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"description": "<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;\">Энцефалоцеле – это порок развития черепа и головного мозга, при котором часть мозгового вещества оказывается вне черепной коробки вследствие дефекта костной ткани.</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;\">Черепно-мозговые грыжи возникают вследствие неправильной закладки нервной трубки во внутриутробном развитии. Факторы, которые приводят к этому, четко не выявлены. Предполагается влияние вредных факторов на организм беременной женщины:</span></p>\r\n<ul style=\"margin-top: 0; margin-bottom: 0; padding-inline-start: 48px;\">\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">употребление наркотиков, алкоголя; курение;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">злоупотребление лекарственными средствами;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">частые простудные заболевания;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">инфекционные болезни во время беременности: токсоплазмоз, краснуха;</span></p>\r\n</li>\r\n<li style=\"list-style-type: disc; font-size: 6.5pt; font-family: Verdana; color: #333333; background-color: transparent; font-weight: 400; font-style: normal; font-variant: normal; text-decoration: none; vertical-align: baseline; white-space: pre;\" dir=\"ltr\">\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;\">внезапные нарушения эмбрионального развития.</span></p>\r\n</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;\">Также не стоит исключать и генетическую предрасположенность, ведь характерная аномалия, преобладающая у кровных родственников, часто распространяется и на будущее потомство.</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;\">Первичная диагностика возможна уже в первые дни и часы жизни ребенка, поскольку образование визуализируется сразу после рождения. Любое опухолеподобное выпячивание изначально расценивается как энцефалоцеле с последующей дифференциальной диагностикой. Чаще всего приходится исключать полипы и ангиомы.</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;\">Диагноз уточняется на основании данных КТ и МРТ, при этом проводится серия снимков, подтверждающих наличие костного дефекта и присутствие мозговых тканей в выпячивании. Просвечивание (трансиллюминация) позволяет заподозрить наличие в образовании нервных тканей. Кроме того, даже легкое надавливание вызывает беспокойство пациента в связи с резким повышением внутричерепного давления.</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 только оперативное. Срочность операции определяется состоянием ребенка. Чаще всего вмешательство по удалению энцефалоцеле планируется в возрасте от 3 лет. Такой срок необходим для того, чтобы понаблюдать за развитием головного мозга, в том числе за участком в составе выпячивания. Кроме того, ребенок этому времени уже достаточно окрепнет, чтобы благополучно перенести такую сложную операцию. Противопоказаниями являются повышенное внутричерепное давление, выраженные психические и неврологические расстройства. Истончение кожи над энцефалоцеле, наоборот, является показанием к срочному хирургическому вмешательству.</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;\">Операция осуществляется в два этапа. Сначала выполняется закрытие костного дефекта и отсечение ножки грыжи. В раннем возрасте отверстие в черепе можно закрыть лоскутом надкостницы, при более поздних операциях (в возрасте более 3 лет) применяется костный трансплантат.</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;\">Второй этап операции – косметическое иссечение поверхностно расположенной оставшейся части грыжевого мешка. Проводится через 15-20 дней после первого этапа (3-6 месяцев в случае интракраниального доступа). Тактику операции в каждом конкретном случае определяют в зависимости от степени вовлеченности мозговых тканей в энцефалоцеле.</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;\">Врожденные деформации лица предупредить невозможно. Если в семье родился ребенок с подобной деформацией, то родителям желательно пройти медико-генетическое консультирование, чтобы иметь возможность оценить риск появления такой же аномалии у следующего ребенка.</span></p>",
