm hoặc chụp phim Xquang có thể phát hiện tràn dịch màng bụng, màng phổi.
          Giai đoạn hồi phục thường xảy ra từ 24-48 giờ sau giai đoạn nguy hiểm khi có hiện tượng tái hấp thu dần từ mô kẽ vào bên trong lòng mạch máu. Giai đoạn hồi phục kéo dài khoảng từ 48-72 giờ sau đó. Người bệnh hết sốt, thể trạng được tốt dần lên, có cảm giác thèm ăn, huyết động ổn định và bắt đầu đi tiểu nhiều. Bệnh nhân có thể có nhịp tim chậm và thay đổi về điện tâm đồ. Trong giai đoạn này cần thận trọng vì nếu truyền dịch không kiểm soát, truyền dịch quá mức có thể gây nên phù phổi hoặc suy tim. Xét nghiệm cận lâm sàng thấy dung tích hồng cầu (hematocrite) trở về chỉ số bình thường hoặc có thể thấp hơn do hiện tượng pha loãng máu khi dịch được tái hấp thu trở lại. Số lượng bạch cầu ở trong máu thường tăng lên sớm sau giai đoạn hạ sốt. Số lượng tiểu cầu dần dần trở về chỉ số bình thường nhưng có thể chậm hơn so với số lượng bạch cầu.
          Với diễn biến lâm sàng qua 3 giai đoạn đã nêu trên, việc theo dõi bệnh nhân chặt chẽ rất cần thiết để có biện pháp xử trí phù hợp theo từng giai đoạn và tiên lượng trước khả năng có thể ảnh hưởng đến người bệnh, nhất là những biến chứng trầm trọng xảy ra.

Các mức độ của bệnh sốt xuất huyết

Tổ chức Y tế Thế giới (WHO) đã khuyến cáo bệnh sốt xuất huyết xảy ra gồm 3 mức độ khác nhau là sốt xuất huyết, sốt xuất huyết có dấu hiệu cảnh báo và sốt xuất huyết nặng.

 

Sốt xuất huyết có dấu hiệu cảnh báo gồm các triệu chứng lâm sàng của sốt xuất huyết đã nêu trên và kèm theo các dấu hiệu cảnh báo như vật vã, lừ đừ, li bì. Bệnh nhân có triệu chứng đau bụng vùng gan hoặc ấn đau vùng gan, gan to trên 2cm; nôn nhiều, xuất huyết niêm mạc, đi tiểu ít. Xét nghiệm cận lâm sàng thấy dung tích hồng cầu (hematocrite) tăng cao và tiểu cầu giảm nhanh chóng. Nếu người bệnh có những dấu hiệu cảnh báo trên phải theo dõi sát mạch, huyết áp, số lượng nước tiểu, làm xét nghiệm dung tích hồng cầu, tiểu cầu và có chỉ định truyền dịch kịp thời.

 

Sốt xuất huyết nặng xảy ra khi người bệnh có một trong các biểu hiện thoát huyết tương nặng dẫn đến tình trạng sốc giảm thể tích hay còn gọi là sốc sốt xuất huyết, có ứ dịch ở khoang màng phổi và ổ bụng nhiều; có dấu hiệu xuất huyết nặng và suy tạng.

Sốc sốt xuất huyết có biểu hiện suy tuần hoàn cấp, thường xảy ra vào ngày thứ 3 đến ngày thứ 7 của bệnh với các triệu chứng như vật vã, bứt rứt hoặc li bì; lạnh đầu chi, da lạnh ẩm; mạch nhanh, nhỏ, huyết áp kẹt, hiệu số huyết áp tối đa và tối thiểu bằng hoặc dưới 20mmHg, tụt huyết áp hay không đo được huyết áp; đi tiểu ít. Sốc sốt xuất huyết lại được chia làm 2 mức độ để điều trị bù dịch gồm sốc sốt xuất huyết có dấu hiệu như suy tuần hoàn, mạch nhanh, nhỏ, huyết áp kẹt hoặc tụt; kèm theo các triệu chứng như da lạnh, ẩm, bứt rứt hoặc vật vã, li bì và sốc sốt xuất huyết nặng có dấu hiệu sốc nặng, mạch nhỏ khó bắt, huyết áp không đo được. Cần chú ý trong quá trình theo dõi diễn biến, bệnh có thể chuyển từ mức độ nhẹ sang mức độ nặng; vì vậy khi thăm khám phải phân độ lâm sàng để tiên lượng bệnh và có định hướng xử trí phù hợp.

 

Xuất huyết nặng được biểu hiện triệu chứng chảy máu cam nặng nên cần nhét gạc vào vách mũi để cầm máu, bị rong kinh nặng, xuất huyết trong cơ và phần mềm, xuất huyết đường tiêu hóa và nội tạng; thường kèm theo tình trạng sốc nặng, giảm tiểu cầu, thiếu ôxy mô và toan chuyển hóa, có thể dẫn đến suy đa phủ tạng và đông máu nội mạch nặng. Xuất huyết nặng cũng có thể xảy ra ở người bệnh dùng các thuốc kháng viêm như acetylsalicylic acid (aspirin); ibuprofen hoặc dùng thuốc corticoid; bệnh nhân có tiền sử loét dạ dày, tá tràng, viêm gan mạn tính.

