ВОзвращает список болезней. Можно фильтр/искать

search, age, gender, parent, symptoms, sort_name, sort_by, rand, branches
GET /disease/?format=api&ordering=name&page=79
HTTP 200 OK
Allow: GET, HEAD, OPTIONS
Content-Type: application/json
Vary: Accept

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                    "lead": "Опущенное верхнее веко или птоз - (от др.-греч. πτῶσις «падение», также: птоз верхнего века, блефароплегия, блефароптоз)[3][4] — патологическое низкое положение верхнего века по отношению к глазному яблоку вследствие его опущения.\r\nРазновидности\r\n\r\nПолный врождённый правосторонний птоз\r\nОдносторонний или двухсторонний\r\nВрождённый или приобретённый\r\nПолный или частичный\r\nПричины\r\nПричиной врождённого птоза является недоразвитие или отсутствие мышцы, поднимающей верхнее веко.\r\nПричиной приобретённого птоза являются, помимо травм, многие неврологические заболевания (инсульт, энцефалит и др., часто в рамках синдрома Горнера), ведущие к парезу или параличу глазодвигательного нерва, иннервирующего мышцу, поднимающую верхнее веко.\r\nДиагностика\r\nПри оценке степени птоза пользуются параметром MRD — расстоянием между краем верхнего века и центром зрачка в мм. Так, если край века проходит через середину зрачка — это MRD = 0 мм, если край века выше середины зрачка, то MRD может быть от +1 до +5, +6, если ниже середины зрачка, то MRD будет — 1-5 мм.\r\n\r\nПри определении степени птоза и подвижности верхнего века важно фиксировать брови пациента в расслабленном положении, так как нередко удается открывать глаз с полным птозом до состояния, походящего на птоз 2-й и даже 1-й степени за счёт сильного напряжения лобной мышцы и бровей.\r\n\r\nУ детей малого возраста особенно важно определить есть ли амблиопия, так как сниженное зрение — показание к коррекции птоза. Если речь идёт о ребёнке до 2-3 лет, когда определение остроты зрения по оптотипам не представляется возможным по понятным причинам, можно заподозрить наличие сниженного зрения, оценивая реакцию ребёнка на прикрывание «хорошего» глаза, при условии, что веко на глазу с птозом принудительно открыто (например пластыревой подвеской). Так, при сниженном зрении на стороне поражения ребёнок будет негативно относиться к прикрыванию здорового глаза — отталкивать руку, плакать и т. п. Значит, глаз видит существенно хуже.\r\n\r\nДалее важно оценить силу леватора, экскурсию века, высоту и вид пальпебральной складки, напряжённость бровей, наличие лагофтальма, феномен Белла и продукцию слезной жидкости. Внимательно осматривают роговицу, чтобы выявить любые поражения или проявления дистрофии, которые могут предрасполагать к послеоперационной кератопатии у пациента. Экзофтальм или «отставание» века может создавать впечатление о наличии птоза на парном глазу. Поэтому полезно выполнить экзофтальмометрию.\r\n\r\nЛечение\r\nЛечение птоза подразделяется на консервативное и хирургическое. Консервативному лечению подлежит нейрогенный птоз. Терапия направлена на восстановление функции нерва. Применяется местная УВЧ терапия, гальванотерапия, препараты для питания нервной ткани. В отсутствие эффекта от консервативного лечения нейрогенного птоза и во всех остальных случаях прибегают к хирургическому лечению.\r\n\r\nВажным этапом в ожидании оперативного лечения у детей младшего возраста с птозами 2-й и 3-й степени является подвешивание верхнего века к коже лба с помощью лейкопластыря. Эта манипуляция имеет плохой косметический эффект и создаёт определённые неудобства, но позволяет избежать депривации и развития амблиопии, а также выиграть время для подготовки ребёнка к хирургическому лечению. Важно обучить родителя правильной технике выполнения данной манипуляции: слегка потянуть верхнее веко вниз, для расправления имеющихся складок кожи, узкую (1 см) полоску пластыря одним концом плотно приклеиваем к коже верхнего века в проекции роговицы, отступив от края века на 3—4 мм, подтягиваем полоску пластыря вверх до открытия большей площади зрачка, затем