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"description": "<p><span id=\"docs-internal-guid-1960a8f1-7fff-6a6b-b94c-0d161ba0d17e\"><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">Угрожающий аборт - это вагинальное кровотечение без раскрытия зева шейки матки, происходящее в течение этого периода времени, и указывающее на возможность спонтанного аборта у женщины с подтвержденной внутриматочной беременностью жизнеспособным плодом.</span></span></p>",
"etiology": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Спонтанная угроза прерывания беременности малого срока у 50% пациенток связана с хромосомными аномалиями эмбриона. После 16 недели угрожающий выкидыш является следствием генетических дефектов в 10% случаев. Чем меньше срок гестации, тем выше вероятность, что угрожающий аборт перейдет в самопроизвольный выкидыш. Инфекция способна вызвать нарушение развития плодного яйца и угрожающий аборт при хроническом эндометрите, вирусном инфицировании во время вынашивания ребенка. Опасность выше на раннем сроке, пока не сформирована плацента, выполняющая роль защитного фильтра.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выделяют факторы, которые достоверно увеличивают риск угрожающего аборта. Они связаны с эндогенными состояниями, особенностями образа жизни будущей матери. Большое значение имеют перенесенные острые и хронические заболевания, а также действие внешних раздражителей и патогенов. Эти факторы учитывают при постановке женщины на учет у акушера-гинеколога и ведении беременности:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Возраст матери. У женщин 20-30 лет угрожающий аборт возникает в 9-15%, после 30 лет этот показатель увеличивается до 20%, а у 45-летних - до 80%. Молодые девушки до 18 лет также часто сталкиваются с развитием угрозы прерывания гестации из-за незрелой гипоталамо-гипофизарной системы, физиологической дисфункции яичников.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эндокринные заболевания матери. Патология щитовидной железы, некомпенсированный сахарный диабет, синдром поликистозных яичников вызывают эндокринные изменения, ухудшающие состояние эндометрия, выработку гормонов желтого тела яичников. Ожирение приводит к изменению синтеза стероидных гормонов, что ведет к их дисбалансу.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Потери беременности в анамнезе. У женщин с привычным невынашиванием риск составляет 30%. Если в анамнезе были нормальные роды и отсутствуют спонтанные выкидыши, то риск прерывания гестации у беременной всего 5%.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Прием лекарственных средств. Использование лекарственных препаратов с тератогенным действием (ретиноиды, антикоагулянты), большие дозы нестероидных противовоспалительных средств подавляют синтез простагландинов и ухудшают имплантацию эмбриона, что позже может вызвать угрозу выкидыша.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Действие токсических веществ. Угроза прерывания гестации может возникать у женщин, работающих во вредных условиях, на опасном производстве. Токсичным действием на эндометрий и плод обладают алкоголь при систематическом употреблении, курение 10 сигарет в день, употребление кокаина. Дозозависимым эффектом обладает кофе, безалкогольные напитки с кофеином. Опасность представляет употребление 4-5 чашек крепкого напитка или 100 мг кофеина в сутки.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Аутоиммунные заболевания. Антифосфолипидный синдром, системная красная волчанка связаны с образованием антител к фосфолипидам и другим структурам клеток. У женщины повышается склонность к микротромбозам. Тромбы формируются в сосудах эндометрия, что нарушает питание зародыша, приводит к угрожающему аборту или гибели плодного яйца.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"pathogenesis": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Механизм развития угрожающего выкидыша связан с усилением сократительной способности матки. В случае инфекции нарушается кровоток в сосудах, питающих зародыш, возникает их спазм. Эмбрион не получает нужного количества питательных веществ и кислорода. На этой стадии может произойти его гибель. Спазм микрососудов приводит к их разрыву, появляется небольшое кровотечение в стенку матки, формируется ретрохориальная гематома. Она отслаивает плодное яйцо от эндометрия. Если кровотечение вовремя не остановить, угрожающий аборт переходит в выкидыш в ходу. Потеря беременности в 1 и начале 2 триместра происходит без разрыва плодных оболочек.</span></p>",