"clinical_picture": "<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;\">Симптомы энцефалоцеле могут варьироваться от одного человека к другому в зависимости от многих различных факторов, включая размер, местоположение, количество и вид мозговой ткани, выступающей из черепа. Энцефалоцеле — врожденный порок развития, т.е. присутствующий при рождении ребенка. Расположение энцефалоцеле очень важно, так как есть определенные клинические последствия для лечения и прогноза для переднего и заднего энцефалоцеле. Задние энцефалоцеле чаще связаны с неврологическими проблемами. Энцефалоцеле передней части черепа обычно не содержат мозговой ткани и, как правило, имеют лучший прогноз.</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;\"> </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;\">Наиболее распространенной областью черепа для развития энцефалоцеле является верхняя часть от лба до нижней части спины черепа в области затылочной кости. Энцефалоцеле также может возникать вблизи пазух, лба и носа или около основания черепа.</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;\">Симптомы, которые могут развиться, включают:</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;\">задержки в достижении основных этапов развития;</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;\">умственную отсталость;</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;\">неспособность к обучению;</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;\">задержки роста;</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;\">эпилепсию;</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;\">ухудшение зрения;</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;\">несогласованные произвольные движения (атаксия);</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;\">гидроцефалию, состояние, при котором избыток спинномозговой жидкости в черепе вызывает давление на мозг.</span></li>\r\n</ul>\r\n<p> </p>",
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},
"code": "A16",
"name": "Туберкулез органов дыхания, не подтвержденный бактериологически или гистологически",
"icd_name": "Туберкулез органов дыхания, не подтвержденный бактериологически или гистологически",
"gender": 0,
"age_min": 0,
"age_max": 100,
"cause": [
3,
2,
4,
5
],
"periodicity": 1,
"slug": "a16_tuberkulez_organov_dyhaniya_ne_podtverzhdennyy_bakteriologicheski_ili_gistologicheski",
"lead": "Нарушение здоровья, относящееся к группе туберкулез",
"description": "Инфекционное, высококонтагиозное заболевание,при котором в органах дыхания образуются очаги специфического воспаления.",
"etiology": "<p>Возбудитель заболевания - микобактерия туберкулеза. </p>\r\n<p class=\"li\">Роль различных видов микобактерий туберкулеза (МБТ) (или бацилл Коха - БК) в развитии туберкулеза у людей различна:</p>\r\n<ul>\r\n<li>M. tuberculosis humanus вызывает 80-85% всех заболеваний;</li>\r\n<li>M. Tuberculosis bovinus - возбудитель 10-15% всех случаев туберкулеза;</li>\r\n<li>M. Tuberculosis africanus вызывает до 90% всех случаев туберкулеза у жителей Южной Африки;</li>\r\n<li>M. Tuberculosis microti редко вызывает заболевание у человека.</li>\r\n</ul>\r\n<p>Главный источник заражения - больные люди или домашние животные. Заражаются обычно аэрогенным путем при вдыхании с воздухом выделяемых больными мельчайших капелек мокроты, в которых содержится возбудитель. Кроме того, возможно проникновение в организм инфекции при употреблении молока, мяса, яиц от больных животных и птиц. В этих случаях микробы заносятся в легкие или из глоточных миндалин, или по лимфатическим и кровеносным путям из кишечника. У подавляющего большинства впервые заболевших в мокроте обнаруживают микобактерии туберкулеза, чувствительные, а у 5 - 10% - устойчивые к различным противотуберкулезным препаратам. В последнем случае заражение происходит от больных, которые неэффективно лечатся специфическими медикаментами и выделяют устойчивые штаммы возбудителя. При специальном исследовании в мокроте и в органах больных иногда удается обнаружить L - формы микобактерий, отличающиеся сравнительно небольшой вирулентностью и патогенностью, но способные при определенных условиях превращаться в типичную микробную форму.</p>",
"pathogenesis": "<p>Впервые проникшие в организм микобактерии туберкулеза распространяются в нем различными путями - лимфогенным, гематогенным, бронхолегочным. При этом в различных органах, главным образом в лимфатических узлах и легких, могут образоваться отдельные или множественные туберкулезные бугорки или более крупные очаги, для которых характерно наличие эпителиоидных и гигантских клеток, а также элементов творожистого некроза. Одновременно появляется положительная реакция на туберкулин, так называемый туберкулиновый вираж, устанавливаемый по внутрикожной пробе Манту.</p>",