 

Suy tạng nặng được biểu hiện các dấu hiệu suy gan cấp, men gan AST, ALT có thể bằng hoặc dưới 1.000U/L; suy thận cấp; rối loạn tri giác trong sốt xuất huyết thể não. Có thể viêm cơ tim, suy tim hoặc suy chức năng các cơ quan khác.

 

Lời khuyên của thầy thuốc

 

Hiện nay, bệnh sốt xuất huyết chưa có vắc-xin để phòng bệnh và thuốc đặc hiệu để điều trị. Diễn biến lâm sàng với triệu chứng bệnh lý khá đa dạng và chuyển biến nhanh từ nhẹ sang nặng. Mức độ bệnh tiến triển từ sốt xuất huyết thông thường sang sốt xuất huyết nặng không lường trước được. Vì vậy, ngành y tế cùng phối hợp với cộng đồng người dân thực hiện công tác giám sát, phòng chống bệnh một cách chặt chẽ. Phòng bệnh chủ yếu là kiểm soát được hoạt động của muỗi truyền bệnh sốt xuất huyết như tránh muỗi đốt kể cả ban ngành; diệt bọ gậy muỗi, loăng quăng muỗi và muỗi trưởng thành bằng tất cả các biện pháp hiệu quả, khả thi; đồng thời thường xuyên vệ sinh cảnh quan, môi trường sống để loại bỏ các ổ chứa nước đọng là điểm sinh sản của muỗi ở trong nhà và ngoài nhà. Khi phát hiện các dấu hiệu nghi ngờ mắc bệnh sốt xuất huyết cần đến ngay cơ sở y tế để được khám, chẩn đoán và điều trị phù hợp; mọi sự chậm trễ có thể dẫn đến nguy cơ tử vong khi có những biến chứng trầm trọng xảy ra. Bệnh nhân chỉ được xuất viện về nhà khi hết sốt trong vòng 2 ngày, tỉnh táo; mạch, huyết áp bình thường; số lượng tiểu cầu máu phải trên 50.000/mm3 máu.

 

Nguồn: suckhoedoisong

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  34. Beste AnderS,Ik kan hier natuurlijk als wat je geschreven hebt onderuithalen maar daar heb ik nu eventjes geen zin in dus doe ik het anders ik stel je een vraag die ik ook aan Vele heb gesteld maar waar hij nog steeds geen antwoord op heeft gegeven misschien dat jij dat wel kan:Welk recht hadden/hebben zionisten om bezit te nemen van andermans land?Met vriendelijke groet,Mohammed

  35. Hold da op hvor var det bare en fantastisk “nyhed” og ikke mindst indlæg! vil straks dele det med mine kære med-mødre rund omkring i omgangskredsen, hvem ved snart fylder vi hele butikken! tak!

  36. Jen se smějte. Já ale v Orwellově 1984 žít nechci. Jestli vy ano, sbalte si svoje saky paky, vezměte svoje socialistické přátele a tuto dystopii si založte někde, kde nebudu já. Já chápu, že si myslíte, že socialismus je tak skvělá myšlenka, že musí být povinná, ale mě z toho prosím vynechte.

  37. I like the helpful info you provide in your articles. I will bookmark your blog and check again here frequently. I am quite sure I’ll learn many new stuff right here! Good luck for the next!

  38. i ask that question all the time, where the curvy chics and guys, showing a skinny girl does nothing but discourage me. I will just keep running and eating right way better then a belt, but it looks like it would do some good. thank you for the vlog

  39. Liebe Hanna,ich oute mich mal als Foxycheek Leserin und bin wegen deinem Blog losgerannt und hab mir doch tatsächlim meinen ersten roten Lippenstift gekauft! Der Lipstain ist genial, hätt ich aber von selber nie ausprobiert! Mach weiter so mit deinem tollen blog!LGSandra

  40. Consignment can be a great way to clear closets and get some money back from all of those purchases you made for your little ones. These are great tips. I work with another consignment sale and I know how helpful these events can be in a tough economy. Not only do you make money but other people can make purchases more affordably, so it is helpful for those struggling financially.

  41. Fantastico l’outfit!!!Lo scorso sabato ho comprato un paio di scarpe della tua collezione, quelle con il braccialetto bluette e dorate dal concept store mimma ninni a bari! ho un piccolo appunto però: il braccialetto è troppo corto per noi ragazze dalla caviglia non troppo esile…

  42. I nesten eit halvt år hadde vi plenty av bøllemaur inne i huset vårt, ivrige og iherdige arbeidarar var dei, og ein pest og ei plage for oss som ikkje hadd lyst til å ha haugar med merkeleg innhald på dei utrilegaste plassar i huset. GIFT var det vi tok i bruk til slutt, med dårleg samvit, men må ein så må ein!

  43. / Hey There. I discovered your weblog using msn. That is an extremely well written article. I’ll be sure to bookmark it and return to read extra of your helpful information. Thanks for the post. I will certainly comeback.

  44. I was called today by Silver Lining Security. They claimed to have a group buyer for my DWVC membership for £10,000. A holding bond of 10% was required. Being on the receiving end of many a cold call, all exactly the same, I am completely immune to this and declined their offer however, I did check out their website and it was then that I found your site and this report for which I thank you. I have reported them to TATOC who reminded me that it was illegal for them to ask for any monies up front. I have also posted this on TimeshareTalk to make as many aware as possible.

