MUHUMCTEPCTBO OBPASOBAHHAI H HAYKH POCCHMCKOM WEAEPALIM MUHUCTEPCTBO 3APABOOXPAHEHHA HM COL|IMAABHOTO PASBUTHA POCCHACKON DEAEPALIMU TOCYAAPCTBEHHOE OBPASOBATEABHOE YUPEKAEHHE BbICLUEPO MPOMECCHOHAABHOLO OBPASOBAHMA ‘CAMAPCKHMt FOCYAAPCTBEHHbIM MEAMLIMHCKMM YHUBEPCHTET* O.B. KaAnHkiHna ] B.A. MeabHuKOB M.FO. AHTHMOHOBa { HA. Kynaes BOCTIAAMTEABHBIE 3ABOAEBAHUA JKEHCKUX TIOAOBBbIX OPTAHOB Yue6uo-memoguueckoe nocobue gaa cmygenmos, UXMepHoB, KAUKUYeCKUX OpguHamopoB, Bpaveli aKyWlepOB-ruHeKOAOTOB rocypapcTBeHHuit Camapenait |EMMUMHCKHA YHABOPCHTET HAYUHAS| BHBMIMOTEKA Yue6ubim POHA Camapa 2004BOCTIAAMTEABHBIE 3ABOAEBAHHA HM)KHETO OTAEAA MOAOBBIX OPTAHOB K mipxnemy oTaery 2KCHCKHX MOOBbIX OpratoR oTHOCATCA: bysibpa, HapyxXuble rosionble pranst H Anarannue. Bocnantrens- inte aaGonenanna mpkUerO OTHIeIa TO.OBLIX opration Hanbonee Xapaxrepin am penpoaykrianoro epiosa aman MeN ity OAlaKo UoTpeuaorca it B 1oH1OM, 1 B cTapecKost Bospactax, Byam BIIT 1 BY.1bBORATILINT COCTABAMOT OKONO 65% oT BEX saGosleDa- unit nononoit cHCTeMBI B eTCKOM H IpenyGepraTHoM nospacrax. lpi e6ope avamneaa sa6oalenanua OTMeHaIOT BpeMa noARAeMHA pnstiakon GonesiH, Hx xapakrep M CTeMleHb BoIparKentiocTH, npo- BOAUBUINECA PaHee NeYeOHBIE MeporIpUATHA H-HxX d¢ebeKTHBHOCTD. Vayyan cunexorozuueckuil aHaMne3, BLIABAAIOT CBASb 3a607eRAHHA co BpeMeleM Ha4aia MeHCTpyatlMii, H3MeHEHHe CHMMTOMOB B 3a- BHCHMOCTH OT (pasbl MeHCTpyaibHoro UnKaa. Ecam naumentKa Be- AeT MOAOBYIO 2KUBH, TO BOLICHATOT KONIVECTBO MOA!ONEIX MapTHe POD, 4ACTOTY NOsIOBBIX KOHTaKTOR, HATE y NaprHepa npitaHa- KOB IMeKUONHOFO NpoUecca Hapy%HBIX MOTOBLIX OPraHoB, Ne- lombaopanne Gapbepiibtx MeToAOB KOHTpaLerittt pu ocnompe wapy2xb1x ToTOBEIX Opranios O6pautaior BriIMa- He Ha MpHsnakn pocrammTenbioro Mpowecca ~ ruinepenia, oTeK, Bbicbinania B o6a1actH RYZE, yperpht, GoxbUNNX xKexea MperLBe- PIA, HX BHIBOAHBIX MpoTOKOB. C nOMON4bIO sepKAT ONICHHLBAIOT CO- crosmme casero OGoOUKH wrara.tUa: FLIepestits, OTEK, 1bsI- BaeilHA, cTenen» ropMonarbioii HacbiMIcHHOCTH cmtaHeToit 0G0- AIOUKHK; OCOGEHHOCTH CocTOsIHA MIeiiKH MaTKH, COcTOAHBIE Hapysk= Horo 3eBa H BHANMOIi YacTH UeppHKasbHoro KaHasta, BepyT MasKn, ALIA MukpoOuonorHMecKoro HecnegopaHiia 113 Brarannnta, yperpbl, epBHKaABHOFO Kalaa, MesIaIoT CMBIB 13 Bnarazuia, a TAROKE 6 PYT Ma3KU ¢ MloBepxHocTH WeiikH MaTKH Ha oHKOIWTOMOrMO. Bu- Manyaxonoe (pexmosaeunaxonoe) uccredoeanue DbINOAHSOT JA OUeHIKH COCTOSHH BHYTPEHHMX TOAOBBIX OPrAHOB, 4TO M0380. eT aariogoapitT» Bocoaauee pacnpoctparienue pocrtamiTesbit ro npouecca. /la6opamopuore uccaedoeanua (KpOBH, MOwH, Kauta) nlooraior onpeeanth copay sa6onenanina: Octpas, xpowit4ec! crenenb paénpoctpanenuoctn npouecca; santHTepecopannoct eMexxitbIx opranon. 4 m — ocrpoe HIK xporecKoe PeuIAHBMpy;oULee BOC- ranenne ay.tousi. ¥ xen PempoayKTHBHOrO BOIpAcTA BY. srry powin BosHuiKaeT neTeacTaNe HiuIMponaHNs Hapy7sHx moxoparx opranion 1aTorenisint MHKpOOpraHtaNanst, CONepA vrorven » noueneniaX 13 HAaraaMiua pw KOABHINTE, LepsMITe, ems werputre. Bropituliblli mpouece YACTO uMeeT XapaKrep BY. Govarnmira, BMI@aeT H epBiDl By.abAMT, BooMKHOReNIO O- roporo crioco6cryror onperocts (mp oxupentinn), Hecobatone- spe rnrnethl Hapy%KMbIX HOAOBBIX OpraHOB, XHMHYECKHE, TePMIt aeccite, MexaHMeCkHe (PACHCCHL, CCAAIIHL H Ap.) BoszteltCTRH, senoxpmmnie (anaGer 1p.) Go.teaHH, BocrramHembuBIE MPOWee- cut B nlepriartastbuioli oGr1acTH. B aerexost i rpetyGepTaTHoM nospacrax ByzibBHT ObipaeT ame nepsivinsin. Hs o6nacTit Hapysxibtx OsORBIX opratios watbextt ponikaeT BO BaarATMULe, BEIgKIBAR