"diagnostics": "<p>Диагноз и рекомендуемые клинические исследования</p>\r\n<p class=\"li\">Обязательный диагностический минимум:</p>\r\n<ul>\r\n<li>изучение истории заболевания и жалоб пациентов;</li>\r\n<li>врачебный осмотр;</li>\r\n<li>клинический анализ крови и мочи;</li>\r\n<li>трехкратное микроскопическое исследование мазков мокроты, окрашенных по Цилю - Нильсену;</li>\r\n<li>рентгенография органов грудной клетки в прямой и боковой проекции:</li>\r\n<li>туберкулиновая проба Манту.</li>\r\n</ul>\r\n<p>Дополнительные методы исследования:</p>\r\n<p class=\"li\">Неинвазивные:</p>\r\n<ul>\r\n<li>исследование мокроты на МБТ (ПЦР, посев на питательные среды с определением чувствительности МБТ к противотуберкулезным лекарственным средствам (ЛС);</li>\r\n<li>посев мокроты на неспецифическую микрофлору и грибы;</li>\r\n<li>иммунологические методы для выявления в крови противотуберкулезных антител и антигенов;</li>\r\n<li>компьютерная томография легких, обычная томография и зонография;</li>\r\n<li>ультразвуковое исследование (при плеврите и субплевральных округлых образованиях).</li>\r\n</ul>\r\n<p class=\"li\">Инвазивные (с последующим цитологическим, гистологическим и микробиологическим исследованием полученного материала):</p>\r\n<ul>\r\n<li>бронхоскопия с различными видами биопсии (аспирационной, щеточной и др.) и бронхоальвеолярным лаважем;</li>\r\n<li>пункция плевральной полости и биопсия плевры;</li>\r\n<li>трансторакальная биопсия легкого;</li>\r\n<li>торакоскопия;</li>\r\n<li>медиастиноскопия;</li>\r\n<li>открытая биопсия легкого.</li>\r\n</ul>\r\n<p>Наиболее широко используется для диагностики туберкулеза легких микроскопия мокроты, рентгенография органов грудной клетки и туберкулиновая проба Манту.</p>\r\n<p>Однако, туберкулиновая проба Манту сохранила свое значение у детей и подростков. У взрослых в большинстве случаев она не позволяет отличить состояние инфицированности от болезни.</p>\r\n<p>Компьютерная томография легких часто оказывается более информативной, чем другие методы рентгенологической диагностики туберкулеза легких.</p>\r\n<p>При установлении диагноза туберкулеза методы полимеразной цепной реакции (ПЦР) и определения антител к МБТ в различных биологических субстратах являются дополнительными, их результаты должны сопоставляться с данными других клинических исследований.</p>",
"treatment": "<p>Лечение туберкулёза легких должно быть непрерывным и обязательно должно проводиться одновременно несколькими противотуберкулёзными препаратами. Каждое из 4-5 лекарств, которые больной принимает ежедневно в течение 6 месяцев, по-разному воздействует на палочки Коха, и только совместное их применение может достичь цели - окончательно ее уничтожить. Для качественного излечения одних противотуберкулёзных лекарств недостаточно. Больным также прописывают физиотерапию, дыхательнаую гимнастику и препараты, поднимающие иммунитет.</p>\r\n<p>Основой лечения туберкулёза сегодня является поликомпонентная противотуберкулёзная химиотерапия (J04 Противотуберкулёзные препараты).</p>\r\n<p>Трёхкомпонентная схема лечения</p>\r\n<p>На заре противотуберкулёзной химиотерапии была выработана и предложена трёхкомпонентная схема терапии первой линии: - стрептомицин - изониазид - пара-аминосалициловая кислота (ПАСК). Эта схема стала классической. Она царствовала во фтизиатрии долгие десятилетия и позволила спасти жизни огромного числа больных туберкулёзом.</p>\r\n<p>Четырёхкомпонентная схема лечения</p>\r\n<p>Одновременно в связи с повышением устойчивости выделяемых от больных штаммов микобактерий возникла необходимость усиления режимов противотуберкулёзной химиотерапии. В результате была выработана четырёхкомпонентная схема химиотерапии первой линии (DOTS - стратегия, используется при инфицировании достаточно чувствительными штаммами): - рифабутин или рифампицин - стрептомицин или канамицин - изониазид или фтивазид - пиразинамид либо этионамид Эта схема была разработана Карелом Стибло (Нидерланды) в 1980-х гг. На сегодняшний день система лечения т. н. препаратами первого ряда (включая изониазид, рифампицин, стрептомицин, пиразинамид и этамбутол) является общепринятой в 120 странах мира, включая развитые страны. В некоторых постсоветских странах (Россия, Украина) ряд специалистов считает данную схему недостаточно эффективной и существенно уступающей по уровню разработанной и внедрённой в СССР комплексной противотуберкулёзной стратегии, опирающейся на развитую сеть противотуберкулёзных диспансеров.