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"lead": "Нарушения зрения — снижение способности видеть до такой степени, что вызывает проблемы, не устраняемые обычными способами, такими как очки или лекарства.[1][2][3]\r\n\r\nЭто может быть из-за болезни, травмы, врождённых или дегенеративных заболеваний. Эта потеря зрения, как правило, определяется как:\r\n\r\nОстрота зрения с коррекцией менее 20/60, или значительный дефект центрального поля,\r\nЗначительный одноимённый или разноимённый двусторонний визуальный дефект периферического поля, включающий дефект поля или общее сжатия или сужение поля, или\r\nПониженный пик контрастной чувствительности с любым из указанных выше условий.[1][2][3][4]\r\nГлазные нарушения, которые могут привести к нарушениям зрения могут включать в себя дегенерацию сетчатки, альбинизм, катаракты, глаукомы, мышечные проблемы, которые приводят к нарушениям зрения, расстройства роговицы, диабетическую ретинопатию, врождённые пороки и инфекции. Нарушения зрения также могут быть вызваны расстройствами мозга и нервной системы, в этом случае их, как правило, называют кортикальными нарушениями зрения (CVI). Путеводитель оценки постоянного ухудшения американской медицинской ассоциации попытался представить «стандартизированный, объективный подход к оценке медицинских нарушений». Глава Визуальная система «устанавливает критерии для оценки постоянного ухудшения зрительной системы, как это влияет на способность человека выполнять действия в повседневной жизни».[5] Путеводитель оценил, что потеря одного глаза составляет 25 % нарушений зрительной системы и 24 % от полного обесценивания человека;[5][6]. Полная потеря зрения на оба глаза, как считается, является 100 % нарушением зрения и 85 % от полного обесценивания человека[5]\r\n\r\nВизуальные нарушения наносят значительный экономический удар даже в развитых странах.[7] Значительную часть глобального нарушения зрения можно предупредить.",
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{
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{
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{
"name": "искривление "
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"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;\">На сегодняшний день окончательная причина возникновения деформирущего остеита так и не выявлена. Многие ученые и врачи считают, что возбудителями выступают дефектные парамиксовирусы, которые оказывают пагубное влияние на костную систему. Однако это утверждение не было доказано в связи с тем, что в клетках костной ткани не была обнаружена эта вирусная инфекция.</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;\">Наиболее вероятными факторами, которые могут влиять на развитие патологии, принято считать следующие:</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;\">ранее перенесенные воспалительные процессы;</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;\">наследственная предрасположенность;</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;\">нарушение метаболизма (фосфорно-кальциевого);</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;\">сочетание двух и более причин.</span></li>\r\n</ul>\r\n<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;\">Считается, что человек может быть носителем данного заболевания на протяжении нескольких лет до ее манифестации, пока один из признаков не начнет проявляться.</span></p>",
"pathogenesis": "",
"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;\">Диагноз выставляется на основании жалоб больного, характерной клинической картины и результатов дополнительных исследований. В обязательном порядке назначается рентгенография. Сцинтиграфия костей скелета важна в установлении точного места поражения костей, она обеспечивает визуализацию всего скелета.</span></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;\">При необходимости проводится неврологическое исследование, исследование полей зрения и аудиограмма.</span></p>\r\n<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;\">Биохимические анализы крови могут применяться для выявления повышенного уровня щелочной фосфатазы. Суточный анализ мочи выявляет повышенное содержание гидроксипролина (продукт, образующийся при резорбции костной ткани). Иногда для подтверждения диагноза назначают биопсию кости — она необходима, чтобы исключить другие болезни, такие как рак кости.</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;\">Лечение болезни направлено на контроль над активностью заболевания и предотвращение осложнений.</span></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;\">Пациенту рекомендуют ограничить нагрузку на пораженную кость. Редко (при угрозе переломов и тяжелом разрушении кости) требуется наложение шины.</span></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;\">При бессимптомном течении и небольших локальных поражениях медикаментозное лечение не проводится. При болях назначают обезболивающие препараты. Для замедления процессов резорбции и неполноценного остеогенеза применяют миакальцик, кальцитонин, памидроновую кислоту, этидронат натрия и фосамакс.