плотно приклеиваем другой конец полоски к коже лба над бровью. При этом следует придерживаться следующих правил:\r\n\r\nне нужно давить на глазное яблоко;\r\nне нужно добиваться строгой симметрии в положении век обоих глаз;\r\nнужно строго следить за тем, чтобы величина неполного смыкания век при спокойном закрытии обоих глаз не была более 2,0—2,5 мм;\r\nиспользовать пластырь-подвеску в период наибольшего времени бодрствования, не менее 3 часов в день;\r\nне использовать во время сна;\r\nпри контактном дерматите отменить пластырь-подвеску, а затем использовать лейкопластырь другой фирмы (или той же);\r\nпротирать кожу влажным тампоном от клейкого вещества после снятия пластыря.\r\nПри невозможности проведения пластыревого подвешивания (ребёнок срывает пластырь, выраженные аллергические реакции, социальная дезадаптация пациента в детском коллективе из-за издевательств по поводу приклееного пластырем века) целесообразно проведение хирургического лечения в сроки от 6 месяцев, поскольку ожидание ранее принятого в России срока проведения хирургического лечения (3—4 года и позже) гарантированно приведёт к развитию стойкой амблиопии.\r\n\r\nПодавляющее большинство случаев птоза лечится хирургическим способом.",
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            "code": "A50",
            "name": "Врожденный сифилис",
            "icd_name": "Врожденный сифилис",
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            "lead": "Нарушение здоровья, относящееся к группе инфекции, передающиеся преимущественно половым путем",
            "description": "Врожденный сифилис — клиническая форма сифилиса, возникающая при внутриутробном заражении ребенка бледными трепонемами. Врожденный сифилис может проявляться в различные периоды жизни ребенка от внутриутробного до подросткового. ",
            "etiology": "<p>Бледная трепонема представляет собой микроорганизм спиралевидной формы; число оборотов спирали от 8 до 12, ее завитки равномерны, имеют идентичное строение. Совершает характерные виды движения: вращательные, поступательные, волнообразные и сгибательные. Размножается преимущественно путем поперечного деления на два или несколько сегментов, каждый из которых вырастает затем во взрослую особь.  </p>\r\n<p>Микроорганизм также может существовать в виде цист и L-форм. Циста является формой выживания бледной трепонемы в неблагоприятных условиях среды и рассматривается как стадия покоя T. рallidum; обладает антигенной активностью. L-форма является способом выживания бледной трепонемы внутри организма без оболочки. </p>",
            "pathogenesis": "<p>Заболевание ребенка врожденным сифилисом обусловлено передачей инфекции от больной матери в период внутриутробного развития. Бледная трепонема (возбудитель сифилиса) не способна проходить сквозь здоровый трансплацентарный барьер. Однако сифилис у женщин в период беременности приводит к поражению плаценты и вызывает нарушение ее защитной барьерной функции. В результате трепонемы проникают в организм плода. </p>\r\n<p>Передача трепонем от матери плоду наиболее вероятна в первые годы заболевания матери, со временем эта способность угасает. Риск рождения ребенка с врожденным сифилисом особенно велик у женщин с вторичной формой этого заболевания, сопровождающейся диссеминацией возбудителя с током крови. У зараженного трепонемами плода поражения внутренних органов развиваются только на 5-6-ом месяце беременности. Поэтому проведенное на ранних сроках противосифилитическое лечение может привести к рождению здорового ребенка.  </p>\r\n<p> </p>",