By.THBORArHEHT. YeAOBHANH, chocoGeTByTOILWINN TOABeHIHO H JUINTeTbHOMY TeNeHIuO By.) ponariinutta y ete, ABAMOTCA HIEKILWOHHO-TOKCHICCKHE TPO- ttecesi, CHIDKaIOUIMe CONPOTHBAAeMOCTS oprantissa, By.wboparn- nitTy mpeaulectaylor HIM ConyTCTBY!OT OGuMHE HHdeKUNOHHDIE gaGoueBanna (Kops, CKapsiaTHlta, HapOTstT, BeTPsNAR cra 1 Xp.). Oco6enuo ¥acTo BYABBOBAFHHHT COueTAETEs C 9KCCYAATHBHDIM AMaTesoM, TOHSHAAUTOM, MHteTOMeKppHTOM. Knunceckas kapmuna. Byaveut 8 octpoit crams Xapaxctepit- syetea runepemueli 1 OTCUHOCTDIO HapYKHBIX MOMIOBKIX OPrattos, Hanmem ceposiio-rHoeBHANbIX HaneTon. ManuenTst npetaBaA- 1oT 9ea10601 Ha Goa, AoKeHHe, HepeKO OOuLee HesoMOraHHe, B xpo- Huseckoit cranUM — rHmepeMua, OTeUHOCTS, IKCCyMAUMA YMEH- liaiores, ayn CTHXaer, HO MepuoanueckH BosobHoRAeTCA. JTeve- nue eynpeuma. CuAAMe BAHHOUKH C OTBAPOM POMALIIKH HLTH Cota 6bim pacrBopom nepMariralara KAIHA, NPHMeHeHHe NO NOKAsAHI- AM aNITHGakTepHabHBIX HpertapatoR MecTHO H/MLM BHYTPB, ee- Hve CONYTCTBYIOULMX FeHHTAAbHBIX M IKCTPAreHHTaNbHUBIX 3a60- aepanutit, Bazunum (xoavnum) — ocrpoe wocnanenue cnusicroii 060- JOURN BaaramHna, OcoBerHocTu TeventiA saBHICsT OT BOSpAcTA Ta- MHeHTOK (y MaeHDKHX NEBOYEK NPHYMHO!! BYLBHTOB, M BYbBO- BarHMHTON OGEIMO sBAKETCA KaKas-NGO OGuLecoMATHMECKAR Ma- ByxvouTONOTHA: caxapy 703, HHOponHOE norper aMHOF “Hoi THrHenb, conyteTByioMMeE comativeckne B uactonm ‘Gennocmu mevems HEE BPEMA MOAKHO Bo acre Mest» 0c MATCH bIX Npoueccos: cunxKenne 4aCTOTHL ne i mall sa6oxenanni, creproe Havano u TeveHMe, 9a Koren BoIparKennoe oGocrpenue, Aenuth 4 Tuna 01 ThponiesnaeroSaerih ee a aDETER ‘ aKTepuit, OTCYTeTBHeM rpaworpiuaTenbuol MuKpoxuiopbt, cop, sues, neeszornibos, HammaneM ein HbIx TeHKOUNTOR 1 "YHCTHIX" OTMTeTAMBHBIX KAeTOK cooTRET- erento (base MenicrpyaibHoro ukxa. Hoxo6ias Kaptinta oxpa~ 2kaeT THM CoCTOAUMHE HopMarbHOro GuoueHOsa BaaramNMA. Hpomescymounoitt mun 6uoyenosa aracaauya xapaxtepusyerca YMEPCHUBIM HUI HesHaUITeZTbHDIM KOJMMECTHOM sJaKTOGaKTepitii, HAAHUHEN rpastoAOKITeADIELX KOKKOD, FpanoxpHuaTesbiAN nanoueK; OGHapyxkitna|oTes neiiKOMUTEL, MOMOWTEL, Makpodarn, ONMTeMManUDIe KreTKH, ABiAeTCA MOrpAHAABIM THIOM, YacTO HaGsIoAaeTCs ¥ SAOPOBLIX 2RENULIEK, PeAKO composoxaaerca CyGvexTHBNDINat xa10GAMtu 1 KAMAUMCCKMAMH MpOABICHAN. Jucéuos exaeanuya xapaxrepnayeren anasHtTeNBHbIM YMeHEIE- ‘ent WIE NOTHIN OTCYTCTBILEM AAKTOGALULTA, OGILTAHO! nae (huoll rpastorpnarexsnoii v rpanonoacreabiot cast KOKKOBO! MHKpodopoli, HamMMHeN tuTOB, OTCYTCTBHEM LH HesaBepule percrnyet MuNKPoGHoOrHUeCKOHt Ka ap EE —— en ssipaxennoro ¢barouirTosa, Mopdo.10- 1 ve eliaakem BocramTemIbHOro Tpouecca, COOTETCTBYET ewer aacexomy nartinntty, Ipst oOHApy>eHIti FOHOKOKKOS, ‘on vimaeatia, TceBaOrNpos, cHOp BBICTABAETCS COOT THOMOrMYeCKHIT AHarHo3. SHecenue. Tepaniio MpovonAT ¢ YUCTOM /aHBIX veciTeOBAIIA oth oveTaHHe MeCTHOFO 1e4eHHA (cue potb: ensaeTca C anixpodptopst. Epis! ‘ " ire BANNONEK, CHPUNUCBANIIT aNTHICeNTHYECKHME PacTPOPA ci, paaraiHaiNbIx WIAPHKOS W KPEMOB ¢ alTHOAKTEPHANDIDIN et oOuielt Tepaninit ¢ HCTONDIOBANHEM CEAATHBHBIX, jperiapaTaniit) 1 SE eee or! qHoTBOPHBIX Iperlaparon, HMMYHOMOAYATOPOB, - siarenue conyrcraytowteli comaruyeckoii naroornt Ips rena oat nanantoae abpekTHBHO HcnoAsonanie Mperapara MUKO- Nraxe. FIpH OCTpOM BATHHATbHOM KaHIMIOBe HerOmayeTeA Cem jonas exenta: 1st kantcyzia (150 mr — 1-ii wen), 2-# kanteyzna (150 ar 3-44 aenb), 3-8 Kamicy.ta — Aevene MoTOBOTO HaptHepa. JleweHHe xponuseckoro peunANBKpyioutero reHHTaTbHOTO KAHAHOSA: 4-H ancy — Iii Mecsit nocae 6wKAiMNX MecABIX, S-a Kaneysa — 2-i1 mecatt, G-a