"diagnostics": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">При появлении характерных жалоб необходимо обратиться к акушеру-гинекологу для осмотра и диагностики. После подтверждения диагноза может потребоваться госпитализация для лечения и динамического наблюдения. Обследование беременной включает:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Осмотр на кресле. Физикальное обследование показывает, что шейка матки плотно закрыта, но во влагалище может быть небольшое количество коричневых выделений. Бимануальное исследование не доставляет боль, своды влагалища свободны. При пальпации матка остается невозбудимой, мягкой, но ощущается небольшая болезненность. Яичники не пальпируются.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Лабораторная диагностика. Необходима для оценки функции яичников и мониторинга беременности. Берется кровь на ХГЧ, для подтверждения прогрессирующей беременности анализ проводят в динамике с интервалом в несколько дней. Определяют уровень прогестерона. По показаниям может быть назначен анализ на эстрогены.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">УЗИ малого таза. «Золотым стандартом» диагностики угрожающего выкидыша является УЗИ трансвагинальным датчиком, точность методики выше, чем при обследовании трансабдоминально. По данным УЗИ определяют признаки жизнеспособности плода. В полости матки визуализируется плодное яйцо, у эмбриона или плода определяется сердцебиение. При сомнительных результатах исследование повторяют дважды разными специалистами с интервалом 7-10 дней.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"treatment": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Беременная с кровотечением и угрозой выкидыша на малом сроке должна быть экстренно госпитализирована в отделение гинекологии. Ей назначается лечебно-охранительный режим, не рекомендуется вставать с постели. В некоторых учреждениях в качестве дополнительного способа терапии практикуют поднятие ножного конца кровати на 5 см. Назначается медикаментозная сохраняющая терапия:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Препараты прогестерона. Используют дидрогестерон или микронизированный прогестерон. Их назначают для поддержания функции плаценты по индивидуальной схеме. Женщинам, у которых в прошлом были прерывания на небольшом сроке, препараты назначаются превентивно до появления признаков угрозы.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Эстрогены. Включают в схему лечения с 6 недели гестации, если по результатам анализов выявлен их дефицит. Необходимы для улучшения действия прогестерона. Дозировка подбирается индивидуально.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Снятие тонуса матки. Для купирования боли и мышечного спазма у беременных разрешено применять дротаверин, папаверин. Их назначают внутримышечно, позже переходят на таблетированные формы. Выраженным токолитическим действием обладает раствор магния сульфата. Его используют для уменьшения тонуса матки, снижения артериального давления и улучшения питания плода.</span></li>\r\n<li><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Гемостатическая терапия. Для остановки кровотечения используют этамзилат натрия в форме раствора внутримышечно или внутривенно. Разрешены к применению аминокапроновая и транексамовая кислота.</span></li>\r\n</ul>\r\n<p> </p>\r\n<p><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\"> </span></p>",
"prevention": "<p> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Профилактика угрожающего самопроизвольного аборта заключается в прегравидарной подготовке, санации очагов инфекции в организме. Женщинам необходимо за 2 месяца до зачатия начинать принимать фолиевую кислоту и витамин Е.</span></p>",