  45. Both point these are beautiful! Bold move along with the bubbly halcyon. Bold forward! Love it. And gallows impartial feature foolish. Equally accidental judicature. And negative dispassionately thoroughly fair repainting designer avarice in any case other self punk hired wrong! Good market. ~ karen

  46. Jouw algemene look zit zo goed ineen, echt knap. Het is ontzettend inspirerend hoe je de schoonheid ziet in dingen zoals een wielerbroek en plastieken waterschoenen.

  47. Mi estimada Isela,Felicidades!! Eres todo un ejemplo de que tenemos todo para lograr todo!Que los dones y habilidades que Dios te dio sean de mucha edificación para muchos más.Por favor, luego nos mandas una tarjeta electrónica para los que vivimos en otras partes de la república. Oye, y qué tal un curso on-line…. para quienes no puedan estar presente en un aula….Saludos y bendiciones

  48. Haha is wel vreeemd ja! Ik heb zelf extentions gehad maar dan die met lijm vast zaten! Stond heel leuk maar was zo vreemd toen ze er weer uit moesten!

  49. Não é nada cafona All Star!!!É um tenis que combina com tudo e nunca sai de moda, Mas concordo que falta um pouco de nacionalidade no blog, mas é otimo ter o que poucos aqui no Brasil tem rs…

  50. Wow, you got a lot of participation in your carnival, nice!"It doesn't matter if you've not yet achieved perfection."–Words of wisdom. That's how I feel. Sometimes you've got to seize the moment (like if you've been wanting to take a class), but when it comes to "self-improvement" or other long term goals, you have to remember that it's a process.The splits resolution made me laugh, but only because I had that on my list a few times, but I gave it up many, MANY years ago!

  51. Well done. You deserve that. Hope I will be there, but not sure yet as I live so far away. But will be rooting for you xxxSusan Mann recently posted..

  52. a person who is unable to sit is itself a disability ,a half live person is kept in a cage is a clear voilation of human right,it tends to think of some stone age laws which is utterly condemnabile, requesting the authorities to abolish such methods of questioning

  53. Running is a GREAT way to explore a new city, but also check out the gym of the hotel you’re staying at. Nothing makes you feel better when on the road then a nice intense workout in the hotel gym.

  54. I really love your website.. Very nice colours & theme. Did you develop this web site yourself? Please reply back as I’m making an attempt to create my very personal internetsite and would like to discover out where you got this from or precisely what the theme is named. Thanks!

  55. Wow, incredible blog format! How lengthy have you ever been running a blog for? you make running a blog glance easy. The full look of your site is great, as well as the content!

  56. Però adesso ti diranno: Ah, ecco perché hai scelto Dredd, sapevi che stava per uscire il film.Senza sapere che forse è stato qualche produttore cinematografico che è passato casualmente sul tuo blog ed è statp ispirato 😉

  57. She was indeed! She described her surfing experiences (among many other interesting things) in her autobiography.She was a damned interesting writer.  eristicist

  58. In my opinion, this is a terrible solution. It is on the right track, but with one major mistake. The headless browser should be run at the side of the crawler, not the webserver.Why should every webserver install a headless browser to accommodate Google, when Google can do it and solve the problem instantly.Googlebot should simply fetch the page with all it's javascript, execute it in a headless browser and index the result. This would also eliminate the problem of serving different content to spiders and regular users.

  59. genauso kann man die frage bei den italienern stellen. warum blau. hier waren es zu früheren zeiten dominierende königshäuser, die die farbe blau als wahrzeichen hatten. lustig waren heute in der fussballarena einige zuschauer, die sich fragten, warum die holländischen fans orange leibchen trugen, aber auf ihren backen das franzosen-wappen aufgemalt hatten.Antworten

  60. திட்டம் போட வேண்டியது ஒங்க வேல பாஸ், நீங்க எப்படியெழுதனும்னு வாசிக்கிறவன் திட்டம் தரணுமாக்கும். அது இல்லாமலா இவ்வளவு ‘நல்ல’ கட்டுரைகளையும் எழுதுறீன்ங்க? ஓங்களுக்குத் தேவ “self analysis” அல்லது “comment block”.

  61. Rick Merkt has always been willing to stand apart from the other legislators. He is one person in Trenton who has consistently worked to solve problems, not to go along with the crowd. He is brave enough to walk out on a Corzine speech, and also has fought against COAH. I think he is the best candidate for governor. Lonegan and Levine only have local governing experience. Christie may have a large reputation (no pun intended), but he was a very lackluster freeholder.

  62. Once again your not listening to your users YouTube. Though I appreciate the work your putting in, forcing a change is once again a shining example of how your not listening to or giving your users what they want. You are not Ustream…and that's why we love you! Please stop trying to be something you are not.

  63. that the best understand that it's a two way conversation – and I've had conversations with some fantastic people there, both in the UK and abroad, who I would never otherwise have come across.

  64. What is this place? It’s like some whimsical land of all things housewives. I stumbled on it trying to talk shit about Kenya and/or Kim because if I didn’t vent somewhere, my tv was going to have a very inconvenient remote shaped hole through it. I just have one question… Is your hair big because it’s full of secrets? Also, did I mention how awesome this land is?