Kanicy.ta ~ 3-ii Mecaul. Kype slewenns — oT 3-x 20 12 mecanes. Baxmepuanvnviit cazunos. Kaunuueckan kapmuna. Beayutn- MIL MacTO BeTPeHAIOLLUMMCS CHMTITOMaMM GakTepHasbHOTO Ba- rinoga (BB) apsmorca 2ano61 na OGHAbHBIE Gem ¢ HenpusaT- ubIM 3anaxom. B Hadasie sa607enanHa GerM MMeI0T %KHAKYIO KOH- cucrenumo, Gensit wm c cepopaTbIM oTTeHKOM 1BeT. [Ip sum TeAbHOM TeveHHH saGoseBAHHA OHM HpHOOperaior rKesITOBATO-—Je- alenylo OKpacky, cTaHOBATCA Gosee TYCTbIMH, HepemKO HanoMHHa- oT TBopoxUCTyIO Maccy, OGaasaloT CROIICTBOM NeAHTbCA, CerKA TATY4He, JTHTKHe, paBHOMepHO pacntpenermIOTCA Ha CTeHKaAX BIA raauuia. Kornyectno Genel 8 cpemnem cocrassaer oko 20 M1 B CyTKH (npHMepHo B 10 pas Bune, ¥em B HopMe). HeKoropsie Gos- sue orsetaor noximunch AMNCKOM(opT, 4yBCTBO sya H ACKEHHA mune Giana, Neetne tees Tipu oGbextHBHom o6cnenoBa- Poona Roauto OOpaNaTs ocoGoe BiwanHeE Ha CocTORIHE Ha- Ocosennoerno BB anaseren orcyrerane npwnnee eaten rcYTCTBHe MPH3HaKOR BOCATeHHA qurbntbix Ko1eTOK, Hast ‘TpHxoMonad, percrsyiouuntii 9ll enox saaraauma. CANsHcTas OGon0%K, Coren ip posonoro sera. KOABTOCKOMHNECKAR KAPTHNA Rapa. cepnayeres naminien ACTOXHYeCKEX HOMeHEHIE “Termocmua, HaGoree MitpopéaTsiBHsIM 1260P3TopHiy Nnnarnoctiixit BB #B4ReTCA OOHAPYREHHE B MASKAX, OK panterntx no Tpawy, KmoveDsIx KAeTOK (CTYIENHB EETOR am Feana puaranHa, NOKPHITBIX HeOOABUINA FPaMOTPHUATE-TbABI- ay maaoaxastt), TOT noKasarem» pbiaBineres y 94,2% manwen wok, B TO BEM! KAK Y 3HOPOBLIX KEMULI OH He OMpeneaseTes, Tloannenne repvenbik x1e70K pit BB MOxHO CBAIATS C ACTpO= qpiseckuain HaMeneHHAMH B causucToii oGo104Ke Baarannmta, ronsiuienHbi cayMuinaunen onMTesIIA H YCHLIeNHO! anresttelt TpaMorpHilaresbIbIX MIKKPOOPraHHIaMOw XK 9THM KaTeTKaM. Bombe oe stiauene n awarnioctuke BB weit pH-MerpHa anamorecr, Oun orniocatea K CKPHINHTOBKIM MeTOaaM HCCACAOBAHMA, HX. MOXHO HCHOMBAOBAT HeHOCpEICTBEHHO BO BPeMa aMGy.1aTOPHO- ro npiena. ¥ Gombbix pH mraraanuta Bcera HaxXOANTCA B Mpene- sax oF 3,0 20 7,5. Ammuorect monoxtTeren B 83,1% cay4aes (no- apienue Hal yeILIeHHe HenpHsITHOrO samlaxa HNO; PBIOEi — 130- IMTpliza nip cMeuIBANIIIN B PABHIX KOAHYECTBAX CoMePAHMOTO puarammta 1 10% pacTbopa rHApOoKHCH KaIMa). Jlevenue. Npuntenaerea abyxaTannbtit MeTOx eYeHH, OCHOR- NOM MIpHMUTOM KOTOpOTO ABARETCA COsMAHHE ONTHMANBHBIX qpuanostornueckix yenoanii BraraMMHoli cpetb HM BOCCTAHORAe- nite muKkpo6Mouenosa. Ha nepeom smane Aevenua nponoaMTes MecTHas arriGakrepna.ibiias Teparita (MeTpOHHUtaso.t, KaMHLANG- Um, epOMMUETHH 1 Ap.), HasHaaioTeA MOMOYNAA KHCHOTA 218 crisxenita pH, siaseporepanisi, no noKasaHiisiM ~ HMMYHOKOPPeK- Topdt, SCTPOTeHBI, MHTHOHTOPA MpOCTarMaHAHHOB MW aHTHEHCTA Minnie npenaparst. Tpit Hani syfa, KKM, Goxeli mpHMe- nawotca MecToaHectesnpyiouue npenaparet. Bmopow aman mipe- aycMarpinaer ucromsonaine GaxtepHiitarx GHOAOrHYECKHX 1Ipe- Maparos: aaxroGaxtepinis, anuaxa, Oicpayaxrepia, 6x MecTHo m1 inavenve oc mpenaparos Ges meena oe Geenepenexruoio no-sa Buipaxennoil KOHYpeMTMGCTH MESIDE anne pouratisseie 2-228 eHHOi KOHKYpeHTHOCTH Mex/LY rua. To cyTH, BBeMeHHE BO BNIAraAH (orexa, rimepewnt) ¢7 MeTOOM 8 ~_ — , ue sxuBHIX KYABTYP MONOYHO-KHCABIX GaxTepHit sBnserca "tpane- ve graugteit” 9THX MHKPOOPTaHHaMOB, 1 HX "TPIOKHBAeMOCTS” BO (iMproat saplicHT OT COCTOSI MECTHOTO HMMYHITETA, O1UOKDHI- Noro cratyca i HATHA cpaxTopoB pHICKa. ‘Judoyepeugum — pocriasiene caHsHeTO!t OGonoyKH Kanata iueiten sarki. Imuonocwueckien axmopon passirria saGonesanna Maimerea NpOHMKHOBEHHE B KANAM UEKI MATKH CTadpILTOKOKKOB, KUIICUHON TANOUKM, IHTEPOKOKKOB, a