#91
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Öèòàòà:
2. Ðå÷ü î ïîìóòíåíèè. Îíî îáóñëîâëåííî íàáóõàíèåì ãëèè à íå íåéðîíîâ. |
#92
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Öèòàòà:
Îòåê åñòü, íî îí âòîðè÷åí ê íàáóõàíèþ. |
#93
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"Ñòðîìàëüíî-ñîñóäèñòàÿ äèñòðîôèÿ – ýòî íàðóøåíèå îáìåíà â ñîåäèíèòåëüíîé òêàíè, ïðåèìóùåñòâåííî â åå ìåæêëåòî÷íîì âåùåñòâå, íàêîïëåíèå ïðîäóêòîâ ìåòàáîëèçìà.  çàâèñèìîñòè îò âèäà íàðóøåííîãî îáìåíà ìåçåíõèìàëüíûå äèñòðîôèè äåëÿòñÿ íà áåëêîâûå (äèñïðîòåèíîçû), æèðîâûå (ëèïèäîçû) è óãëåâîäíûå. Ñðåäè äèñïðîòåèíîçîâ ðàçëè÷àþò ìóêîèäíîå íàáóõàíèå, ôèáðèíîçíîå íàáóõàíèå, ãèàëèíîç è àìèëîèäîç. Ïåðâûå òðè ñâÿçàíû ñ íàðóøåíèåì ïðîíèöàåìîñòè ñîñóäèñòîé ñòåíêè.
1. Ìóêîèäíîå íàáóõàíèå – ýòî îáðàòèìûé ïðîöåññ. Ïðîèñõîäÿò ïîâåðõíîñòíûå íåãëóáîêèå èçìåíåíèÿ ñòðóêòóðû ñîåäèíèòåëüíîé òêàíè. Çà ñ÷åò äåéñòâèÿ ïàòîëîãè÷åñêîãî ôàêòîðà â îñíîâíîì âåùåñòâå âîçíèêàþò ïðîöåññû äåêîìïîçèöèè, ò. å. ðàñïàäàþòñÿ ñâÿçè áåëêîâ è àìèíîãëèêàíîâ. Àìèíîãëèêàíû íàõîäÿòñÿ â ñâîáîäíîì ñîñòîÿíèè è îáíàðóæèâàþòñÿ â ñîåäèíèòåëüíîé òêàíè. Çà èõ ñ÷åò ñîåäèíèòåëüíàÿ òêàíü îêðàøèâàåòñÿ áàçîôèëüíî. Âîçíèêàåò ôåíîìåí ìåòàõðîìàçèè (ñïîñîáíîñòü òêàíè èçìåíÿòü öâåò êðàñèòåëÿ). Òàê, òîëóèäèíîâûé ñèíèé â íîðìå ñèíèé, à ïðè ìóêîèäíîì íàáóõàíèè – ðîçîâûé èëè ñèðåíåâûé. Ìóöèí (ñëèçü) ñîñòîèò èç ïðîòåèäîâ è ïîýòîìó ñâîåîáðàçíî îêðàøèâàåòñÿ. Ãëþêîçîàìèíîãëèêàíû õîðîøî âïèòûâàþò æèäêîñòü, êîòîðàÿ âûõîäèò èç ñîñóäèñòîãî ðóñëà, è âîëîêíà íàáóõàþò, íî íå ðàçðóøàþòñÿ. Ìàêðîñêîïè÷åñêàÿ êàðòèíà íå èçìåíåíà. Ê ôàêòîðàì, âûçûâàþùèì ìóêîèäíîå íàáóõàíèå, îòíîñÿòñÿ: ãèïîêñèè (ãèïåðòîíè÷åñêàÿ áîëåçíü, àòåðîñêëåðîç), èììóííûå íàðóøåíèÿ (ðåâìàòè÷åñêàÿ áîëåçíü, ýíäîêðèííûå íàðóøåíèÿ, èíôåêöèîííûå çàáîëåâàíèÿ). 