</p>\r\n<p>Пятикомпонентная схема лечения</p>\r\n<p>Во многих центрах, специализирующихся на лечении туберкулёза, сегодня предпочитают применять ещё более мощную пятикомпонентную схему, добавляя к упомянутой выше четырёхкомпонентной схеме производное фторхинолона, например, ципрофлоксацин. Включение препаратов второго, третьего и выше поколения является основным при лечении лекарственноустойчивых форм туберкулёза. Режим лечения препаратами второго и выше поколения подразумевает как минимум 20 месяцев ежедневного приёма препаратов. Данный режим гораздо дороже, чем лечение препаратами первого ряда, и составляет эквивалент примерно в 25 000 долларов США на весь курс. Существенно ограничивающим моментом также является наличие огромного количества различного рода побочных эффектов от применения препаратов второго и выше поколения. Если, несмотря на 4-5-компонентный режим химиотерапии, микобактерии всё же развивают устойчивость к одному или нескольким применяемым химиопрепаратам, то применяют химиопрепараты второй линии: циклосерин, капреомицин и др. Кроме химиотерапии, большое внимание должно уделяться интенсивному, качественному и разнообразному питанию больных туберкулёзом, набору массы тела при пониженной массе, коррекции гиповитаминозов, анемии, лейкопении (стимуляции эритро- и лейкопоэза). Больные туберкулёзом, страдающие алкоголизмом или наркотической зависимостью, должны пройти детоксикацию до начала противотуберкулёзной химиотерапии. Больным туберкулёзом, получающим иммуносупрессивные препараты по каким-либо показаниям, стараются снизить их дозы или совсем отменить их, уменьшить степень иммуносупрессии, если это позволяет клиническая ситуация по заболеванию, потребовавшему иммуносупрессивной терапии. Больным ВИЧ-инфекцией и туберкулёзом показана специфическая анти-ВИЧ терапия параллельно с противотуберкулёзной.</p>",
"prevention": "<p>В целях профилактики необходимо проведение следующих мероприятий:- проведение профилактических и противоэпидемических мероприятий адекватных сложившейся крайне неблагополучной эпидемиологической ситуации по туберкулезу. - раннее выявление больных и выделение средств на лекарственное обеспечение. Это мероприятие сможет также уменьшить заболеваемость людей, вступающих в контакт в очагах с больными. - проведение обязательных предварительных и периодических осмотров при поступлении на работу в животноводческие хозяйства, неблагополучных по заболеванию туберкулезом крупного рогатого скота. - увеличение выделяемой изолированной жилой площади больным, страдающим активным туберкулезом и проживающим в многонаселенных квартирах и общежитиях. - своевременнее проведение (до 30 дней жизни) первичной вакцинации новорожденным детям.</p>",
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"code": "Q03",
"name": "Врожденная гидроцефалия",
"icd_name": "Врожденная гидроцефалия",
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"slug": "q03_vrozhdennaya_gidrocefaliya",
"lead": "Нарушение здоровья, относящееся к группе врожденные аномалии [пороки развития] нервной системы",
"description": " \r\nВрожденная гидроцефалия – это патологическое состояние, которое сопровождается накоплением спинномозговой жидкости в желудочках мозга из-за ее избыточной продукции, нарушения всасывания или препятствие на пути оттока. ",
"etiology": "<p>К причинам врожденной гидроцефалии относятся пороки развития ликворной системы : </p>\r\n<ul>\r\n<li>атрезия отверстий, соединяющих желудочки мозга (Мажанди и Люшка); </li>\r\n<li>дефекты в строении подпаутинного пространства; </li>\r\n<li>сужение (стеноз) сильвиевого водопровода; </li>\r\n<li>краниовертебральные аномалии (аномалии границы между основанием черепа и верхнешейным отделом позвоночника) - аномалия Киари, врожденная базилярная импрессия. </li>\r\n</ul>\r\n<p>Причинами врожденной гидроцефалии могут также быть внутриутробные инфекции (токсоплазмоз, врожденный сифилис, цитомегалия, краснуха), родовая травма. </p>",
"pathogenesis": "<p>Традиционно модель гидроцефалии трактуется как дисбаланс между продуцированием и абсорбцией черепно-мозговой жидкости. Современные исследования показывают, что основная роль определяется абсорбцией капиллярами мозга. Гемодинамический патогенез гидроцефалии (первичная и вторичная) определяется нарушением венозного оттока (обструктивная гидроцефалия) и уменьшением артериальной пульсации (сообщающаяся гидроцефалия).</p>",