</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;\">Курс лечения миакальциком при внутримышечном введении продолжается не менее 3 месяцев, при интраназальном — в течение 1,5-3 лет. Срок приема этидроната и фосамакса в среднем составляет полгода. Длительность курсов лечения кальцитонином и памидроновой кислотой может варьироваться. Многие из перечисленных препаратов могут вызывать достаточно серьезные побочные эффекты, поэтому их следует принимать только по назначению врача. Для пациентов разрабатывают индивидуальные программы упражнений, подбирают диету со сбалансированным потреблением витамина D и кальция, при необходимости назначают замещающие препараты.</span></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;\">При снижении слуха подбирают слуховые аппараты.</span></p>\r\n<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;\">Хирургическое лечение проводится по показаниям при переломах. При поражении сустава и развитии артрита может потребоваться эндопротезирование суставов. Проводится остеотомия для коррекции деформаций костей, вызывающих сдавление нервов или спинного мозга. Иногда необходима хирургическая коррекция искривления костей ног. При потере слуха, вызванной сдавлением нервов, назначается операция на костях черепа.</span></p>",
"prevention": "<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;\">Так как истинные причины развития этой болезни не установлены, меры профилактики не разработаны. Риск нарушения со стороны костей можно уменьшить, соблюдая общие рекомендации – это:</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;\">употребление продуктов с достаточным количеством кальция – молока, молочных продуктов и других;</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;\">отказ от вредных привычек;</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;\">посильное занятие физическими упражнениями;</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;\">соблюдения здорового образа жизни в целом.</span></li>\r\n</ul>\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;\">Важное значение для своевременного выявления этой патологии и профилактики ее последствий имеют:</span></p>\r\n<ul>\r\n<li><span style=\"font-size: 7pt; font-family: Verdana; background-color: transparent; font-style: normal; font-variant-numeric: normal; font-variant-east-asian: normal; vertical-align: baseline; white-space: pre-wrap;\">обследование людей, близкие родственники которых болеют деформирующим остеитом;</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;\">проведение регулярных профилактических осмотров – даже при отсутствии жалоб на нарушения со стороны опорно-двигательного аппарата и объективных признаков такого нарушения.</span></li>\r\n</ul>\r\n<p> </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;\">Симптоматика зависит прежде всего от формы и фазы протекания. Однако выделяют общие признаки:</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;\">поражение опорно-двигательного аппарата, сопровождающееся острыми болевыми ощущениями;</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;\">искривление позвоночника;</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;\">деформирование ног Х-образным или О-образным способом;</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;\">проявление неврита;</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;\">дискомфорт во время передвижения, скованность в суставах;</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;\">в качестве осложнения может выступать потеря зрения или слуха.</span></li>\r\n</ul>\r\n<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;\">При выявлении вышеперечисленных симптомов необходимо в срочном порядке записаться на прием к врачу, чтобы исключить тяжелые последствия.</span></p>",
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},
"code": "E06",
"name": "Тиреоидит",
"icd_name": "Тиреоидит",
"gender": 0,
"age_min": 25,
"age_max": 100,
"cause": [
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"periodicity": 1,
"slug": "e06_tireoidit",
"lead": "Воспаление неизмененной щитовидной железы.",
"description": "<p>Тиреоидит представляет собой большую категорию новообразований в щитовидной железе, сопровождающихся воспалительными процессами. Наиболее частным видом тиреоидита является хроническое течение.</p>",
"etiology": "<p>Острый гнойный тиреоидит развивается на фоне острого или хронического инфекционного процесса (тонзиллит, пневмония, сепсис и др.).</p>\r\n<p> </p>\r\n<p>Острый негнойный тиреоидит может развиться после травмы, кровоизлияния в щитовидную железу, лучевой терапии.</p>\r\n<p> </p>\r\n<p>Подострый тиреоидит развивается после вирусных инфекций (ОРВИ, Коксаки, инфекционный паротит и др.). Заболевают чаще женщины в возрасте 30-50 лет.</p>\r\n<p> </p>\r\n<p>Аутоиммунный хронический тиреоидит заболевание, в основе которого лежит аутоиммунное поражение щитовидной железы, образуются антитела к различным компонентам щитовидной железы (в норме антитела в организме человека вырабатываются только на чужеродное вещество). Это наиболее часто встречающееся воспалительное заболевание щитовидной железы. Чаще всего аутоиммунный тиреоидит встречается у пациентов от 40 до 50 лет, причем у женщин в десять раз чаще, чем у мужчин. И в последнее время аутоиммунным тиреоидитом страдает все больше пациентов молодого возраста и детей.</p>\r\n<p> Причина хронического фиброзного тиреоидита неизвестна. Есть версия о том, что зоб Риделя это конечная стадия аутоиммунного тиреоидита. Риск развития заболевания имеют люди, у которых наблюдались базедова болезнь или любые формы эндемического зоба.</p>\r\n<p> </p>",