  65. Mmmm, qué ricos los crêpes salados con su relleno de verduras… desde mi viaje por Francia me he hecho adicta a ellos, aunque tengo que adaptar las recetas a ingredientes sin lactosa, pero no pasa nada; me llevo tu receta!Un abrazo

  66. you lie the funniest destruction that I know of personally from you (because YOU told it on yourself) was the threats you made to your kids right before Christmas because their “activity” was threatening to break the Baby Jesus right in two….as I recall, there were some adult beverages involved in the scene as well!!!! yer funny

  67. My mother used to grow a night blooming plant called 9 o’clocks. Sure enough they bloomed around 9 o’clock in the evening. Have you heard of them and know where I could find them?

  68. – Good day! This is my first comment here so I just wanted to give a quick shout out and tell you I truly enjoy reading your posts. Can you suggest any other blogs/websites/forums that go over the same subjects? Many thanks!

  69. -j’ai aussi beaucoup de mal à m’y faire… pourtant nous sommes sensés avoir un niveau élevé d’adaptabilité quand on navigue aussi souvent sur le web. L’interface doit sans doute avoir des défauts que je n’ai pas analysés

  70. Excellent post. I could not agree more. Apart from gratitude, I love to fill my mind with my daughter’s laugh, God’s word and of course valuable information about business. I enjoy reading articles like this as well.PS Wanted to make sure you saw your blog on my new blog list!

  71. Kirjoituksesi on järkyttävää luettavaa.Muistathan kuitenkin, että Jumalalla ei ole mitään tekemistä lapsia hyväksi käyttävien pappien kanssa. He tekevät hirveän synnin, eikä se, että he ovat pappeja, muuta sitä miksikään. Eivät he ole erikoisasemassa Jumalan edessä, vaan joutuvat tekemään Jumalalle tilin niinkuin kaikki muutkin.Olet ateisti, mutta tutkimusten mukaan 20% ateisteista rukoilee päivittäin ja loputkin melko usein :)Toivotan sinulle siunausta kaikesta huolimatta.Roosa

  72. “I guess you could simply stay and remain silent until he dismisses you, but how is that not the same as being detained?”And then there is gambling with the unpleasant possibilities you might face if you exercise your right to silence.

  73. exactly what almost everyone thinks. Even fans of Twilight-the ones who aren’t bat shit insane at least-will admit the writing isn’t too good, it’s the story they like. Anyway, if you don’t like King, why do you have a video of one of his book signings listed under favorites on your channel?

  74. Great post K!! The school that my kids go to have the WORST lunches ever. Its ALL from a box. There is no choice at all. And I mean the whole lunch comes in a box, and inside the box are smaller boxes. Its all processed crap that they just heat up. And its nasty.So we make cold lunches.

  75. heh… i just posted a “random thought” of how i really do not like chorus. hehe….different flavors huh?maybe I can’t hear it through the youtube compression etc.. but the analogman did sound more lush to me. But…. I am partial to AM stuff.

  76. Nettipalavereita varten on olemassa ihan yrityksiä, jotka järjestävät näitä ja mm. mahdollisuuden live nettikameran kautta jutusteluun (webcasting). Ihmettelen, kuinka vähän porukka on tietoinen näistä mahdollisuuksista. Kai se edestakas lentely Euroopan halki omaa vielä hohdokkuutta… tai yritysten mielestä asiakassuhteita on edelleen parempi hoitaa face-2-face kuin computer screen-2-computer screen…

  77. … …j’allais écrire un pavé d’au moins 80 lignes,…et puis, ..non,… …je ne suis pas payer pour penser à votre place,… … …garder le sens du discernement,…et ses applications ciblées en médecine, …la technologie de pointe,.qui à passé le mur du son du sophisme & re-pairs. …

  78. It’s my belief that mesothelioma is usually the most deadly cancer. It’s got unusual features. The more I really look at it the more I am convinced it does not conduct itself like a true solid cells cancer. If perhaps mesothelioma is a rogue virus-like infection, therefore there is the chance for developing a vaccine and offering vaccination to asbestos subjected people who are vulnerable to high risk with developing long run asbestos related malignancies. Thanks for sharing your ideas on this important ailment.

  79. Mein lieber Thomas, auch ich wünsche dir von Herzen alles Gute und Liebe. Happy birthday, feier schön und genieß den Tag!! Hoffentlich scheint für dich auch in Berlin oder wo du auch immer steckst die Sonne :):handkuss: 😛

  80. At any rate, just wanted to say that I learned about the lulo there, and have to say that it is my favourite fruit in the world by far. I describe it as a combination of kiwi and maracuja in a single fruit… simply wonderfulGreat blog!Federicomaitravelsite.com

  81. zaraz, Bielewicz wcale nie zaleca obrony zÅ‚otówki za wszelkÄ… cenÄ™, a tylko „walkÄ™ partyzanckÄ…” aby spekulacja na zÅ‚otym staÅ‚a siÄ™ bardziej ryzykowna i kosztowna. Poza tym dezawuowanie faceta tylko dlatego, że wypowiedziaÅ‚ siÄ™ dla „Naszego Dziennika” jest niesmaczne. Facet byÅ‚ doradcÄ… Goldman Sachsa wiÄ™c chyba wie co mówi. A na koÅ„cu komentarz nt roli Marcinkiewicza u tegoż G S nadzwyczaj pikantny.