2. Ôèáðèíîèäíîå íàáóõàíèå – ýòî ãëóáîêàÿ è íåîáðàòèìàÿ äåçîðãàíèçàöèÿ ñîåäèíèòåëüíîé òêàíè, â îñíîâå êîòîðîé ëåæèò äåñòðóêöèÿ îñíîâíîãî âåùåñòâà òêàíè è âîëîêîí, ñîïðîâîæäàþùàÿñÿ ðåçêèì ïîâûøåíèåì ñîñóäèñòîé ïðîíèöàåìîñòè è îáðàçîâàíèåì ôèáðèíîèäà. Ìîæåò áûòü ñëåäñòâèåì ìóêîèäíîãî íàáóõàíèÿ. Âîëîêíà ðàçðóøàþòñÿ, ïðîöåññ íîñèò íåîáðàòèìûé õàðàêòåð. Ñâîéñòâî ìåòàõðîìàçèè ïðîïàäàåò. Ìàêðîñêîïè÷åñêàÿ êàðòèíà áåç èçìåíåíèé. Ìèêðîñêîïè÷åñêè íàáëþäàþòñÿ êîëëàãåíîâûå âîëîêíà, ïðîïèòàííûå áåëêàìè ïëàçìû, îêðàøèâàåìûå â æåëòûé öâåò ïèðîôóêñèíîì." Íî - ñîåäèíèòåëüíîé òêàíè â ñåò÷àòêå íåò! |
#94
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Ñ ìóêîèäíûì íàáóõàíèåì ãëèè ìåíÿ çàíåñëî. Öèòàòà Àðõàíãåëüñêîãî ïî ïàìÿòè îêàçàëàñü âåðíîé. Ïîçæå ñêèíó äîñëîâíûé òåêñò.
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#95
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Àðõàíãåëüñêèé Â.Í. Ìîðôîëîãè÷åñêèå îñíîâû îôòàëüìîñêîïè÷åñêîé äèàãíîñòèêè. Ìîñêâà: Ìåäãèç, 1960
Ñóòü ïîìóòíåíèé ñåò÷àòêè….çàêëþ÷àåòñÿ â èçìåíåíèÿõ ñîñòîÿíèÿ åå ìåæóòî÷íîãî âåùåñòâà, êîòîðîå èìååò ñòðîåíèå êîëëîèäà è îòíîñèòñÿ ê ìóêîïîëèñàõàðèäàì. Ïðè ñåðåáðåíèè (ïî Ôîãòó) ëåãêî óäàåòñÿ îáíàðóæèòü ìåæóòî÷íîå âåùåñòâî, èìåþùåå âèä ìåëêîäèñïåðíîãî êîëëîèäà. Îíî âûïîëíÿåò âñå ïðîìåæóòêè ìåæäó òêàíåâûìè ýëåìåíòàìè è ìîæåò ëåãêî èçìåíÿòü ñâîå ñîñòîÿíèå îò ðàçëè÷íûõ âîçäåéñòâèé.  íîðìå îíî ïî ñâåòîïðåëîìëåíèþ íå îòëè÷àåòñÿ îò ýëåìåíòîâ ñåò÷àòêè, ïîýòîìó ïðè îôòàëüìîñêîïèè îñòàåòñÿ íåçàìåòíûì, à âñÿ ñåò÷àòêà - ïðîçðà÷íîé. Ìåæóòî÷íîå âåùåñòâî ñåò÷àòêè ïðè ïàòîëîãè÷åñêèõ ïðîöåññàõ ìîæåò èçìåíÿòü ñîñòîÿíèå êàê êîëëîèäíîå âåùåñòâî: íàáóõàòü, óïëîòíÿòüñÿ, óñèëèâàòü ñðîäñòâî ê ñåðåáðó ïðè