TAKIKE pa3- Bosnuxtonennto saGonenanis cnoco6ersyior avpatinrrsie paapaisbt WelIK MATKH. MHoc.te ponoB, onywleNte NO- Nopnix opravion, pasapaenve elikit MarKHX XHMUMECKHMEE H/HLIH vrexanureckuit (BMC) CpesicT#astit, xponmieckie BoctAUtTete- ste npotteccb! MATKH, MpIULaTKoB, BrIaramuta. B sWArHOCTHKE aN eli naToOTUHt BENYIUCE MECTO MpHHAILIEXHT MpoveTeM0 KO. nocKOnItit KAK CKPHHWITY B OGCseTOBANHH 2keHULH, a TAIOKE OM peaenenitio MUKpodOp HI, C BOaMOXKHBIM BbIABACHHEM BOIByAN- reas. Jlevenue ctpourca io aTHONATOreHeTHMECKOMY MPHHUNNY, C ucnosnsonaHHest MeCTHBIX 1 OGUUIX mpoueayp. IpuMensoT an- quGaxrepilanbible KPeMbI HC BrIArAAHULHBTE WaPHKM, crpHHUeBa- fiat anrucentHkamit. BUYTpb Hastavaior anTHOOTHKH IAPOKO- to enexrpa selicTBna (orbuioKeHt, AOKCHUMIKANH, MakPO-BL) HUI hnperiaparat ¢ yHeTOM HyBCTAHTeNbHOCTH MuKPod-!OpHt, MPOBOANT- ca nporpiuiaxrinka Kanuutoaa (ststKoMaKc). [pit savanyBuleNcA npoulecce stevenua # GeaycneumNocTH KoHCepBaTHBuO!t Tepariit ApHMensMOT sMaTepMoaKCUHIHWO HH KpHOdecTpyKUMO NeltKH MaTKH, O6bI'MHO OMHOBPeMeHHO C e4eHHeM NceBLOIpOsHIH. Bapmoaunum — wocnanenue Gonbunx 2xenes mpesiwepia B7a- ranula, pachosoxenntix B HyDKHeHt TPeTH GommUmHX MoAOBDIX ry6. Dmuonoeug: puigviBaeTca saille HecTopoobpasyioul4MH. aslaopoba- Mil, FOHOKOKKaMH HULL CTa>ILIOKOKKAMH, Pee CTPETITOKOKKAMH, kuttzenoii rranowKoil, TpuxXoMoNaloli, a TaIoKe cMeUTaNHoit HHKpeK- CTPeNTOKOKKOB, HHYHBIX. BUPYCOB. uneit. BaGonevanne Obinaer KaK nepeuuneL, TaK H emopUNnibis, BOS- HUKas B peaysbraTe MPOHUKHOBEHHA B BHIBOAHO! MPOTOK 2es1e3bl cracpIOKOKKOR, CTPEMTOKOKKOB, FOHOKOKKOB, KHIIeYHOIt 1a104- kat, Bocnianrensuptit Mpouecc M OTEK aBHOro BEIBOAHOTO POTST —_ faa oKa «Kee3bI (xananunysum) MpenaATCTBYIOT OTTORY Cexperta ix koropsili sacTamBacTcn nnc>suspyetca. Ito octpetit roy, iy abeyecc (‘peTMOH¥a) BOSHHKACT pit exon, a eae iiecca Ha OKPYZKarouwse TRAN Jloxxetbie AGCUECCEI YaCTO BeKpEing. fore casionporigBobHo ¢ oMfopoxnennest rnofinnxa. pn xymy, ponann ocTporo mipowecca, Heno”HoM onopoxHeHHn 114 crarounom oTTOKe BOSHMKAeT KHCTA GapronMHosoit *ereSHi (Kye. foarioe o6pasonanne 6€9 B “AWMNITBI CKAIOHHBL K PeuHANBAM. Kaunuueckan kapmuna. Kaxo6vt 1a CHABHBIE Goan B o6nacty aynsput ronaene 8 toiopofl ryGe y BXOMA HO Harane Onyx veaniavoro GoslesteNHoro OGpasonanuna BETHHHOH 10 pasMepon kypinioro sit, Meuraxouero XOHTE; NOBEIINEHHE TeMMepATYH thee nexoworanne. VicTHnnbiit aGcuece ACT KAMHHYECKYIO Kapri \ aexenoro saGonenarina (peaKne GoM, YBeANYEHHE 1 Goneaten. HOCTD MaXOBKIX AUMAATHECKHX Y310B, TOBBIILEHHe TeMTIepATYpsl ea 10 39-40 °C). Augrpepenyuaronas duaenocmuxa. Kuery Gaproannonoit #e- ‘eabl, BHe Boctanenus, creayeT AuMcpdepentspoBATs OT KHCTBL TaprHeposa xona, KoTopam pacniostaraeTca B cpeaweli ie1t Bepxnell TPeTH MaIBIX TIOTORKIX FY H He COMPOBOAMACTCA ABCHHAMIT BOC naxerua. Tpi namin pocnamrexbuoit peaxiunnt ~ ¢ cbypyHKy- tom Goapwioii nosoBoii ry6u (pacno.araetca O6br4HO Goxee NO- BepxHocTHo Ht niKorza we OsiRaeT TaKoii Bem KAK aGcuecc); raterolt npononsioro nporoKa npiaaxa nein (KucTa FaprHe- ofa Sa onpeenneen ne soe pet Gombumix nox0Bex . pH Heil MoxHO MoU it De Cae ao nea sienna TKaHeli, OKpUIB: - ool ese (sapanrepna taorioets, Gyrpucnocr, Eeaboneae tceT, moras nevazenenne anyenhe A wad revenue. B navanrnoii cmaduu ocrp kyinposaiina socnanurexsuoro npotreces romans aa Saranoe aesene (pene eee arizasiast: nysuips co anno, oGerbomrernane a. M; o6ex6o.THBaLoUUTe CperCTBa). Tipu naenoen mu u Noserenue dy puroxmyalgute MOKaxaHO nexpprrue a6- 1e3bI, voit a6cuecc. Meran lyenun THOS B KEES, 10 th ia