"pathogenesis": "",
"diagnostics": "<p>Лабораторная и инструментальная диагностика.</p>",
"treatment": "<p>Острый тиреоидит требует приема антибиотиков, препаратов с витамином C и витаминами группы B, а так же лекарств, которые устраняют симптоматическое проявление болезни. Если имеется абсцесс острого гнойного тиреодита, то неизбежно оперативное вмешательство с целью удаления гнойного накопления. В процессе операции абсцесс вскрывается и из него удаляется весь гной. После этого воспаленное место обрабатывается антибиотиком и закрывается повязкой.</p>\r\n<p>Хронический фиброзный тиреоидит, сопровождающийся возникновением гипотиреоза, требует назначения заместительной терапии препаратами синтетических гормонов щитовидной железы. При обнаружении сдавливания дыхательной трахеи пациенту проводится хирургическая операция.</p>\r\n<p>Подострый тиреоидит лечится длительным приемом препаратов категории «кортикостероиды», лекарств салицилового комплекса при снижении дозы кортикостероидных лекарств. При обнаружении гипертиреоза назначаются медикаменты, которые способны уменьшить количество тиреоидных гормонов в крови больного. При выявлении гипотиреоза назначаются препараты, содержащие тиреоидные гормоны.</p>\r\n<p>Хронический аутоиммунный тиреоидит требует применения препаратов с содержанием тиреоидных гормонов. Если узловой зоб не уменьшается при проведении заместительной терапии в течение 4-х месяцев, то врач может назначить сильные гормональные препараты типа преднизолон, который необходимо принимать не менее 3-х месяцев. Только после этого периода можно снижать ежедневную дозу и постепенно полностью отказываться от препарата. При динамично развивающемся заболевании с болезненными проявлениями и быстрым ростом опухоли требуется незамедлительное хирургическое вмешательство с целью отсечения больной ткани щитовидной железы.</p>",
"prevention": "",
"clinical_picture": "<p>Острый гнойный тиреоидит: боль в области передней поверхности шеи, отдающая в затылок, нижнюю и верхнюю челюсть, усиливающаяся при движении головы, глотании. Увеличение шейных лимфатических узлов. Повышение температуры тела, озноб.</p>\r\n<p> Острый негнойный тиреоидит: проявления менее выражены, чем при остром гнойном воспалении щитовидной железы.</p>\r\n<p> Подострый тиреоидит: боль в области шеи, отдающая в затылочную область, нижнюю челюсть, уши, височную область, головная боль, слабость, снижение двигательной активности, повышение температуры тела. В начале заболевания (гипертиреоидная, острая стадия) могут наблюдаться симптомы тиреотоксикоза: учащение сердечных сокращений, потливость, похудание, тремор рук. В крови - повышенные уровни гормонов щитовидной железы. При длительном течении могут развиться симптомы гипотиреоза (гипотиреоидная стадия), сонливость, вялость, заторможенность, зябкость, отечность лица, сухость кожи, урежение сердечных сокращений, запоры. Щитовидная железа увеличена (часто только правая доля), плотная, болезненная. В крови - низкое содержание гормонов щитовидной железы. <br />В стадии выздоровления исчезает болезненность щитовидной железы, уровни гормонов щитовидной железы.</p>\r\n<p> Заболевание склонно к рецидивированию (возврату), особенно при повторных вирусных инфекциях, переохлаждении.</p>\r\n<p> Хронический фиброзный тиреоидит: диффузное (распространенное), реже очаговое увеличение щитовидной железы. Железа очень плотная, неподвижная, не смещается при глотании.</p>\r\n<p> Прогрессирование и распространение процесса на всю железу сопровождается развитием гипотиреоза. При больших размерах железы наблюдаются симптомы сдавления органов шеи: осиплость голоса, затруднение глотания, дыхания.</p>\r\n<p> Аутоиммунный хронический тиреоидит: в течение первых лет заболевания жалобы и симптомы, как правило, отсутствуют. В дальнейшем, диффузное, иногда неравномерное увеличение щитовидной железы, плотная, подвижная. При больших размерах железы появляются симптомы сдавления органов шеи. По мере развития заболевания изменения, разрушающие щитовидную железу, приводят к нарушению функции железы - вначале явлениям гипертиреоза вследствие поступления в кровь большого количества ранее выработанных гормонов, в дальнейшем (или минуя гипертиреоидную фазу) - к гипотиреозу. Содержание тиреоидных гормонов в крови снижено. В диагностике большое значение имеют определение титра антитиреоидных антител антител против собственной щитовидной железы.</p>\r\n<p> </p>",
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"standard_type": 1,
"danger": 41,
"published": 1,
"parent": null,
"block_rubric": 45,
"standards": [
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{
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