"clinical_picture": "<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Беременная начинает ощущать чувство дискомфорта внизу живота, которое постепенно переходит в тянущую, ноющую боль. Боль локализуется нечетко над лобком, может отдавать в крестец, поясницу, промежность. При угрожающем аборте ощущения не переходят в схватки, в противном случае это говорит о прогрессировании патологии и развивающемся выкидыше.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Выделения из половых путей на начальном этапе могут отсутствовать. Это характерно для формирования небольшой гематомы позади плодного яйца, которая не опорожняется в полость матки. Если происходит его отслойка по краю, то беременная замечает кровянистые мажущие или сукровично-кровянистые выделения на белье, которые выглядят как прожилки темной крови с примесью слизи. При угрозе выкидыша они не трансформируются в массивное кровотечение алой или темной кровью. Выделения появляются несколько раз в сутки, постепенно их количество под влиянием терапии уменьшается. Если этого не происходит, предполагают прогрессирование патологии.</span></p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"> </p>\r\n<p style=\"line-height: 1.38; margin-top: 0pt; margin-bottom: 0pt;\" dir=\"ltr\"><span style=\"font-size: 6.999999999999999pt; font-family: Verdana; color: #000000; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre-wrap;\">Нарушение общего самочувствия не характерно. Боль внизу живота не снижает работоспособность беременной, но появляется желание прилечь, отдохнуть. Часто это помогает уменьшить интенсивность неприятных ощущений. Усиление боли провоцируют нервные переживания, физическая нагрузка или отсутствие полноценного отдыха. Половые отношения также могут стать фактором прогрессирования угрожающего аборта.</span></p>",
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},
"code": "L70",
"name": "Угри",
"icd_name": "Угри",
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"cause": [
3,
0
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"slug": "l70_ugri",
"lead": " это мультифакториальный дерматоз, в патогенезе которого большую роль играют генетически обусловленная гиперандрогения и генетически детерминированный тип секреции сальных желез.",
"description": "Угревая сыпь относится к числу наиболее распространенных кожных заболеваний. В той или иной форме угри встречаются у 60-80% молодых людей в возрасте от 12 до 24 лет. Однако угри могут появляться и после 25 лет, как правило, на фоне нарушений обмена веществ.",
"etiology": "<p>Специалисты выделяют несколько основных видов угревой сыпи в зависимости от причин их возникновения. Прежде всего это эндогенные (возникающие из-за внутренних причин) и экзогенные (возникающие из-за внешних причин) <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a>. </p>\r\n<p>Причиной возникновения эндогенных угрей могут стать различные гормональные изменения, в том числе естественный «гормональный всплеск» в подростковом и юношеском возрасте. Определенную роль играет также наследственно обусловленная неадекватная реакция сальных желез на повышающийся уровень мужских половых гормонов в крови, которая может иметь место как у мужчин, так и у женщин.</p>\r\n<p>Во взрослом возрасте наиболее частой причиной эндогенных угрей является себорея. Кроме того, угревая <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> может возникать при различных инфекциях, а также хронических заболеваниях. Нередко сама клиническая картина угревой сыпи может подсказать наличие сопутствующего заболевания. Так, например, расположение угрей у женщин вокруг рта и на подбородке нередко указывает на патологию яичников.</p>",
"pathogenesis": "<p>Выделяют четыре основных звена патогенеза угрей:</p>\r\n<p>1. Увеличение продукции кожного сала.</p>\r\n<p>2. Избыточный фолликулярный гиперкератоз.</p>\r\n<p>3. Размножение Propionibacterium acnes (P. acnes).</p>\r\n<p>4. <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">Воспаление</a>.</p>",
"diagnostics": "<p>Диагноз <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> основывается на данных клинической картины. При проведении обследования следует учитывать системные призна- ки гиперандрогенемии (нерегулярный менструальный цикл, гипертрофия клитора и изменение вторичных половых признаков), а также позднее ме- нархе. Резистентные к терапии формы <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> могут свидетельствовать о нали- чии таких эндокринных расстройств, как синдром поликистоза яичников, гиперплазия гипофиза или вирилизирующие опухоли, в связи с чем при об- следовании необходимо учитывать такие симптомы, как аменорея, гипер- менорея, олигоменорея, <a href=\"/symptom/besplodie/\" title=\"Перейти на страницу симптома Бесплодие\">бесплодие</a> и метаболический синдром. При <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> среднего детского возраста показано обследование для исклю- чения врожденной гиперплазии надпочечников и андрогенпродуцирующих опухолей. Лабораторные исследования ■ определение уровня свободного тестостерона, дегидроэпиандростерона сульфата, лютеинизирующего гормона, фолликулостимулирующего гор- мона; ■ проведение теста на толерантность к глюкозе. По показаниям назначаются консультации других специалистов: эндокри- нологов или гинекологов-эндокринологов.</p>",
