V. Table of contents of teaching

Presently tuberculosis (tuberculosis) again began to meet enough often. In surgical tuberculosis select: bone-joint tuberculosis, tuberculosis of lymphatic knots, seroznih cavities, cishcivnica, sechostatevih organs, and also some forms of pulmonary tuberculosis.

All of them, as a rule, surgical medical treatment is required.

A tubercular stick (mycobacterium tuberculosis)which was opened R. Cohom in 1882р is the exciter of tuberculosis.

Inficouvannya of man takes place by a povitryano–craplinnim or digestive way. In some case, possible penetration of tubercular stick at the damage of skin and mucus shells because through an inficovanou placenta.

Getting in fabrics a tubercular stick causes the inflammatory reaction. A tubercular hump develops (tuberculum). He consists of giant cages the Pie – Langhantsa, tubercular micobacteriy and epithelium cages, surrounded by limfotsitami. In subsequent cazeozniy necrosis comes in his center. Confluence of such knots forms a tubercular hearth. In the case of high rezistentnosti of organism it is possible his liming and encapsulation. At unfavorable terms (gipo-, avitaminosis or imounodefitsitni positions and in.) a tubercular process can become sharp, and a tubercular stick from a hearth in future spreads to contact, by limfogenim or gematogenim ways.

The origin of specific osteomielitou, that will be localized at metafizah and epifizah tubular cistoc is the feature of bone tuberculosis, where and cazeozniy disintegration develops. Cavities with the soft rounded sequestra, that remind the “pieces of sugar” appear in cistcah. Tuberculosis can strike vertebrae. Then their goubchata matter is added to rapid necrotizouvannyo and cazeoznomou disintegration, that results in forming of cold natichnogo abscess. It is saccate granouloma with inflammation of pouhcoi connecting fabric and its spaces. The blasted part of body of vertebra nasidae on a nigchelegachiy vertebra, and results in development of clinopodibnoi deformation of spine. A hump will appear (gibbus).

A cold abscess can penetrate on considerable distance from a primary hearth. Way of his passing from lumbar and півздошно-lumbar muscles downward to the inguinal region, and sometimes even with an output on the front surface of thigh. Above a cold abscess flyoctouatsiya is determined. However, a skin above him has an ordinary color, a local temperature is normal. At pounctsii there is a vidsmoctouetsya pus, and bacteriological research exposes tubercular sticks in him.

Primary ostit (preartrichna form) and second arthritis is selected (artritichna form). For last characteristically penetration of process in a joint cavity.

Joint tuberculosis begins, how primary ostit is. However, here, the goubchatiy layer of bone, which adjoins to the joint, is damaged.

Select sinovialnou, foungoznou and bone the forms of joint tuberculosis. For a sinovialnoi form there is characteristic ecsoudatsiya from the sinovialnih shells of joint. Ecsoudat can be added to complete rozcasouvannyo or takes place the deposit of fibrin(«rice corns»). It results in limitation of motions in a joint.

When the processes of productive inflammation prevail, there is a foungozna form. At her granulation fabric fills all cavity of joint and surrounding fabrics. The cavity of joint narrows, the so called turns out costoida (caris sicca).

The bone form of joint tuberculosis is characterized by the picture of primary ostitou on a background reactive inflammation of joint. It results in a contractouri joint and appearance of norits, and also pathological dislocations.

Clinic.Bone–joint tuberculosis is characterized by the gradual beginning. Local symptoms (pain, limitation of functions, deformation of the staggered extremity, violation of carriage, atrophy of muscles) turns out after great while.

Irritation of the nervous ending by toxins or squeezing by their inflammatory infiltratom causes a sickly syndrome, that carries permanent or peremegovaniy character, that loading on a body or staggered extremity increases at the rise.

Reflex limitation of function of extremity is determined in the initial stage of disease. A patient saves the staggered extremity, trying to add her the position at which diminishes pain.

The forced positions of extremities are led to the firm joints contractour.

The protracted limitation of functions results in violation of nervous trofici, the result of which the origin of m'yazevoi atrophy is, sclerosis of skin and hypodermic fabrics. The fold of skin with a hypodermic cellulose on sick extremity always is more thick, than on healthy (symptom Alecsandrova). The bulge of skin fold is on all length of extremity, out of dependence on that, where a pathological process is disposed. The changes of joint contours appear and in more late term the deformation of the staggered extremity.

General simptomatica in the initial stage of disease is expressed poorly. At patients there is only a soubfebrilna temperature, a weakness and anaemia grows slowly. Worsening of the common state comes at joining of festering complications or second infection. Thus a temperature rises sharply, great pains appear, there is high leycotsitoz and rises SHOE.