ñåðåáðåíèè. Ïðè ýòîì îíî ñòàíîâèòñÿ çàìåòíûì ïðè îôòàëüìîñêîïèè â âèäå ðàçëè÷íîé ñòåïåíè ïîìóòíåíèÿ ñåò÷àòêè… …Ãåìàòîêñèëèíîì-ýîçèíîì ìåæóòî÷íîå âåùåñòâî íå îêðàøèâàåòñÿ, ïîýòîìó â ñåò÷àòêå âìåñòî íåãî âèäíû ïóñòîòû. Ïðè îêðàñêå, âûÿâëÿþùåé îäíî ìåæóòî÷íîå âåùåñòâî, ïîëó÷àþòñÿ îáðàòíûå îòíîøåíèÿ: âñå òêàíåâûå ýëåìåíòû ñåò÷àòêè îñòàþòñÿ íåîêðàøåííûìè – ïóñòûìè, êàê íà íåãàòèâå. Îíè âèäíû íà ôîíå âûÿâëåííîãî ìåæóòî÷íîãî âåùåñòâà, òîíêîäèñïåðñíîé àðãèðîôèëüíîé ñðåäû, çàïîëíÿþùåé âñå ïðîìåæóòêè. (Ñ. 29-30) Èíîãäà ïîñëå òóïîãî óäàðà ïî ãëàçó ïðè îôòàëüìîñêîïèè â îáëàñòè çàäíåãî ïîëþñà îáíàðóæèâàåòñÿ ïîìóòíåíèå ñåò÷àòêè. Åãî ïðèíÿòî îáúÿñíÿòü «îòåêîì», êàê ïî÷òè âñÿêóþ ïîòåðþ ïðîçðà÷íîñòè ñåò÷àòêè. Î÷åíü ÷àñòî ÷åðåç íåñêîëüêî äíåé ýòî ïîìóòíåíèå èñ÷åçàåò, ñåò÷àòêà âíîâü ñòàíîâèòñÿ ïðîçðà÷íîé, à ôóíêöèè íîðìàëüíûìè.  íåêîòîðûõ ñëó÷àÿõ ïîìóòíåíèå îñòàåòñÿ íà áîëåå äëèòåëüíûé ñðîê, ôóíêöèè ïðè ýòîì îñòàþòñÿ ïîíèæåííûìè. Ìîðôîëîãè÷åñêàÿ ñóòü îïèñàííûõ íàðóøåíèé ñâÿçàíà ñ èçìåíåíèåì ñîñòîÿíèÿ êîëëîèäíîãî ìåæóòî÷íîãî âåùåñòâà ñåò÷àòêè, êîòîðîå íàñòóïàåò êàê îò íåïîñðåäñòâåííîãî ðåçêîãî òîë÷êà, èñïûòûâàåìîãî îò ïðîòèâîóäàðà, òàê è âñëåäñòâèå ðåçêîãî èçìåíåíèÿ ôóíêöèè êîíöåâûõ êàïèëëÿðîâ… (Ñ. 97-100) |
#96
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 íîðìå âîäà ìîæåò ïðîíèêàòü ÷åðåç ãåìàòîðåòèíàëüíûé áàðüåð (ÈÌÕÎ).À êàê ïî âàøåìó ïîääåðæèâàåòñÿ òóðãîð ñåò÷àòêè?Ïðè íàðóøåíèè ãåìàòîðåòèíàëüíîãî áàðüåðà ïðîèñõîäèò ÷àùå ãèáåëü åãî êëåòîê,÷òî ïðèâîäèò ê ïðîõîæäåíèþ ÷åðåç íåãî áîëåå êðóïíûõ ìîëåêóë,÷åì âîäà,êèñëîðîä,óãëåêèñëûé ãàç è ò.ä.Ïî ýòîìó ÿ è ãîâîðþ,÷òî èíòåðåñíî áû áûëî óâèäåòü ÔÀÃ.Òîëüêî ÷òî-òî ìíå â ãëóáèíå äóøè ïîäñêàçûâàåò,÷òî ïðîñà÷èâàíèÿ ïðè "áåðëèíîâñêîì ïîìóòíåíèè" íèêàêîãî íå áóäåò.