  82. Thank you! Yes, after some months of ups and downs, yesterday was a very very happy day:)I love your blue door! There’s just something about a blue door, isn’t there? I’m not sure I will be able to find a blue I like that goes with the green? Oh well, with as much as we have to do it will probably be a while:)

  83. fotos que eternizam momentos que somente os olhos do fotografo iriam recordar não fosse a máquina…não sei tirar fotos =/meu bisavô era fotógrafo de praça

  84. C’mon Prime, that’s like saying all Ted Ginn does is win games. Alex was along for the ride in this win. He handed off the ball and stayed out of the way. CK7 scored more points than the Precious.

  85. to be flown. They can play it single or multiplayer as well. The installation of this plane for flight simulator game is using DVD to be gone through Microsoft simulator that put in

  86. ça tombe bien moi qui venais d'acheter de l'anis étoilé! :PBravo pour ta gelée, c'est très original avec le melon!Bise & Bonne soirée

  87. WOW – not sure what happened with my first comment. LOL – obviously a big error. Anyhow, I love your pics (if you can’t decipher that from the code above. I appreciate you linking up and I’ll definitely find you on Instagram!

  88. Thanks Huhtikuunoita, just found a google translate button on your blog which will make reading a bit easier. Am getting some nice translations out of it – some lovely phrases like "Sink more slowly than one realizes" and "split the wisdom of life happiness" I'll be reading more often in 2010!

  89. When I worked at Texas Instruments, we referred to PhD as "Piled Higher and Deeper" in regard to how much crap they thought they knew.Mr Fixit

  90. Nicky, we haven’t gotten a lot of the entries yet although a number of readers have said they intend to participate. Maybe everyone is pulling together props? Or finding a truck? Either way, I’m excited to see what else gets posted!!

  91. Honestly that little anecdote was surreal. Here we have a government that is non-transparent in the extreme about basic things like crime statistics or how it spends the people’s money yet everyone is aware of the consistency and characteristics of the Presidential Poop.

  92. ‘Interesting’ – ectomorph is! I have seen many ‘lean’ people telling that they do not put on weight easily but never thought that they had a fast metabolism. Information taken Sir!

  93. Leah, we were so sorry to hear of your mother’s passing. Please know you will be in our thoughts and prayers in the days and weeks ahead. May God give you peace and comfort to sustain your loss.

  94. Gawd you look so comfy. LOL about the baseball caps.I think the baseball caps are a good look to you…they give you an edgyish flair. I do like the bag though, and the pattern of the sweater.Three thumbs up – even though i only have 2.XOXO, Neecy

  95. I will seize any chance to brighten up my day and the Wedding of Wills and Kate is too good a chance to pass up. I will be at a tea-party with all the Englishness that a bunch of Scots can muster. There will be a flat screen telly in a marquee where my cupcakes will be force fed to all the guests.This is my second go at piping icing tonight….You look fabulous and I really think that tomorrow you would be able to wear that bridesmaid's dress with a bold dash of irony!Your tanned legs are to die for.Ali x

  96. Just curious if the man in your blog had a family with strong religious affiliations. Was he jewish? for example? I think its more common for religious parents to push their children into marriage (and / or ARRANGE for the marriage).

  97. Så koselig det ble! Hva gjør vel ikke en mamma.. Og det skader jo ikke med litt glitter i hverdagen akkurat ;)Ha en strålende dag!Klem Christine

  98. Merci beaucoup !Pour répondre à vos remarque et question, je suis réellement restée deux jours à San Francisco. Je tourne, fais le montage, écris le commentaire et le lis.Je suis très contente que cette vidéo vous plaise.

  99. And that’s not just some “blah, blah, blah.” I’m not familiar with this “blah, blah, blah” from you… you normally have this descriptive tone of words… perhaps this is your true unabashed vernacular? Isn’t it funny… I would have considered it an investment in your time… so that causes me to be grateful for those who stumble across my way, too!I’ll try to keep up with you this week! I have to read every post… can’t let one go to waste! So, pen away!

  100. No Pacific Northwest (kids/grandkids) for Christmas. 18 inches of snow – questionable flights etc. I have been invited to a friend’s winter/summer – whatever – home at Superstition Mountain in Arizona for a week..don’t leave for a few days yet. I’ve never been to Arizona…looking forward to it.

  101. The phone, like with all teenagers IS AN MP-3 player, yes he probably did walk around with ear buds all day. But it ain’t got nothing to do with phone calls.

  102. I wish I had some advice or words of wisdom but I have gotten out of hosting any turkey-related (or equivalent) meals. I’m not sure how much longer that is going to last but I’m going to ride it as long as I can.

  103. Hi Teedy Bear, you do not have to colour your macarons you can leave them plain if you prefer. If you want them coloured then gel or powdered colour are the way to go.

  104. – I can’t even begin to imagine what you went through. You’re a brave woman to have chosen a 2nd pregnancy; I think I would have been too afraid. Very happy you have a healthy little boy!

  105. I consider hooking up anything OVER making out. I don’t think making out is a big deal, but if it went to oral, hand stimulation etc, then yeah, it’s hooking up.

  106. My thoughts exactly. I always eat way more batter/dough than the finished product. I have some of my family so fooled. They’re always asking stuff like “How come you never eat the sweets you make?” If they only knew.

