CHRONIC SPECIFIC SURGICAL INFECTION

The power particular surgical an infection is brought on by particular brokers and has a imprecise medical course. Surgical tuberculosis, actinomycosis, bone-joint syphilis, lepra, brucellosis, tularemia, leishmaniosis belong to the power particular surgical an infection. All these ailments are characterised by improvement of particular granulomas.

SURGICAL TUBERCULOSIS

Tuberculosis of joints and bones, tuberculosis of lymph nodes, serous cavities, intestines, urine and genitals tracts, and in addition some types of pulmonary tuberculosis belong to the group of surgical tuberculosis. At remedy of those types the surgical technique is utilized.

Aetiology and pathogenesis. The agent of tuberculosis is Bacillus tuberculosis.

An infection happens via respiratory methods by the air-drop method, via the digestive tract by the contaminated meat-milk merchandise, by swallowing sputum (self-infection), via the broken pores and skin, mucous, ulcers, decubitus, contaminated placenta.

Particular granuloma (tubercular tubercle) types as the results of infecting, during which a selected caseosis (curdle) necrosis takes place in future. Tubercular tubercles be part of and type a tubercular focus, during which caseous disintegration of tissue happens or salts of calcium deposit and the connecting tissue grows. If resistance of an organism is excessive, incapsulating of the main target takes place. With low resistance of an organism the Bacillus tuberculosis can unfold by contactic, lymphatic, haematogenic methods. The lymph nodes are the essential barrier on the way in which of an infection spreading. There are big packages of the lymph nodes. Haematogenic method of the tubercular course of generalization leads to formation of the secondary foci within the distant organs and tissues, which is typical for surgical tuberculosis.

Tuberculosis of Bones and Joints

Aged folks undergo from tuberculosis of bones and joints, largely with damage to the thoraco-lumbar a part of the spinal twine, hip and knee joints.

Patho-anatomic image. The bone tuberculosis is characterised by prevalence of a selected osteomyelitis (osteitis), a excessive diploma of a sensitization and allergization of the affected person. Metaphysis and epiphysis of the tubular bones with caseous disintegration of tissue are largely affected. The cavities with tender sequestrations type within the bone (a bit of melting sugar), and irritation response takes place within the surrounding tissues.

The first osteitis (pre-arthritis type) and the secondary arthritis (arthritis type) with the involvement of joint cavity are distinguished within the bone tuberculosis.

With tubercular harm to vertebrae (tubercular spondylitis) the spongy substance of vertebrae is topic to quick caseous necrotic disintegration with formation of chilly abscess. A destroyed vertebra covers the underlaying one, and the hump types. The chilly abscess can unfold right down to inguinal area and seems as protuberance and swelling within the inguinal area, within the area of the higher third of the anterior floor of the hip. The pores and skin color above is common, native temperature is regular. On the abscess puncture Micobacteria Tuberculosis are revealed in its contents.

With tuberculosis of joints the method includes the adjoining spongy layer of the bone. Synovial, fungous bone types of an articulate tuberculosis are distinguished.

The synovial type is characterised by elevated exudation from the synovial membranes of the joint which may resolve utterly or fibrin deposit takes place, that leads to restriction of actions in a joint.

The fungous type arises at development of granulation tissue from the synovial membranes, which fills the joint cavity, grows into the joint’s capsule, surrounding tissue, the bone. The joint enlarges. The pores and skin above it’s pale, skinny. The joint’s slit narrows.

The bone type of surgical tuberculosis seems as major osteitis in opposition to a background of reactive irritation of the joint of the infiltrative character and is accompanied with rising contracture, improvement of fistulae, pathological dislocations, secondary an infection.

Medical image. With surgical tuberculosis native signs are noticed: pains, restriction of operate, deformation of the injured extremities or infringement of bearing, atrophy of muscle groups, which seem very long time after the second of infecting and depend upon reactivity of an organism, age of the affected person, localization of the main target.

The ache is the results of irritation of the nerve endings with inflammatory infiltration, or poisonous affect. The ache is fixed or alternating, will increase at loading on the zone of harm.

Restriction of operate of the injured extremity or the vertebral column are noticed on the preliminary stage of improvement of surgical tuberculosis as sparing of the injured extremity or the vertebral column at tubercular spondylitis. The compelled place of the extremity results in regular articulate contractions.

Restriction of operate, intoxication outcome within the infringement of nerve trophism: muscular atrophy develop, sclerosis of the pores and skin and subcutaneous tissue, oedema. The pores and skin fold with the subcutaneous tissue on the facet of damage is thicker (the Alexandrov’s symptom).

Deformation within the injured extremity, adjustments of joint’s contours seem in later phrases.

The liquid accumulation within the joint manifests itself as fluctuation (balloting of the patella of the damage knee joint).The joint is spindle-shaped pale, skinny pores and skin. In uncared for instances fistulae can burst, from which liquid, pus, flakes of fibrin, merchandise of caseous disintegration of tissue, wonderful bone sequestrations discharge.