            "diagnostics": "<p>Абсолютным доказательством наличия заболевания является обнаружение бледной трепонемы в образцах, полученных из очагов поражений, с помощью микроскопии в темном поле зрения или прямой иммунофлюоресценции, а также выявление специфической ДНК и РНК возбудителя методом полимеразной цепной реакции (ПЦР). </p>\r\n<p>Используются методы определения специфических иммуноглобулинов к белой трепанеме - ИФА, иммуноблоттинг. </p>\r\n<p>Серологические методы исследования - РПГА, РИФ, РИБТ - позволяют выявить специфические антитела к бледной трепанеме. Диагностически значимым считается увеличение титра специфических антител в 4 раза и более. </p>\r\n<p>Диагностика сифилитического поражения внутренних органов и опорно-двигательного аппарата основывается также на клинических проявлениях, данных инструментальных исследований (рентгенологических, ультразвуковых, магнитно-резонансной томографии, компьютерной томографии).  </p>",
            "treatment": "<p>Основная терапия врожденного сифилиса заключается в длительном системном назначении пенициллинов (бензилпенициллины в комбинациях и в сочетании с экмолином). При возникновении у ребенка аллергической реакции на пенициллин или выявлении устойчивости трепонемы по результатам бакпосева с антибиотикограммой, лечение проводится эритромицином, цефалоспоринами или производными тетрациклина. </p>\r\n<p>При поражении врожденным сифилисом нервной системы с развитием нейросифилиса показано эндолюмбальное введение антибиотиков и проведение пиротерапии (продигиозан, пирогенал), улучшающей их проникновение через гематоэнцефалический барьер. В лечении позднего врожденного сифилиса наряду с антибиотикотерапией назначают препараты висмута (бисмоверол, бийохинол). Применяются также витамины, биогенные стимуляторы, иммуномодуляторы. </p>",
            "prevention": "<p>Антенатальная (до родов, во время беременности) профилактика: своевременное выявление и адекватное лечение   заболевания у беременной (обязательное 3х-кратное обследование беременной на сифилис – при постановке на учет в женской консультации, на 32 неделе беременности, а также при поступлении в родильный дом). </p>\r\n<p>При положительной серологической реакции у беременной после рождения ребенка необходимо его полное обследование и курс профилактического лечения.  </p>",
            "clinical_picture": "<p>Сифилис плода. </p>\r\n<ul>\r\n<li>Увеличение массы плаценты до соотношения 1:3 к массе плода (в норме 1:6): сама плацента гипертрофирована (увеличена в размерах), дряблая, хрупкая, легко рвется. </li>\r\n<li>Уменьшение объема околоплодных вод. </li>\r\n<li>Поражение практически всех жизненно важных органов ребенка (сердце, мозг, костная ткань, легкие) ведет к выкидышу на поздних сроках беременности и рождению мертвого ребенка; обычно такой исход беременности наступает в том случае, когда у матери развивается вторичный активный сифилис. </li>\r\n</ul>\r\n<p>Ранний врожденный сифилис плода. </p>\r\n<p>Врожденный сифилис грудного возраста – до одного года (чаще всего проявляется в первые 2 месяца жизни): </p>\r\n<ul>\r\n<li>“ старческий вид” новорожденного — кожа морщинистая, дряблая, грязно-желтого оттенка; </li>\r\n<li>голова увеличена, с заметно выраженной подкожной венозной сетью, кожа нередко покрыта себорейными (плотные желтые, жирные, липкие чешуйки, перхоть) чешуйками; </li>\r\n<li>дети очень медленно прибавляют в массе, плохо развиваются, нередко не могут сосать грудь матери (или соску бутылочки), беспокойны, тревожны, плохо спят, почти постоянно плачут, иногда издают резкий пронзительный крик (симптом Систо); </li>\r\n<li>сифилитическая пузырчатка — пузыри с серозно-гнойным, иногда кровянистым содержимым локализуются чаще всего на ладонях и подошвах стоп, изредка – на других участках кожного покрова; в основании пузырей находится специфический инфильтрат (скопление в тканях организма клеточных элементов с примесью крови и лимфы), поэтому пузыри окружены красновато-лиловым ободком, они быстро лопаются, обнажая эрозивную (поверхность с дефектом ткани) поверхность, окруженную обрывками эпидермиса (наружный слой кожи); </li>\r\n<li>диффузная инфильтрация кожи — чаще на ладонях и подошвах, также поражаются лицо (часто – вокруг рта), волосистая часть головы, ягодицы, бедра, кожа на локтях и коленях, измененная кожа уплотнена, ее поверхность блестит, легко образуются глубокие трещины, особенно вокруг рта (рубцы