ocnamirresbHbIX mpoaBtennit). Bapro. euecca, BBETEHUE B HOAOCTh OHOPOAHEHHOLO FHoFiMHKA TypyHAb! cee pTOHUINECKIDN PACTBOPOM XIODHTE arp. BexpeiTie aGe- c mime ppeationTirtesitee MPOHSBORTS ‘no Hapy:kuioii NoBepxtto- wey Gobuolt mOOBO!E ryGoi, WFOGM Ne sHKpMUNPoDaT BaaraAN ca Perenuornias nitcTa Gaprosionel HKENEIHL TOMIEKHT XH wprnecKoMy JeweHio (osinyuieninio ¢ Tosi. yatatenites Kart- B nmmaewiom xooanton mepHtoze. K MerosaMt XMPYP- rennet oTHOCHTCA H MapcyIHAsrgauts (COsAKUE HO- ro erBepCTHA BbIBOAHOTO MPOTOKA), JaKMOYAIOUIAA- fen CTeHKI BCKDBITO!I KENEBDL K KPASM KOK poro Hapy2kHo! ca p osmumBanntt KPa oit pantbl. BOCITAAMTEABHDBIE 3ABOAEBAHHS BEPXHETO OTAEAA 2KEHCKUX TIOAOBBIX OPTAHOB Pa qouer Wann oe arjerestnibiM saGOsIEBAMILEM BEPXHETO OTA HOAOBHIS gpranon rant nocranitrenbIrint Sa60senauiaNy OPFaNCH wamnoro opranpoeiry wocriaicnie axvtoMeTpHat (NHOMeTPHIA), MATOS AS Toyo. auesnikon Ht Tagonoit Oprouwarst, Haom7posayne nocriane- ‘vrux opranop rro.1onoro Tpakra B KAHIYECKOHE MPARTHKe tare KaK nce Orit MpeACTABALAIOT estHHtyI0 cpyHK- Dr aa6omenaltHs BbISBIBAIOT TOWOKOKKS, nem, cTpenTOKOKKIR, CTApITOKOKKM, NHKOTLTIM DI, KIN aan raiouKa, aiTepoKOKKH, MpoTeit. BonbusaA post B HX BOSHIK: vremenn HpHHasLIeXKHT axaapooHbim Bor6yauTesiast (GakTepON en, Kak ripapii1o, socrianMrenbuble Mpouecc! BuIaeIBAeT CME tan MuKpocpaopa. BoaGysuren pocttamTesTbIbIx sa6osienanitii tame pero sauocaTca HaBHe (akgorenHas wipeKiUe): PRE NA° Gmoaawotca npoueccet, MPOncKoxsteHHte KOTOPHIX CBAGAIO C TPO HKHOBeHHeM MHKPOGOB M3 KUUIEHHKA HAH sIpyTHx O4arOB UH (bexun B opraniiome wenuusitb (oHaOrenaA WucpeRUs). 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Ms noxasareneii HecneumuvecKoii saumTbt cmenyeT onpeaeant» carouttrapnyi axrusxocrs veiiKkoumton. Jn yera- Se eer aa 9THOROTHN 3aG01eBAHHA HCHOABSYIOT cage iabiynaipepuerea Meroast. [pit nonospe- er omre Ncnoabaylor yabrpasByKoBOe noone sa eaaee ae ott Norn open mamyeonoe wocassaa KOMIIIOTePHYIO TO ‘sa, slanapocKonmo. Ip oTeyTeTBsH BOSMOXHOCTH BLINOMEHHA JamapOCKONMH NPOMSBORAT MYHKLNIO ‘ Sproumolt nonocTH Yepes aannnii cBon Baran 1a. 2 bt ACYCHHA BOCHAAHTCABHBIX 3a60ACBaHHA Mpusuum pepxHero OTACAA MOAOBBIX OPFaHOB KeMIIMHD! Tipu suixearennit octporo nocnianenin Goabiaa noma Gort rocriraanampowana B crauuionap, Fe efi oGecrieunpatoT e4e6H0- sae ienbitit pextiN CO CTpOrHN coGaoreHies dsivecKoro oxPMomuronaabitoro TioKoR. HaaHayaor mocresbubilt pexun, 163 Mor moracrpautottyio o6ziact» (0 2 vaca c Mepepsisanst 30 yt mi nen reaene 1-2 cYT), uauanyro avery. Twrarenbwo nest 3 JemrecinocTDto KIIESHHKG, Mit HeOONOMIMOCTH HasHaNaior yen se oancTuTeTbIIbIe KHISMBI. Bosbabin foneswnt mperapars 6po- ar ureprranb, cesaTHBHbte cpescTBa. IruoMaroreHteTHwecKOe Ae wave nantiteHTOK ¢ ROCTUTHTENDHDIMIE saGoAIeRAMANI OpraHion yaaa mpexycMaTpngaer MpuMeneHHe Kak KoHCepBaTHBHoil Tepa- Jun, Tak H CBOEBPEMEHHOTO XHPYPIUMECKOTO AeeHHA. Koxcepsa- sn ge JeucHHTe OCTpHIX BOCTLaHTEABHDIX daGorenanut BepXwe- vonnesta TO.IOBEIX OPFaHOB MPOROANTCA KOMILIEKCHO H BKUHONA- ree eeGa: aNrTHGAKTEPHANBHYIO 1 ACTOKCHKALOHHY!O TEpaTio, oppextiio HapyuieHtiit o6stena peuecTB; aNTuKOaTY.UNITHYIO Te panto; uaimyntorepamito; cistiroMariecky¥ Tepario “inmuGaxmepuanrnaa mepanus. TIOCKOsDKY MIKPOOHEAI pak- op irpaet peulaiomty!o pou B ocrpoli cranun BoctianeHiys, ompe- Rensiouiell B 9TOT HepHOn saGoenanns ABARETCA aHTHGAKTEPH” uiuiiaa Tepania, B repabie cYTKH npeGstnariHs GoaBHOll B CTaLLHO- nape, Korda eulle OTCYTCTBYIOT sraGoparopHbie AawHBIe © Xapakrepe posGyautrens Hero HyBcTBITeNbHOCTH|K