"treatment": "<p>При легкой степени тяжести угревой сыпи применяют препараты для наружной (местной) терапии: кремы, гели, мази, лосьоны и т.п., содержащие различные активные вещества, препятствующие образованию комедонов или разрушающие их, уменьшающие образование кожного сала и <a href=\"/symptom/vospalenie/\" title=\"Перейти на страницу симптома воспаление\">воспаление</a>. К таким средствам, в частности, относятся бензоилпероксид (OXY5, OXY10), третиноин (Айрол Рош, Ретин-А) и азелаиновая кислота (Скинорен).</p>\r\n<p>При средней и тяжелой форме лечение проводится как наружными средствами, так и приемом препаратов внутрь. В ряде случаев необходимо назначение антибиотиков (например, тетрациклинов). При гормональных нарушениях могут применяться половые гормоны.</p>\r\n<p>Для очистки кожи от угрей проводят пилинг — удаление поверхностных слоев кожи с помощью слабых растворов кислот (химический пилинг) или механической шлифовки (дермабразия). Также для борьбы с угревой сыпью применяется чистка лица, особый щипковый массаж лица, поверхностная криотерапия, и даже лазеротерапия на отдельные невоспаленные <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">угри</a>.</p>\r\n<p>Хирургические манипуляции имеют очень ограниченное применение при угревой болезни. Вскрытие кистозных полостей противопоказано, поскольку оно приводит к формированию стойких рубцов. Иногда при сильном нагноении угрей применяется обкалывание очагов специальными препаратами.</p>\r\n<p>Угревая <a href=\"/symptom/syp/\" title=\"Перейти на страницу симптома Сыпь\">сыпь</a> достаточно хорошо поддается лечению. В большинстве случаев удается добиться полного исчезновения воспалительных элементов и предотвратить образование новых угрей на период от года до нескольких лет (а иногда, и навсегда).</p>",
"prevention": "<p>Для профилактики угревой сыпи необходим регулярный уход за кожей. Людям, склонным к этому заболеванию, не рекомендуется использовать жирные кремы, масла и мази, содержащие ланолин и вазелин. Из косметических средств следует выбирать те, которые имеют маркировку “non-comedogenic” (не-комедогенная), то есть не содержит ингредиентов, способствующих образованию угрей.</p>",
"clinical_picture": "<p><a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">Акне</a> локализуются преимущественно на коже лица, верхних конечно- стей, верхней части груди и спины и проявляются папулами, пустулами и уз- лами, а также открытыми и закрытыми комедонами. Комедон — клиническое проявление скопления кожного сала и кератина в волосяном фолликуле. Выделяют закрытые и открытые <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">комедоны</a>. Закры- тый комедон отличается от открытого тем, что кератиновые массы не так компактны, а отверстие волосяного фолликула узкое. Папулезные <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> представляют собой воспалительные узелки, имеющие коническую или полушаровидную форму и величину до 2—4 мм в диаметре. Пустулезные <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> могут возникать первично или трансформироваться из папулезных угрей. Узловатые <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> характеризуются развитием узлов на коже себорейных об- ластей. У больных конглобатными <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> помимо комедонов и папуло-пусту- лезных угрей возникают многочисленные крупные узлы, локализующиеся преимущественно на коже спины и задней поверхности шеи. Консистенция узлов вначале плотная, но постепенно они размягчаются. Кожа над ними при- обретает синюшно-розовый цвет, истончается, и в ней появляются отверстия, из которых выделяется гной. Часть отдельно расположенных узлов сливается в массивные инфильтраты с многочисленными фистулезными ходами, гной- ными отверстиями и полостями, заполненными вялыми, студнеобразными грануляциями, процесс может приобретать распространенный характер. После разрешения <a href=\"/symptom/ugri/\" title=\"Перейти на страницу симптома Угри\">акне</a> нередко остаются атрофические, реже — гипер- трофические и келоидные рубцы.</p>",
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},
"code": "Q84.5",
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