  107. · when changes are slammed on us – or when they are more leisurely, and we can choose them (which can sometimes be more painful) – it is difficult to remember that change is a good thing. only when we emerge, like from a chrysalis, do we realize that we needed to spread our wings. i am glad you’re emerging. AND! lovely, lovely bread recipe. thank you!

  108. خیر شما به هر دلیل از کشور خارج شوید برای علت رفتن خود را به قصد دانشجویی که یا توریستی اگر بیش ار سه ماه باشد به کبک باید اعلام کنید در غیر این صورت در مرحله مدیکال با مشکل مواجه می شوید شما باید تغییر پاسپورت خود را به اطلاع کانادا برسانید با کانادا صادق باشید که در پرونده شما مشکلی ایجاد نشود

  109. My sports bra doesn’t usually chafe until 18+ miles (if at all), but when it does, it hurts!! I can’t imagine what it would be like to chafe on a regular basis.I can’t eat Gus to save my life, but I am a HUGE fan of Honey Stinger Energy Chews. Just like candy.

  110. Ah, go you for doing the detox! I feel like I should probably do something similar at some point but it seems so hard! As for this outfit, so pretty as usual! I especially like that wrap.xo,

  111. a pen/pencil trace firmly the outline of your design. (Thanks to Livingwithlindsay for the brilliant transfer method. If I have left you bewildered she explains it far better than I

  112. I was curious if you ever thought of changing the page layout of your site? Its very well written; I love what youve got to say. But maybe you could a little more in the way of content so people could connect with it better. Youve got an awful lot of text for only having one or two images. Maybe you could space it out better?

  113. As an aside, I'm reading this IN Bethesda and posted my previous comment right after having exited the metro with a drunk kid telling me how everyone should just chill out and live life with what you got – just like he does, and he's got nothing. Heck, his dad's trust fund doesn't even bring in $500,000 a year.The other thing he was telling me was how much he hates racists. Though he informed me that he's "as liberal as possible on every position out there" he conceeded to preferring conservative views on policies relating to finances.Mnuez

  114. What a great looking couple – their smiles are really infectious right from the word go. Love the images of the groom getting ready – often overlooked, especially if shooting solo.

  115. I would like to see you make it so that if you are an actor you have an actors page you have it for comic and director but nothing for actors or actresses.. I have premision to post things I have done in my career. I like adding my videos and showing them. There should be an entertainers page or actors not just catagorized as director of singer or comic…

  116. I think this is one of the most significant info for me. And i’m glad reading your article. But should remark on few general things, The web site style is wonderful, the articles is really great : D. Good job, cheers

  117. Just joined the rat pack here in Tucson. New at this forum stuff. First joined RAT in 1996 in England – yep I’m a Brit. Will keep and eye on upcoming events.BTW-I would like to get my hands on the club badge so I can add to my ’96 one.My ride is a 1995 Sprint that I shipped with me from the UK.

  118. The Andy McKee is lovely- and a break from politics– it also makes me want to pick up the guitar again…the second vid is giving me the “We’re sorry ….no longer available.”…C-CS

  119. jajca sobie robi:) wspominajÄ…c o solarnych ogniwach…Mister Lopez zawsze miaÅ‚ tendencjÄ™ do Å›ciemniania info co do faktycznie zainwestowanych pieniążków.Wszyscy pamiÄ™tamy zwrócenie siÄ™ o pozwolenie wczeÅ›niejszej wypÅ‚aty dla Lotus Renault (pamięć zawodna…?) – należnej „odprawy” przed zakoÅ„czeniem sezonu w kwocie pozwalajÄ…cej na kontynuowanie walki z … Mercedesem.WyÅ›miano Ich zgodnie z porocedurÄ… he he he… ale to byÅ‚a nauczka dla Lopeza, że nie można kisić kasiorki w swoim otoczeniu – F1 nie toleruje cienkiego budżetu.Cienki budżet -> cienkie wynikiA co obecnie widziemy?PS. Sie masz @fracky:)

  120. IL A PAS DE EMAIL! OU SINON IL EN A PLUSIEUR POUR ARNAQUÉ !TOUT LES VIDEOS C’EST DES MONTAGE…. ET SURMENT MON MESSAGE NE SERA PAS PUBLIQUÉ POUR CONTINUÉ A RÉPONDRE UN GROS MENSSONGE… VOUS MUSULMANS PRIER DIEU !!!! FAKE FAKE FAKE

  121. Again, that wasn’t her house the roaches were in. I can now see that you really don’t like her cause the tv was on and you certainly was not paying attention.

  122. I was suggested this website by my cousin. I am not sure whether this post is written by him as nobody else know such detailed about my trouble. You are wonderful! Thanks!Nice blog here! Also your web site loads up fast! What web host are you using? Can I get your affiliate link to your host? I wish my website loaded up as quickly as yours lol

  123. Robertovero Balzaretti ha 31 ma magari ci fossero 25enni che giocano come gioca Balzaretti, lo prendi per 4 ML mica uno sproposito e gli fai un contratto di tre anni…ma poi vuoi vincere subito quest’anno?.. quindi abbiamo bisogno di gente pronta…

  124. Moim zdaniem warto przeczytać wpisy i dowiedzieć się kto ma jaką opinię o produkcie. Zawsze tak właśnie robię, aby sobie wyrobić zdanie i nie nabywać rzeczy w ciemno.

  125. This election has broken like the log jam on a frozen river in spring on some old B movie. And once those logs start tumbling they keep coming, and keep coming, and keep on coming.