orpesenenHoMy aNTH6n- OTHKY, Ip HagHaweHIMH mpenapaton YMHETDIBAIOT MPeITOAOH- Tenenvio sTHOsIOTHIO saGonenann, 3a nocaeanwe roast SXpipeKTu9- Hoctb seveHtHst TA>KENBIX (POPM THOMHO-BOCTAATENBHEIX OCHO nenuit pospocaa npy HcrioabaopaHun COBpeMeHHLIX aNTHOMOTH- ov umpoxoro cnlektpa, yuurTbiBas cMeuaninbit xapakrep Hdek- i HE saHacTyio HeBOSMOKHOCTS MHKKPOGHOTOFHECKOFO MOHHTO: punra, He noc.resHto1 post urpaeT 1 cbapakoakonomnveckuit adibexer (cooTHomente Hera: kaxectBo). Hzteanbro noAXOHT pe napat odploKcHH, OTHOCAULHiiCA K TPyHTe OKCHXHHOOHOD, B03 aelicrayiomuit KaK Wa rpaMMt TlosoxkHTesTbHKLe, OTPHUATETDUnE MUKpoopraruaMbr, Tak M Ha XmaMnUtit, MHKON2IM rapawepet. Umelouutii mpocroil pexsis oaHpoBaHtHA 1 OTHOCHTEMbHO AOCTY 13+ ommetn Benonetayere ENE AUTHGHOEIKON Nepey 7. ay ere a ypenestetHeN AITHGHOTHKOYPANN. egy aio ppaanieriont MPH anim GnogunpTepar MeCTHOLO 146 wera KUNAUAANIKON HEOONCAHN HECACROnG remo> W_YpoKytbTyPs & TAKE NAAAMEHHE HPOTHBOLPUKOHOK Nruxoatae, [ptt ROATHKHORCHHH OAMEORIYPIT Hoya, npevapara % pr earetentatl HepeeMOrP 08 HPHMEHBICNIIX AUTHOHOTHKOR @ jwerost Hx MepHONA HOAYPACHAA, av cxena A (e ucnansoaanuent Yeparocnopunod 2-20 noKarenun): nedporeran 2 r n/nentto (adece W danee dawimncn cy npenapanoa) Kassie 12 4acow 1A HepOKeHTTUL 2 F /ueIO Kan tae 6 acon WIN HecpypoKcut 25-6 F B/neMKO KaxADIE 8 acon + Sroxcinuxmt 100 str H/nCHHO HIN Mepoparbnto KarKABIE 12 Yacon, Yuutrninas, 40 nipyaHouttoe BHeseHHe Mpenapaton cossano ¢ Gosenninit OMLYIMEHIUANIH, HORCHIMIGINE CHIeYeT HaaHataTE ne pOPAIbNO, KOFAA 9TO HOSMOKHO, AWE CCAM MALWeNTKA HaxomUTes cramuionape. Hepopabitoe 1 BIYTpHBeIOe JteveNMe AOKCHLUNK- ANHON O6sIUIAET OAMHAKOBO! GuOAOCTYNHIOCTHIO, TIpH HeOBxO; MOcTH BLYTPHBEHHOFO HAgHAMENH HCHONDSOBAUHE JHOKANHA WU APYrHX Goicrpo sAelteTRYIOULHX MecTHBIX anecteTHKOB, rena- pita 11301 creposaon, a TaIOKe NPOsUIEMHE Benet suyaitN Mo- CT YMENbUNNITD 1MKpysHOMDIE OCAOKHEHUs. FapenTeparsnoe sevene Moxker ObiTb tIpekpailerio Yepes 24 Yaca Hocse TOTO, KaK Y HaWMeNTKH NosMIOcD KsUMMECKOE YyHUIeHHe, a Nepopartbtoe aevenne HoKcuumemnom (100 str 2 pasa p nents) LOMKHO Oot MponosnKeHo 20 14 jel. Hpu nant TyGooRapHatHoro abc uecea caetyeT HCHOABIOBAT KANHAAMMILH WIM MeTpOHHAAIOA ¢ AOKCMIMI.TINNOM JU1H NPOROMKENMA Never - WHkaIIH, TaK KaK 970 cnocoberBy siebeeiauy nek yer Goxree axcpekTuBHomy mepe- HiTeaeli, BkOWas anaapobut. Kit eM uetboxcutHn Ham uedoreran, “ = * Cxema Bi: wamiaminuin 900 str n/menmo KarxnDe 8 wacon + peuraviniint yaapiast oan p/nenno WK B/stuumedno (2 sr/Kr traf), a-anrest rowulepaRinaiouast tos (1,5 M/k) KarkAble seein, {lapenrepabioe Jewentne MoxkeT Obit» mpepsanto epes 4 aca ine, 1 aurea epexONT 1a Hepopatblioe AeveHHe AOKCH- yy tiom Ho 100 MF Ana pas naets, OGUAA NpOOARHTEAbMOCTS tatonut nospeita cocranaurr 14 zutcl. IIpH tyGoonapuambitix o6- eomnnis Ax MpOAOMXCHIA NENEHUST MONO HeHOAKIORSTD pital, a We LOKCHIIIIN, TAK KAK OM Gostee ofpexTunen poruis aMtaopoGub4x suAKPoopralntaMoD. "AsrepitiTHDUbIe CXMB HlapeltTepatbHoro sAeeHHst: OCbiIOK- cau (mopxunonon) 400 mr B/weno Karsabte 12 wacos + MetpO- fumon 500 MF B/BENHO KaKaE B skAcow HTH ANTHALLAAI/Cy-nb- Gaxram 31 p/ueIMO KAKALIE G Hacon + AOKeHIUKKTH 100 sir HepO- pani HH B/uenHO KarkaWe 12 acon HM uINpodp-zoKeatsAH 200 tie p/senno Kaxkabie 12 acon + AoKenuMtUH 100 Mr nepopasHo jut B/scuno Kaxkute 12 Yacos + Merpontiaasoa 500 Mr B/penHo Kaxapie 8 4acoB. Cxema asminiuuuiinnt/cyrGaKram ¢ AOKCHIMKZINHOM O6aqaeT xopouuat oqbextowt 8 otHomennt N.gonorthoeae 1t C.trachomatis, a TaKaxe anlaapo6on 1 Gbula a¢xpeKTHBHA