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#97
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Òàê è ÿ î òîì, ÷òî ïåðâè÷íî ýòî íå îòåê. Õîòÿ èç-çà èçìåíåíèÿ îñìîòè÷åñêîãî-îíêîòè÷åñêîãî äàâëåíèÿ â ðåçóëüòàòå äåçîðãàíèçàöèè ñòðóêòóð êîëëîèäíîãî âåùåñòâà âòîðè÷íî íåêîòîðîå îáâîäíåíèå áûòü, âèäèìî, ìîæåò.
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#98
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×òî êàñàåòñÿ íàðóøåíèÿ ãåìàòîðåòèíàëüíîãî áàðüåðà, òî îí íå òîëüêî ñòàíîâèòñÿ ïðîíèöàåì äëÿ áîëåå êðóïíûõ ìîëåêóë, íî è íîðìàëüíûé òðàíñïîðò æèäêîñòè íàðóøàåòñÿ. Íàïðèìåð, ïðè êèñòîçíîé ìàêóëîïàòèè, ñêàæåì ïðè ÒÖÂÑ, ìû âèäèì àáñîëþòíî ïðîçðà÷íóþ îòå÷íóþ ñåò÷àòêó.
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#99
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Öèòàòà:
(Âåíäåð, Ñåêðåòû îôòàëüìîëîãèè). Ïðî îòñóòñòâèå èçìåíåíèé íà ÔÀà ìíîãî ãäå áûëî íàïèñàíî, èìåííî ñ àðãóìåíòàöèåé ïðîòèâ òîãî ÷òî ýòî âîîáùå îò¸ê. |
#100
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Èíòåðåñíûå èññëåäîâàíèÿ Àðõàíãåëüñêîãî - ÿ ëþáëþ ÷èòàòü êíèãè, êîãäà ê âðà÷àì è èññëåäîâàòåëÿì îòíîñèëèñü áîëåå èëè ìåíåå ïðèëè÷íî, ðîâíî, êàê è ñìîòðåòü ôèëüìû 70 ãîäîâ, ñ ïðåæíèìè àâòîáóñàìè è äîìàìè áåç ðåêëàìû - ñîãðåâàþò ÷åì-òî ïî-äåòñêè îñîáåííûì......Ó ìåíÿ åñòü êíèãè îôòàëüìîëîãè÷åñêèå, ìîåãî äåäóøêè, âûïóùåííûå â 1903 ã., òàì òàê îïèñàíî ñòðîåíèå çðèòåëüíîãî íåðâà - ÷òî ñîâðåìåííîå èçëîæåíèå îòäûõàåò - íåìåöêàÿ ïóíêòóàëüíîñòü....
Äóìàþ, ñïîð äîëæíû ðàññóäèòü ìîðôîëîãè. ß ïî÷èòàþ ê âûõîäíûì - ïîêà àâðàë, íåêîãäà. |
#101
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Òàêóþ ÷óäåñíóþ ññûëî÷êó Eyedoctor íàì âûëîæèë äâå ñòðàíè÷êè íàçàä. È îïðåäåëåíèå òåðìèíà, è ãäå-÷òî îòåêàåò èëè íå îòåêàåò è â çàâèñèìîñòè îò ÷åãî, è ïðî ÔÀÃ, è ñõåìà ëå÷åíèÿ, è îò÷àñòè ñïîñîáû ïðîãíîçèðîâàíèÿ èñõîäîâ.