Робинсона-Фурнье); </li>\r\n<li>специфический ринит (насморк) — сначала это значительное набухание слизистой, затрудняющее дыхание, затем появляется отделяемое из носа – слизистое, гнойное и, наконец, кровянистое, позже наблюдаются обильные гнойно-кровянистые зловонные выделения из носа, носовые кровотечения. Ринит сопровождается появлением глубоких язв (дефекты поверхности)  слизистой, повреждениями хряща и костей; </li>\r\n<li>остеохондрит Вегенера – поражение длинных трубчатых костей на границе эпифиза и диафиза (центральной длинной части кости и ее головки), которое вызывается нарушением образования кальция и торможением развития остеобластов (костеобразовательные клетки). Вторая и третья стадии остеохондрита (псевдопаралич Парро) встречаются только при врожденном сифилисе и диагностируются при рентгенографии трубчатых костей предплечья и голени.</li>\r\n</ul>\r\n<p>Врожденный сифилис раннего детского возраста (от года до 4 лет) — обладает всеми признаками вторичного рецидивного (повторение, возврат клинических проявлений заболевания после их временного ослабления или исчезновения) сифилиса: </p>\r\n<ul>\r\n<li>многочисленные разнообразные высыпания на коже и слизистых (пятна, бугорки, узелки, единичные и группами, в виде колец, дуг, гирлянд); </li>\r\n<li>выпадение волос на голове и теле; </li>\r\n<li>поражение внутренних органов (печень, почки и др.), нервной, эндокринной и костной систем. <full></full></li>\r\n</ul>\r\n<p>Поздний врожденный сифилис (от 4 до 17 лет) — симптомы третичного сифилиса: </p>\r\n<ul>\r\n<li>бугорково-язвенные сифилиды и гуммы (узелки), располагающиеся преимущественно на коже туловища, конечностей и лица, которые быстро распадаются с образованием язв; располагаясь на слизистой оболочке носа, могут захватывать хрящевые и костные части, вызывая перфорацию (разрыв) носовой перегородки и западение переносицы; при гуммозном (развитие сифилитической гуммы — воспалительного узла с распадом в центре) поражении твердого неба происходит разрушение костной ткани с образованием перфорационного дефекта (дырок в небе); </li>\r\n<li>проявления сифилиса, перенесенного в грудном возрасте, — рубцы Робинсона-Фурнье (рубцы кожи вокруг рта на месте воспалительных сифилитических узелков), седловидный нос (деформация носа с поперечным прогибом посередине), деформации черепа, остаточные явления остеопериоститов (воспалительное поражение кости и надкостницы) и др. </li>\r\n</ul>\r\n<p>Сифилитическая триада: сочетание кератита (помутнение роговицы, светобоязнь, слезотечение), глухоты и дистрофии зубов (зубы Гетчинсона — зубы по форме напоминают бочку или долото, жевательная поверхность их недоразвита, имеет полулунную выемку) — особый признак врожденного сифилиса. </p>\r\n<p>Скрытый врожденный сифилис — клинические проявления отсутствуют, серологические реакции положительные, спинномозговая жидкость без патологии. </p>\r\n<p>Нейросифилис. Различают асимптомный и манифестный нейросифилис.  </p>\r\n<ul>\r\n<li>Асимптомный нейросифилис характеризуется отсутствием клинических проявлений. Диагноз основывается на патологических данных исследования спинномозговой жидкости.  </li>\r\n<li>Нейросифилис с симптомами. Проявляется любыми неврологическими или психическими нарушениями, которые имеют острое или подострое развитие и прогрессируют в течение нескольких месяцев или лет. Чаще всего из ранних форм нейросифилиса встречается менинговаскулярный сифилис, в клинической картине которого преобладают симптомы поражения оболочек и сосудов мозга: сифилитический менингит, сифилитический увеит, васкулярный нейросифилис (ишемический, реже геморрагический инсульт), спинальный менинговаскулярный сифилис (сифилитический менингомиелит). К поздним формам нейросифилиса относят прогрессирующий паралич, спинную сухотку, табопаралич, атрофию зрительных нервов и гуммозный нейросифилис, в клинической картине которых преобладают симптомы поражения паренхимы мозга. </li>\r\n</ul>",
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}