y NaNHeHTOK c TyGoOBa- piianbinim aGceccom. OGa BiyTpuBeHHBIX Mpertapata ~ o¢x0K- calli 1 upodroKcaMH GoLUTH HayseHDL KAK Mpenapatss 2.1 Monorepanuu. C yYeTOM UMeIOWLIXeH AaHHbIX 0 Mamoa<>epeKTHB- HoM aeiicran winpodtoKcanHa Ha C.trachomatis pexomeny- etest B pyTININOM HopsAKe 1OGaBAATD K JeYeNINO AOKCHAUETI Tlockobky ykasantble XHMO.TONDI AKTHBHLL TOsIDKO MOTH YaCTHL anagpo6on, B KaxKIIyIO CXeMY CJe/eT BKOMATh MeTpOHHUIasON. Cymectayer mao jartnbix oTiocttTetbHO HeMesLTeHHBIX H OT- AAEINBIX HEXORON sICMeHHA KAK pH NapenteparbHOM, Tak Ht MpHt Tepopanbiiom pexime. [Ipumenenne cateayiouUrx xen oGecTedt- baer anrtiauiKpo6nioe Aejicrae npoTHB HaNtGoxee pactpocrpamten- HbIX STHOTOrHYeCKHX arentos B3OMT. TlauentoK, y KoTOpEIx pW nepopanoiiom event He naGmonacren YaysuIeHs B TeHe- ine 72 yacon, HeoGxoNMO HOBTOPHO OGeREAOBATE JIA HOATBE- ARMENIA JMATHOSA H HagHAuNTH UMt MapeHtteparbHoe jeweHMte B AMGyLATOPHBIX HIM CTALMOHAPHBIX YCOBMAX. 15~~ ..}» @—§ noxcun 400 mr 2 pasa B eb B TeveHHe 14 nue}; 4 merponnaazon 500 Mr nepopabHo 2 pasa B eH» BTevenHe 14 neji, Tlepopanbubiit orpxoKcauint, TpHMensioumiica B KaNeCTBE Mong, repanint, agypextiwer nporHe N. gonorrhoea s« C.trachomatis. CQuaxo, mpinislag Bo BHUMAHHe, ITO OcpAOKCALMH BCC TAK ne. cataroano apypexTHBelt HPOTHB a¥aaPo008, HEOGXORINO 1OGap- arene MeTpOHBti1a30.12. Crema B (¢ ucnonssosanuen 4eipanocnopuos 3-20 noxonenua): ued>tpuaxcon 250 mr B/sbiuseso OAHOKPATHO WH uecboxeutnn 2r B/mpmuewio + npobeneuwt 1 F repopastbHo OAHOKpaTHO O7Ho- fpewtenno Wi Apyroit napenTepatoubiii werbastocHopHHt 3-r0 no- xomensa (tanpuMmep, HepTHSOKCHM, HepoTaKcHM) + AOKCHILMK- inn 100 Mr nepopatbto 2 pasa p Tevenme 14 aneit (neromLsoBaTE bry cxemy C oftiofl 13 sbuuieyKasannbtx cxeM). Onrrustanbnet wit Gop nedbanocnopiiia LIA STOTO PEKHMa He OM|peeTeH, B TO Bpenta eae uecbOKCHIt AKTHBEH MPOTHB Go.tbIMIeTO KOAMYECTHA BHLAOD ata spo6os, uedrpHAKcoH oGIaaeT Gostee wEICOKOlt aqxbeKTuBHOCTEIO potas N.gonorrhocae. Kanmmueckwe HemmiTaiiis noKagatt, 40 oawoKpatias jlosa uedoKcuTHna Avanerca apeKtuoHolt AA hoayuenia Guictporo KaunuyecKoro adibexta y XENI c B3OMT, omtiako TeopeTHuecKHe AaHMHbIe YKaabIBAIOT ta HeoGxo- AuMoctb qoGannenust Merponmmasona. Merpoumason Gyser TaK- 2xe adipexrueno sieunTs 6akrepHanbussit BarHHo3, KOTopBIit 4acTo hmeetea y 2kenmun ¢ B3OMT, Y natwterrtox, nomyyarouurx epo- pasbioe HAH NapeHtTepatbHoe eemste sHaUHTeAbHOe KAMHIIEC- koe yayuurenme (CHIDKeHMe Temneparypbl, YMeHBIIeHMe HartpsKe- Huta MBI OpIOUMNO! CTEHKH, YMeHbUIeHHe GonesHeHHocTH MH hasibiaiwiH 80 BpeMa OGcHeOBAMIA MaTKH HM MIpHAaTKOB) AOIKHO naGmogateca B TeveHwe 3-x jueii or HaYana aeyeHHa. TauneHT- KaM, Y KOTOpbIX TaKoro yayYUleHHA He HaGmogaetca, TpebyeTca yrountenue ANarHosa H pM 1eo6XOAMMOCTH XUPYPrH4ECKOE BMe- iateabcrpo. C uenbio peaGumrrannn, mpexpaittenna Bocaire ss HoH undbHABTpaLitM MaToUHDIX Tpy6 M AMYHHKoB, a TaKoKe 610KA- Bis Nps anebebaieeise npoueccos HM OBYAALMM peKOMeHAyeTCA ee PENH Hi KOMOMHHPO- pallenrHBos He Meee 3-4 mecattes. Cxena A: ob: 16 Jlemoxcuxayuonnas mepanua u koppexuus napywenuit o6mena geuecmo ~ 970 OANH H3 BAKUEHUIX KOMTONEHTOD JeveNHA, Ha- papsesbiit Ha paopoib MaroaorHvecKOrO Kpyra npHymHO-caea- crneHHBIX BIAUMOOTHOWEHNt, BOSHHKAIOUUNX pH THOIiMO-oC Girreabiisix sa6oenantnax. Manectuo, 470 97H saGoncwania co- rpovoxaiores HapywleHveM BCex BiLIOS oGsea vewtecrD, Bue: sprites GoAbIwOrO KOAIMCCTBA KUAKOCTH; HOOHKAIOT sNeGaaNe sex TpOsINITOB, MCTAGOINECKHIt asLA03, NOYeNHO-neYeHouNaA Meaocrarosnoct. AAeKBATHIA KOPPeKUNA BUIABCHHDIX Hapyie- jutit