The final signs within the preliminary stage of the illness are imprecise: subfebrile temperature, weak spot, anemia. Secondary an infection joins, improvement of purulent problems is accompanied with deterioration of common situation, elevating of the temperature and ESR, sturdy pains, leukocytosis. Within the distant interval organs and programs are concerned (amyloidosis of the parenchymatous organs), miliary tuberculosis, regular deformations of joints and vertebral column can develop with shortening of the extremities, breaching of the bearing, showing of paresis and paralyses.

Analysis and differential analysis. Varied radiological exams (fluorography, X-ray, laptop tomography, ultrasonotomography), bacteriological examination of the secretions, the particular Mantoux check play an vital function whereas establishing the analysis.

Surgical tuberculosis ought to be differed from nonspecific osteomyelitis, syphilis of bones and joints, bone tumours, infectious (gonorrhoea, typhus, scarlatina, influenza), posttraumatic, rheumatic, endocrine arthritises.

Therapy. In remedy of surgical tuberculosis early analysis has nice worth.

The surgical tuberculosis is handled within the specialised antitubercular hospitals, sanatoria, clinics. Medical actions are divided into common and native.

The final remedy is directed at improve of organism resistance, its immunobiologic properties and activation of regenerative processes. Full-value feeding, contemporary air, photo voltaic radiation (heliotherapy), labour remedy, physiotherapy workouts, utility of preparations of blood, chemotherapeutic means have particular worth.

Antibacterial remedy of the surgical tuberculosis consists in prescription pf canamycin, streptomycin, para-aminosalicylic acid (PAS), phthivasid, rifadin, ethambutol, bepask, tubasid, salusid. The dosage and remedy mode are established for every particular person case. Native remedy consists in conservative and operative actions.

Conservative native remedy consists in revealing bones and joints, upkeep of relaxation as a result of immobilization by the strategy of extension, making use of the plaster bandages which they modify every 4–6 weeks with stage redressation. At tubercular spondylitis the affected person is positioned in a plaster mattress for 1–2 years, with the next utility of a plaster corset or particular plastic clamps. Within the publish arthritic interval physiotherapy is prescribed, with the presence of fistulae — laser remedy.

Puncture and opening of an abscess, joint resections, amputations, bone-joint plasty, orthopaedic operations are utilized.

Punctures are used with the diagnostic and medical goal, awaiting that the needle was entered from as much as down, and after the injection the channel closed and fistula didn’t seem.

Lancing of abscess is mixed with necroectomy and elimination of infiltrated tender tissue with the next washing a cavity by rifadin, PASA.

Bone resections are carried out after abatement of the energetic tubercular course of. Operation is accomplished by plasty of the bones and joints with the usage of allotransplantats, endoprosthesis. Amputation is indicated with full disintegration of bones and joints with the specter of sepsis improvement.

Tubercular Lymphadenitis

The tuberculosis of lymph nodes belongs to moderately usually manifestation of tubercular harm of an organism, each major and secondary. It’s brought on by pathogenetic mechanisms of the illness improvement.

With tuberculosis of bronchial lymph nodes an infection happens by the air method, mesenteric lymph nodes — via the digestive organs, cervical lymph nodes — by the lymphatic or haematogenic method, via the mucous membrane. Function of a tuberculosis of lymph nodes is plurality of their harm with conglomerates formation.

Medical image. The illness has power course with moderately passable common situation, subfebrile temperature. The illness is of a season sort — in the summertime the lymph nodes lower, within the winter — improve. With harm of the cervical lymph nodes, necrosis within the injured nodes with plural fistulae, via which white-grey pus and grains of the necrotic mass discharge, may be noticed. The anemia, accelerated ESR, leukocytosis, lymphacytosis are revealed within the blood analyses.

The differential analysis is critical to hold out with banal lymphadenitis, actinomycosis, lymphagranulomatosis, lymphasarcoma, most cancers metastasises to the lymph nodes of the neck. Particular checks for a tuberculosis, puncture biopsy play an vital function in analysis.

All commonplace methods of the tubercular course of remedy talked about above are used for the tubercular lymphadenitis remedy.

Surgical remedy is indicated with problems brought on by tubercular lymphadenitis. At compression of the important blood vessels, nerves, respiratory methods with enlarged lymph nodes exterpation of the lymph nodes conglomerate are made with utility of the particular antibacterial preparations within the pre- and postoperative interval.

ACTINOMYCOSIS

Actinomycosis is the power particular infectious illness, characterised by improvement of dense infiltrations during which particular druzen are discovered.

Aetiology and pathogenesis. The causative brokers of the illness are particular fungi Actinomyces israeli, Gr+ microorganisms from the group of Fungi imperfecti, and in addition Actinomices naestundii and Arachnia propionica. These brokers are met in stalks of cereal cultures, different crops and are extensively unfold within the nature. Whereas inhaling the mud containing in these fungi, will get to the lungs, with the saliva — to the gastrointestinal tract.