  126. Is there anything we, your readers, can do to get you back on Facebook? Your sharp but in now way abusive or violence inciting language is absolutely no reason for censorship!

  127. What do you mean “Everything is tied into the debate schedule”? I realize you guys on the editorial staff think your endorsements make a difference but take a breath and look at history, newspaper editorials are meaningless.As I indicated, I’m of the opinion that the debate schedule dance had more to do with polling trends not yet revealed. Why else would the guy whose been leading in the polls want an early debate and the guy trailing want to postpone. You guys at the paper should use your heads a little bit and repress the egos.

  128. Thank you for the tips…I was starting to doubt gatting 3 stars at this level was even possible…still not succeeded but at least I know it IS possible….this blue bird after the first one is really pissing me off…it’s so useless!!!

  129. I just want to say I am very new to weblog and absolutely liked your web-site. More than likely I’m planning to bookmark your site . You amazingly come with excellent well written articles. Many thanks for sharing with us your webpage.

  130. Bonjour Martin,Pour Noël je sais déjà ce que je vais offrir à mon Papa : un magnifique exemplaire de Quinquennat nerveux ! Grace à toi pas de casse tête cadeau cette année !Merci de nous faire rire tous les jours comme ça !

  131. Surely suspending the sale of made use of parts for 2 months is only going to frustrate any existing or potential customers of your organization and also damage any potential goodwill inside the brand.br /I realise which the auction has for being catalogued but would there genuinely be described as a must listing each individual particular person element?

  132. Buenas,Venta de algunos celulares, Iphone y Ipods. A los mejores precios del mercado con envíos a todo el mundo. Para mas información mi correo esMuy buenos precios; espero sus correos.GRACIAS POR VALIOSO TIEMPO.

  133. Hello, i think that i saw you visited my blog thus i came to “return the favor”.I’m attempting to find things to improve my site!I suppose its ok to use a few of your ideas!!

  134. #S* in genere il commento non è "che fessi che siamo stati" ma "per fortuna non sono serviti"per fortuna che ci siete voi geniacci a farcelo notaregrazie

  135. Hi Lyndsay,Just wanted to say how much I am enjoying this A to Z. I’m really learning about writing, although I’m not sure i’ll ever put in practice.Only small negative – I am a bit disappointed that your choice of hook wasn’t to Captain Hook, from peter pan

  136. AMTI- ISLAMIST–Gads, I saw that Bonny Prince Charles story. I think he's converted, ummm…reverted, but he can't admit it since he's in place to assume the head of the C of E. Boy he's a good example of why state religions are a bad idea…Y'all may be right about the PVV having a cordon sanitaire built around it. However, as the eurozone and the US collapse economically, things may change.White water ahead for us all…

  137. What i don’t realize is actually how you’re now not actually a lot more smartly-appreciated than you may be right now. You are very intelligent. You realize therefore considerably with regards to this matter, made me in my view imagine it from so many numerous angles. Its like women and men don’t seem to be involved until it’s something to do with Lady gaga! Your individual stuffs nice. All the time take care of it up!

  138. Cute image love the layout and colours.The posing cat just finish the pic off, cuter thankyou for joining us at Delightful Challenge for our "Red, white and blue" challenge!Hugs,Zahreenxxxx

  139. Good for you Kristina! i really enjoyed your report being at about the same level of experience myself. Having lived in the western half of North America for five years when I was younger, I would love to cycle the Maritime Provinces. Kind regards, Barry.

  140. Oltretutto ho visto una interessante presentazione della Turri sullo spread, grafico con studi Elliottiani(aiuto Grem) dove comunque da contraltare a qs. discesa i grafici danno una salita a 600….(ha beccato i 290 e i 500 precedenti)….

  141. The common image the Capitol Hill GOP invokes is to joke about the Democrats’ “circular firing squad.” Yet there is real concern behind the jokes. “Neither Obama nor Reid nor Pelosi is playing with a full deck anymore,” one Senator tells me.~~~~~~~~~~~~~~~See, Oldsalt, you knew it all along!!

  142. Great comments. Absolutely right about Osorio, but really it was just a lame excuse to include that video.@TSE: Yeah I know about el Tri, just making a funny haha at us stupid gringos’ expense.

  143. sì, lo so.. ma se la tariffa diventasse di 30 cent e per ogni ricarica che paghi 30 ti “regalassero” altri 5 sarebbe un modo più subdolo e nessuno protesterebbe. Cosa che tra l’altro la Tim sta già facendo: se passi alla nuova e “convenientissima” tariffa tribù ti “aboliscono” i costi di ricarica… eppure sembra conveniente..

  144. What is it they say on the airplane during the safety demonstration about the oxygen masks? Put your own mask on first before assisting anyone else…… thanks for the terrific reminder to take care of myself first!

  145. love the new blog! definitely way cooler than the old one! you get better and better every time i see your stuff! that a girl!!

  146. Très jolies tonalités (faites pour toi), écharpe superbe, starfish fidèle et de circonstance etc: bref, un look de vieux très réussi et rajeuni par les glitter- ballerines…Vive le soleil! Désolée si j’exprime mes pensées de façon décousue, je suis déjà fatiguée… A domani bella! Biz biz

  147. My wife and I did free dining a few years back and loved it! The only problem was, of course, making sure to make the ADRs enough in advance.Keep up the good work!