MPOBOAMTCA COBMECTHO C Bpaamul-pearmmaronoramm, [lpi fiponesentiit ETOKCHKALHN H KOPPEKUMH BoAHO-2AeKrpOAITHO- wpeouctia cnenyet HaGerath ABYX Kpalinnx cocroamuit: wexocTa- rpantoro BoemeMiisl KNAKOCTIL Ht runepriaparaun oprartaMa. C eowwio HCKINONEHII YKAIAIIIX OUINGOK HeOGXOANMO KOHrTpO.AH- ponarb KoJNWECTDO HUEEHHOMT AUAKOCTH HaBHE (MITBE, MHA, poaeGuibie pacTBOPbl) M BBILEICHHOM ¢ MONOH H APyTHMH HyTAMI. Pacuer BRegeHHOi AHAKOCTHL AOZTAKeH GIT HHLLUIBMAYAATBHBIM ¢ yaetos ykagantmbix mlapamerpon it cocoanut GoasHoit. Mpansits- haa unebyaMontasl TepallHs IIpH eveHH4M OCTPLIX BocraAN TEND HbIx HM FHOHHO-BOCTAAMTCAbHbIX saGonepannit He MeHee BaxkHa, treat Hagnauenne auTHOMoTHKon. Kamiunveckit omit noKasbIBa- et, 470 GonbHtaa co craGsIbHOML reMoAMMaMuKOit MPH aneKBaTHOM pocnonmenun OLLK settee Hogwepxkerta paswiTiio WHPKYsATOp- tiuix pacerpoiicTs M nosHiKHOBeNtHIO cenTTHYeCKOTO WOKA. OcHoB~ HIM KAMHUMECKUMA npHHaKaMnH BoccraHoBmensia OL, HK PHAALAH THTOBOTeMHK sBAAIOTCA oKagaTemH LLB/L (60-100 soe oa. cr.), anypes (once 30 1/4 Gea npHMentenHa ZHyPeTHKOB), Yayunlienne MKPOUMpKY.AAUNN (1BeT KOXHBIX TOKPOBOB H MP.) Coraacno coppeMenitbim mpestcTaBieHnaM CrexyeT BBOANTS Kak Kosnonaubie (ILIAaMa, aIbOyMIH, HHBKOMONEKY.ApHBte WeKCTPA- nui), TaK M KpHerasstouAnste pacTBopst (0.9% pactBop XAOpHAa narpu) c pacuerom Ha 1 Kr Macchi Teva GoabHoli. Hs Kpucraio~ Manerx pactsopos mpuMensioT Ha0TORMYECKHTt pacTBOp HaxPIE utopia, 10 1 5% pacraop rroKosts, pacrsop Pusirep-JToKKa, nom Honubie pacroopst. Hs KontonHbix pacTBopoB HCIONDIyIOT HH comonexyaapnbie excrpanbt. CatesyeT rloaepkHyTb, 470 o6uLee Kommuectso AeKcrpaxos He aosKHo mpesbimraT» 800-1200 s1/¢ ‘crak rocyaapcTeennull cena yannagen et HAY'/HAs| BABMIMOTEKA yueoubin DOHA> — = Gurrounoe 1x BpeAeHHe MORET CTOCOBCTBOBATS pasy, anateso. Bombuble € CENTHYECKHMH gy. Tie esa, sueGoMDINHOTD AGOPTA BMECTE C PNKOCTSIO Tepa. ao gunressHoe KOMIYECTRO A7CKTPOMITOB. B MPOUECCE Aeveryy vor mnaer HeoGxoasisocT KOTHNECTBEHHOFO PACHeTa BoexeHyg pcnounbix aeKTpOaNTOB ~ HaTPHA, KATH, KATBLBIA H X7Opa, but nponeaeniia jconNTOKCHKanWONNOT Tepam MIpoxg enonbayior NeToaMiky apo6woro ¢opcHpoBaHHOrO AUtypesa C no. vryuentest sa cytKnt 3000-4000 si Most. TOCKOMBKY Mpa cen. uecknx cocTOANHAX Rceria HabmONAeTCA THNONpOTeHHesiA nerencrane tlapyureniit Ge-1KOPOTO CHHTESA, a TaOKe M3-sa'NoBss- trenoro pacnaza Gerkon 1 HMcBILICiICH KPOBONOTepH, BBeReHHE GexKoubix nperiapaton ABAAcTCH OOssaTeAbMMIM (Lassa, aTbby- un, nporenn). TIpi pacnpocrpanenibix BocnamHTeAbHLEx mIpo- tueccax, nembnnonlepHiTomliTe, epsTOHtTe y GoxbIsX BosMoxtE TpoMGooNGomIMecKHe OCIOKHCHHA, & TAKE pasBirTHe CHHLApOMA AncceMMitiposaniioro BlytpHcocyaNcroro cHepremwannn (JBC). B nacroauee apes oauna 113 nepaeix rtpiattaxon JBC cairraer- ca TpomGonnTonenna, Ciupkenne KoANMecTBa TpPoMGoLUTOB 20 150x10/n aBaneTca MHNIMYMOM, KOTOpHIi He NpHBOANT K FNO- KoaryJMMONHOMY KpoBoTeventio, B npaxTiKke OMperenenne tpo- TpowOimnonoro 1nyteKca, KonNYecTRA TPOMGoILNTOR, ypoBHs bi6- pinorena, ¢bu6pHt-MonoNepos i BpeMentit CbeprbiBatita KPoBIt OkASIBACTCH MOCTATONNBIM JI CHoeBpeMeNHOll ANArHOCTHKH ABC. [na npodpunaxtixn JBC 1 npH HeaHaynTerBHOM wameHe- tnt rasan Tecron naaHa¥aeret renapan no 5000 EJ ax: nn oe mea eptea oes CBeprbInaHitA KPOBI B Mpenenax B12 sa (vo Zi Vai), [eoremanocrrenapaonepami sas coctapaset 3-5 aneii, Tenapan Se eae teed rope Crone eee nen MHTeABHO yMeHbuIaTca. JleweHt cntapowta JIBC, ocoGennio coan 8 THRCABIX CAYYASX, ABMACTCA OCHE Husynomepanua. 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