Berlin's Edema or Commotio Retinae Discussion Áåðëèíîâñêèé îò¸ê èëè ñîòðÿñåíèå ñåò÷àòêè. Commotio retinae is a contrecoup injury to the retina. It can occur centrally or peripherally, and when it involves the macula, it is called Berlin's edem. Ñîòðÿñåíèå ñåò÷àòêè ... ìîæåò ðàñïîëàãàòüñÿ öåíòðàëüíî èëè ïåðèôåðè÷åñêè, è êîãäà âîâëåêàåòñÿ ìàêóëà, òîãäà ýòî íàçûâàåòñÿ Áåðëèíîâñêèì îò¸êîì. The retina appears normal on examination although the patient may complain of decreased vision. The affected area becomes white and opaque usually hours after the trauma . On careful examination, most of the opaqueness and whitening is in the outer retina and the blood vessels are clearly seen. Ïîâðåæä¸ííûå àðåàëû ñòàíîâÿòñÿ áåëûìè è ìóòíûìè îáû÷íî ÷åðåç íåñêîëüêî ÷àñîâïîñëå òðàâìû. Ïðè òùàòåëüíîì îñìîòðå áîëüøèíñòâî ïîìóòíåíèé è ïîáåëåíèé ðàñïîëàãàþòñÿ â íàðóæíûõ ñëîÿõ ñåò÷àòêè, ñîñóäû ñåò÷àòêè ïðè ýòîì âèäíû ÷¸òêî. On fluorescein angiography, the opaque retina blocks background choroidal fluorescence, with minimal leakage usually. Íà ÔÀà ìóòíàÿ ñåò÷àòêà áëîêèðóåò ïîäëåæàùóþ õîðèîèäàëüíóþ ôëþîðåñöåíöèþ, ïðîñà÷èâàíèå îáû÷íî ìèíèìàëüíîå. Berlin's "edema" is not a true edema. Swelling and disorganization of the outer retinal layers causes the opaqueness and there is no intercellular fluid. Áåðëèíîâñêèé "îò¸ê" íà ñàìîì äåëå íå ÿâëÿåòñÿ èñòèííûì îò¸êîì. Âñïó÷èâàíèå (íàáóõàíèå) è äåçîðãàíèçàöèÿ íàðóæíèõ ñëî¸â ñåò÷àòêè ïðèâîäèò ê ìóòíîñòè, íî íå âñëåäñòâèå óâåëè÷åíèÿ ìåæêëåòî÷íîé âëàãè. The visual acuity in commotio retinae varies from 20/20 to 20/400 and does not always correlate with the degree of retinal opacification. There is no known treatment. Ñïîñîáû ëå÷åíèÿ íå èçâåñòíû. Prognosis is usually excellent except in cases with associated subfoveolar choroidal rupture and /or subfoveolar hemorrhage. Ïðîãíîç îáû÷íî õîðîøèé, åñëè òîëüêî íå îáíàðóæèâàåòñÿ ñîïóòñòâóþùèå ñóáôîâåîëÿðíûé ðàçðûâ ñîñóäèñòîé è\èëè ñóáôîâåîëÿðíîå êðîâîèçëèÿíèå. Poor outcome is also expected in cases with severe retinal pigment epithelial damage. Serous retinal detachment signals this condition, which can be confirmed by leakage of fluorescein into the subretinal space. Ïëîõèå èñõîäû áûâàþò ïðè î÷åíü âûðàæåííîì ïîâðåæäåíèè ÏÝÑ . Ñåðîçíàÿ îòñëîéêà ñåò÷àòêè ñèãíàëèçèðóåò îáýòîì ñîáûòèè, êîòîðîå ìîæåò ïðèâåñòè ê ïðîñà÷èâàíèþ è îáíàðóæèâàåòñÿ ïî ÔÀÃ. Other late manifestations of blunt injury to the RPE vary from minor atrophic changes to massive hyperplasia and migration resulting in bone corpuscular and granular pigmentation that resembles retinitis pigmentosa. If the trauma to the RPE destroys photoreceptor cells, localized visual field