In tissues fungi type druzen within the heart of which the interwaved threads are seen, which go within the mace-shaped endings within the exterior zone. Beneath favorable situations druzen merge in uniform dense infiltration.

Medical image. Like in any infectious illness, actinomycosis has the incubatory interval, which lasts from a number of weeks to a number of months. Extra usually the infiltrations are positioned within the area of the decrease jaw, the neck, are topic for disintegration with formation of plural fistulae from which pus with an impurity of druzen discharge. The pores and skin across the fistulae turns into darkish blue, purple.

In case of damage of the lungs perifocal pneumonia, lungs abscesses, secondary bronchoectasis develop of their decrease lobes. The method can go to the wall of the thorax, the diaphragm with formation of intercostal fistulae.

Among the many organs of the abdomenal cavity the blind intestine is usually affected. The formation of induration in the precise ileac area reminds the appendicular infiltration and shortly the fistula types on the anterior stomach wall.

Differential analysis. Actinomycosis ought to be differed from tubercular lymphadenitis, malignant and benign tumours. For institution of the analysis the intracutaneous checks and serologic reactions with actinolysate are carried out. The pus is investigated for presence of druzen.

Therapy. Therapy of actinomycosis ought to be complicated and long-term. Antibiotics, iodide preparations, X-ray, transfusion of blood elements, particular actinolysate are utilized. The actinolysate is entered intracutaneously or intramuscularly in response to the strategy of G. R. Suteyev and D. I. Asnin two instances per week after the scheme beginning with 0.5 ml, rising the doze by 0.1 ml as much as 2.0 ml (20–25 injections for the course, which may be repeated in 2– 3 months. Surgical elimination of dense infiltration is made whether it is potential.

SYPHILIS

Syphilis is a venereal illness brought on by pale spirochete (treponema pallidum) of spining types, the sizes of 5–15 microns, facultative anaerobe.

An infection is transmitted principally by the sexual method. The direct method of an infection via the pores and skin damage, blood and its elements transfusion and oblique one (family) are potential.

Getting in an organism of the particular person, treponemas settle within the regional lymph nodes.

Analysis of syphilis is carried out by microscopic method and serologic technique — the Wassermann’s response.

Syphilis is characterised by staged course.

In 5–8 days after infectioning the first syphilis declares itself by formation of the onerous chancre (inflammatory response of the mucosa or the pores and skin on inoculation of spirochetes), exudation, infiltration with lymphocytes and macrophages of the injured web site, proliferation of the connective tissue, necrosis of the epithelium, regional lymph nodes enlargement. Onerous chancre, or the first syphilis, spontaneously disappears in 2 weeks and not using a hint. Lymphadenitis disappears in a month.

The second interval of the illness (secondary syphilis) is available in 1.5–2 months. The secondary syphilis is the manifectation by common harm of an organism and declares itself by weak spot, fever, headache, common lymphadenopathy, pains in the entire physique, enlargement of tonsils, native syphilides — rashes on the pores and skin, mucous membrane of the mouth, vagina, conjunctiva. The vast condylomas and indurative keratosis type across the genital organs and anus on account of power irritation by discharge.

The tertiary syphilis is consequence of secondary syphilis and develops in 3–4 years after it, generally — later. The morphological substratum of the tertiary syphilis is formation of gumma, within the inner organs. Gumma is the proliferative-necrotic type of the restricted irritation as granuloma, brought on by spirochaetemia. Syphilitic gummas are topic to disintegration. The necrosis of superficial gummas causes formation of deep ulcers, which can penetrate into the thickness of sentimental tissues and bones with hazard of improvement of secondary an infection, formation of deep necrosises, which after therapeutic go away tough cicatrices, which deform the pores and skin floor. The flat and tubular bones are broken inflicting periostitis, osteitis, osteomyelitis within the tertiary interval of syphilis.

The syphilitic periostitis is accompanied by vital osteoblastic periostic response of domestically restricted sort with formation of painful nodes within the periosteum and deformation of the bones. The osteitis is accompanied by targeted destruction of the bones with formation of small sequestered and vital periosteal response.

The syphilitic osteomyelitis is characterised by targeted necrosis, sequestration of bones, acute osteoblastic periostic response with its ossification and calcification, obliteration of the bone medullary cannel, and the bone (for instance the shin bones) appears like a deformed formation. It’s enaburation of the bones.

Clinically tertiary syphilis of bones manifests itself by night time pains within the bones, insignificant infringement of operate of extremities, lack of sensitivity.

The differential analysis ought to be made with bone tuberculosis, power osteomyelitis, malignant osteosarcomas.Therapy of syphilis is restricted: antibiotics, particularly preparations of penicillin. Damaging adjustments in bones are handled by the surgical method with utility of varied plastic orthopaedic operations.