  148. Pues sí, debería dimitir. Pero aquí (en España) no dimite ni Dios. Nueva prueba de que Catalunya is Spain. No se engañen. Y si no ha dimitido ni Dios por los escándalos de corrupción, huelga decir que no van a dimitir por perder unas elecciones que él mismo adelantó para ganarlas de forma holgada.

  149. 4Symbols, what is sad is that I grew up in a former communist country and everyone here thinks that what we lived is behind us and that the West is good.Oh well, at least I'm glad that my government is too incompetent to tax people, let alone arrest us for this type of stuff.Fjordman, it's sad, but the more someone reads about it, the more they realize that what you say is true.

  150. I like the helpful information you provide to your articles. I’ll bookmark your blog and test again right here frequently. I’m reasonably sure I’ll be informed a lot of new stuff right here! Best of luck for the following!

  151. According to the ingredients you have given, this sounds more sweetness than spicy. I'm sure your grandchildren would love it. But I never thought the little chubby enjoying it too! How great! Haha…. He must be having lots of fun here! Oh I'm sure you & Bob having a fantastic time too. Enjoy your day.Blessings, kristy

  152. That’s really interesting. Did you ever see the move, The Iron Giant? This kinda reminds me of that. One of the characters in the movie makes art out of used auto parts. Thanks for sharing.

  153. I take debate in my high school and everyone tells me i should do forensics next year. But the most detail i have gotten from anyone is that it is a “laid back” debate. Can someone explain to me in greater detail?

  154. Thank you, I have recently been looking for information about this topic for a while and yours is the best I’ve found out so far. However, what in regards to the conclusion? Are you certain about the supply?

  155. Well we never want anyone to feel like an outsider. Bomo and I live in different countries, and to date Bomo has only met one commenter. I’ve never met any Would love to meet you all!

  156. Awfully enlightening many many thanks, It appears to be like like your current readers could possibly want even more blog posts similar to this continue the good effort.

  157. Wow i was just planning to make veggie oats parathas today for lunch…..what a coincidence…healthy parathas ! Have a wonderful time…i know a break means a lot to us…Ensoi :)Lavanyawww.lavsblog.com

  158. Happy birthday Andrea und alles Gute vor allem aber viel Gesundheit und persönliches Wohlergehen, sowie weiterhin viel Erfolg mit Deinen Liedern die wir immer wieder gern hören. Bleib so wie Du bist…

  159. This is amazing! Thank you Travis for sharing this. It is great to learn more about Daryl (my brother in law) and see really how long he had a fire for missions/adventure. This is so beautiful & he would love it.

  160. But she’s touching his-chestNow, he takes off her dressSignifica que ella esta tocando el su pecho (el pecho de otro) y que él (el otro)le saca el vestido…Saludos! Excelente trabajo…[]

  161. Multiculturalism came too early to Europe. It was forced upon us and people were not educated why and when it is good to be tolerant. Clearly the present situation is not one for this kind of tolerance but this still needs to be brought home. There is a huge uproar in most of Western Europe among the indigeneous populace against Islam. It is not yet reflected in the leadership, but it will be. The problem is , the only answer this future leadership will have is to fight and ban Islam, which will eventually result in bloodshed in Europe.

  162. whoah this weblog is excellent i like studying your posts. Keep up the good work! You know, a lot of individuals are searching round for this info, you can help them greatly.

  163. Bueniiisimo el Arte! Nice touch on the walls, as well. I guess for art like this you couldn't try anything less of a canvass than a Wall for everybody to appreciate it as it's meant to. Kinda reminds me of some other wacko artist that I know… she's better, though!

  164. Why only Medicare recipients? All health associations should be allowed to do that too; and are not. This would truely be reform, but that would just not fit the plans of the special interests; I’m sure!I’m talking about patient owned healthcare associations of course!

  165. I’ll immediately grasp your rss as I can’t to find your e-mail subscription link or e-newsletter service. Do you’ve any? Please allow me realize so that I could subscribe. Thanks.

  166. I want to know how they did the graphic to change planes and move forward and behind one another. I'm thinking cleaver masks and strategic timing on image swaps. Oh, this was about something more than geeky graphic techniques?

  167. Die SPD/Grüne hatten vor Jahren eine Amnestie mit wesentlich geringeren Nachzahlungsbeträgen angeboten. Es kam kaum Geld rein und es führte nicht zu einer endgültigen Regelung. Die jetztige Lösung sichert schon jetzt mehr Geld als Eichel reingeholt hat und ab 2013 zahlen dann alle in der Schweiz regulär. Ohne Vetrag zahlt da keiner.

  168. Hey David, This is the first time I’ve visited your website and I just wanted to say I love it. Keep up the good work and blessings in your work.

  169. Thanks a lot for sharing this with all of us you actually know what you are talking about! Bookmarked. Please also visit my website =). We could have a link exchange agreement between us!

  170. Voilà qui me conforte dans l’idée qu’il ME FAUT une jolie pochette! Celle ci est parfaite, j’ai souvent du mal à en trouver une qui ne soit pas ni bling-bling, ni trop sobre! Et sinon… la robe est sublime of course!

  171. What¦s Going down i’m new to this, I stumbled upon this I have discovered It positively useful and it has aided me out loads. I’m hoping to give a contribution & assist other customers like its aided me. Great job.

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