defects result. Destruction of the photoreceptors may be related to the release of catalytic enzymes from lysosomes within the cytoplasm of the RPE. Äåñòðóêöèÿ ôîòîðåöåïòîðíûõ êëåòîê ìîæåò áûòü ñâÿçàíà ñ ïîâðåæäàþùèì äåéñòâèåì ëèçèðóþùèõ ôåðìåíòîâ, âûøåäøèõ èç ëèçîñîì ïîâðåæä¸ííûõ êëåòîê ÏÝÑ. In rare cases the retinal contusion causes cystoid macular edema that may, in turn, progress to a macular hole .  îòäåëüíûõ ñëó÷àÿõ êîíòóçèÿ ñåò÷àòêè âûçûâàåò êèñòîçíûé îò¸ê , êîòîðûé ìîæåò ïðèâåñòè ê îáðàçîâàíèþ ìàêóëÿðíîãî îòâåðñòèÿ. Finally, it is possible that multiple pathogenetic mechanisms contribute to the appearance of commotio retinae, depending upon the violence of the blunt injury to the eye (i.e., in milder blunt trauma, there is only photoreceptor damage and the gray-white opacification resolves, whereas in more severe trauma, there is true macular edema and/or Müller cell damage, which may lead to macular cyst). Berlin's edema is usually self limited and resolves without sequelae , and there is no known intervention that alters its course and prognosis Áåðëèíîâñêèé îò¸ê îáû÷íî îãðàíè÷èâàåòñÿ è ðàçðåøàåòñÿ ñàì, è íå èçâåñòíû âìåøàòåëüñòâà, ñïîñîáíûå ïîâëèÿòü íà åãî òå÷åíèå è èñõîä. Íåìíîæêî îò ñåáÿ - ïîõîæå, äèàãíîç Áåðëèíîâñêîãî ïîìóòíåíèÿ êîððåêòíî ìîæíî ïîñòàâèòü òîëüêî ïîñòôàêòóì, êîãäà ñåðûå-áåëûå ó÷àñòêè â ìàêóëå ðàññîñóòñÿ è íå îáíàðóæèòñÿ íè ðàçðûâîâ ñîñóäèñòîé, íè ãåìîððàãèé (êàê â ñëó÷àå, ïðåäñòàâëåííîì Ophthalmist) ïðè óñëîâèè ïðèëè÷íîé îñòðîòû çðåíèÿ, ïóñêàé ñ ìèêðîñêîòîìàìè. Èëè êîãäà åñòü è ìîæíî ñäåëàòü ïî ñîñòîÿíèþ ãëàçà ÎÊÒ è ÔÀÃ, íî "ýòî âðÿä ëè êòî äåëàòü áóäåò, ðàçâå ÷òî äëÿ íàóêè èëè òîãî, êîãî Áîã ëþáèò". |
#102
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Óâàæàåìûå êîëëåãè! Ïðèøëà êî ìíå æåíùèíà 45 ëåò ñ ÖÑÕ.
[Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ß å¸ ïîëå÷èë. Òàê âûãëÿäåëî ãëàçíîå äíî ÷åðåç íåäåëþ ïîñëå ôîê. ËÊ, vis = 1.0: [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] À ñåãîäíÿ îíà êî ìíå ïðèõîäèò ñ 0.4 í/ê (ðîâíî ìåñÿö ïîñëå ËÊ): [Ññûëêè äîñòóïíû òîëüêî çàðåãèñòðèðîâàííûì ïîëüçîâàòåëÿì ] ×òî ýòî? Ðóêîòâîðíàÿ ÕÍÂ? |
#103
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Ìîæåò ýòî ïðîñòî ðåöèäèâ?À íà ÔÀà ÷òî?Íå õî÷åòñÿ âåðèòü â ÕÍÂ!
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#104
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ïîõîæå... îòñëîéêà ïýñ åñòü? à íå áûëî ëè èçíà÷àëüíî? ïîçäíÿÿ ôàçà - ÷å òàì?
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#105
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Ìíå êàæåòñÿ, ÷òî îêêóëüòíàÿ ÕÍ áûëà èçíà÷àëüíî.
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