"diagnostics": "<p>Гидроцефалия может быть выявлена у плода в перриод внутриутробного развития при проведении скрининга беременной женщины. УЗИ плода позволяет обнаружить гидроцефалию у ребенка на 16–20 неделе беременности. После рождения у некоторых детей гидроцефалия выявляется сразу в родильном доме специалистом-неонатологом. </p>\r\n<p>Трансиллюминация (диафаноскопия) черепа позволяет выявить наружную гидроцефалию у детей, исключить гидроанэнцефалию и субдуральную гигрому. Суть его в просвечивании головы пучком света от лампы в затемнённом помещении. В их лучах при гидроцефалии начинает светиться вся голова. </p>\r\n<p>Рентгенография черепа – выявляют истончение костной ткани, расхождение швов черепа, на внутренней поверхности черепной коробки присутствует характерный симптом “пальцевидных вдавлений”. </p>\r\n<p>Магнитно-резонансная и компьютерная томография позволяют с большой точностью визуализировать патологические изменения внутри черепа, выявить место, которое препятствует оттоку ликвора. </p>\r\n<p>Ультрасонография – ультразвуковое исследование головного мозга через открытый большой родничок. Позволяет определить степень повышения внутричерепного давления. </p>\r\n<p>Офтальмоскопия – осмотр глазного дна. Выявляют застойные диски зрительных нервов, как следствие повышенного внутричерепного давления. </p>\r\n<p>Для оценки давления цереброспинальной жидкости, исследования ее состава и проведения ликвородинамических проб прибегают к вентрикулярной и люмбальной пункциям. </p>",
"treatment": "<p>Основными принципами лечения гидроцефалии у детей является снижение продукции спиномозговой жидкости и нормализация ее циркуляции по ликвороносным путям, в т. ч. с помощью создания обходных анастомозов. </p>\r\n<p>С целью снижения продукции ликвора и внутричерепного давления проводится дегидратационная терапия диуретиками, ингибиторами карбоангидразы, салуретиками. При прогрессирующем нарастании гидроцефалии у детей в течение 2—3-х месяцев ставится вопрос о хирургическом вмешательстве. </p>\r\n<p>Оптимальный способ оперативного вмешательства определяется этиологией, формой, стадией гидроцефалии у детей. В настоящее время все виды операций при гидроцефалии у детей могут быть поделены на 5 групп: </p>\r\n<ul>\r\n<li>паллиативные вмешательства, позволяющие временно снизить внутричерепное давление и устранить краниоцеребральную диспропорцию (люмбальные и вентрикулярные пункции, наружное вентрикулярное дренирование) </li>\r\n<li>операции, направленные на подавление ликворопродукции (клипирование, коагуляция сосудистого сплетения) </li>\r\n<li>операции, направленные на восстановление естественных путей циркуляции ликвора или создание новых путей ликворооттока (удаление опухолей, внутричерепных гематом , вентрикулостомия) </li>\r\n<li>операции, активизирующие ликворосорбцию (рассечение арахноидальных спаек и др.) </li>\r\n<li>шунтирующие операции, предусматривающие отведение ликвора в другие системы организма (вентрикулоперитонеальное шунтирование, люмбоперитонеальное шунтирование, вентрикулоатриарное шунтирование, вентрикулоцистерностомия, кистовентрикулоперитонеостомия, субдуроперитонеостомия). При невозможности выполнения стандартных шунтриующих операций проводятся атипичные шунтирующие вмешательства - вентрикулоплевральное, вентрикулоуретральное вентрикулобиллиарное шунтирование. Ликворошунтирующие операции при гидроцефалии у детей сопряжены с риском нарушения функционирования дренажных систем, гипердренированием или осложнениями воспалительного характера. </li>\r\n</ul>",
"prevention": "<p>Чтобы предупредить развитие врожденной гидроцефалии необходимо: </p>\r\n<ul>\r\n<li>Защищаться от инфекционных заболеваний во время беременности </li>\r\n<li>Не принимать никаких медикаментов во время беременности, кроме тех, которые прописал врач </li>\r\n<li>Профилактическое плановое УЗИ-обследование беременных женщин и нейроультрасонография у младенцев. </li>\r\n</ul>",
"clinical_picture": "<p>У детей из-за большой податливости костей черепа не наблюдается повышения внутричерепного давления, гидроцефалия у них сопровождается увеличением размеров черепа. У новорожденных и детей раннего возраста гидроцефалия характеризуется слишком большим размером головы, выбуханием вен скальпа, напряжением и отсутствием пульсации большого родничка, отеком дисков зрительных нервов. Часто отмечается симптом «заходящего солнца» - ограничение движений глазных яблок кверху. Может наблюдаться расхождение швов черепа. Постукивание по черепу сопровождается характерным звуком (симптом «треснутого горшка»). У детей первого года жизни гидроцефалия приводит к отставанию в физическом и умственном развитии. Они позже начинают держать голову, переворачиваться, сидеть и ходить. </p>\r\n<p>Дети, у которых имеется выраженная гидроцефалия, отличаются шарообразной формой головы, ее слишком большим размером, глубоко посаженными глазами, оттопыренными ушами, истончением кожи головы. Может отмечаться снижение зрения, повышение мышечного тонуса в нижних конечностях, нарушения со стороны черепных нервов. Дети, страдающие гидроцефалией, малоподвижны, не могут следить глазами за родителями. Они раздражены, часто плачут, постоянно сонливы, плохо едят. Их часто тошнит. </p>",
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]
}