In late, the postartritichniy stages of bone-joint tuberculosis are marked deformation of joints, spine and extremities, possible pathological breaks and dislocations. At tubercular spondiliti a process can pass to the spinal cord, that can result in paresis or to the paralysis.

At raising of diagnosis an important role is spared to roentgenologic research. Are executed tomogrami cistoc and aiming radiographs.

Lethality hesitates from 1% to 3% and is mainly related to the origin of sepsis and development of miliarnogo tuberculosis.

From bone–joint tuberculosis it is needed to distinguish subsharp and primary chronic unspecific osteomieliti (for the last characteristic periostalni stratifications which are not at tuberculosis), Syphilis of cistoc of joint, bone tumour, infectious arthritiss (gonorrhoeal, typhus, scarlatina, postgripozni, posttravmatichni, rheumatic, endocrine arthritiss, and also changes at siringomielii and osteohondropatiyah).

Medical treatment.Medical measures divide into general and local. Patients with bone-joint tuberculosis treat oneself in the specialized protitoubercouloznih hospitals, sanatoriums and dispensaries.

Purpose of common medical treatment – to promote opirnist of organism and activate regenerativni processes. In the complex of measures enter: valuable feed, aero-, climato– and heliotherapy, troudoterapiya, medical physical education, gemo- and chemotherapy. Climatoterapiya desired in a south seashore area (Caucasus).

For conducting of antibacterialnoi therapy canamitsin, paraaminosalitsilovou acid (PASC)is used, ftivazit, rifadin and etamboutol. Canamitsin is appointed in doses 1-2 gr. in a day(to the children 0,5-1г) during a few months and usually in combination with Pass (6-10 g) or with ftivazitom, toubazidom, galouzidom, etamboutolom or rifadinom.

Local therapy is related to the conservative and operative measures.

Conservative measures allow to disburden cistci and joints. It is achieved by extraction (leycoplastirne and cuff), gipseous bandages and small beds. Gipseous bandages change every 4–6 weeks, simultaneously doing staging redresatsiyo. Children with the tubercular defeat of spine are placed in a gipseous small bed, that with growth of child renew, and in the following a gipseous corset or special plastic fixednesses is applied.

From surgical methods pounctsii and opening of abscess, joint resections, amputations, кісно–joint plates is applied, imobilizouyochi and orthopaedic operations, that correct.

In a postartritichnomou period local physical therapy procedures are used. At presence of svishiv gelio is recommended – neon laser therapy with influencing by red monochromatic light(laser LG – 75, power 25 mv, duration of session – 10 – 15 minutes).

Tuberculosis of bronchial is distinguished, mezenterialnih and neck limfovouzliv.

Tubercular limfadenit has the chronic flow. More frequent all the common state of patient is satisfactory. Temperature of soubfebrilna. The disease carries a seasonal character (limfovouzli diminish in summer, in a winter are increased).

To differentiate the disease follows from actinomicozou and diseases of blood (limfogranoulomatoz, limfosarcomi).

At medical treatment use conservative methods – heliotherapy, ultraviolet and x-ray photography irradiation, small doses of gelioneonovoi laser therapy.

At are constrained blood vessels and nerves of neck or respiratory tracts by megascopic limfovouzlami it is needed to do to the ecstirpatsiyo conglomerate of limfovouzliv.

Actinomicoz (astinomycosis)– chronic specific infectious disease, which dense infiltrat in which the specific drouzi turn out is formed at.

Etiology and pathogeny. The special mushrooms of astinomyces iszaeli are the exciter of disease, grampozitivni microorganisms from the group of mushrooms of fungi imperfecti, and also astinomyces naestundii and azeshnia pzopionica. These mushrooms are wide-spread in nature and met on the stems of yachmenya, rye and other plants. At inhalation of saws, that contains these mushrooms, osidae in lights. Mushrooms can get in an organism at mastication of stems of cereals.

In fabrics the mushrooms form granular educations(drouzi). In the center of drouz there are filaments, that interlace between itself, and in an external area pass to characteristic, look like with boulavochcoyo, ending. In the case of damage slizouvati mushrooms can strike root in fabrics which infiltrati of woody closeness develops at.

Clinic.The latent period of actinomicozou proceeds a few weeks. Infiltrati has a different localization, more frequent (about 50%) all it is a lower jaw and neck. Afterwards infiltrati are added to disintegration and developed plural svishi, which festering ecsoudat in which turn out drouzi mushroom in the type of yellow granules is selected through. Skin round has darkly – dark blue or crimson colors.

At the defeat of lights perefocalna pneumonia, abscesses of lights and second bronhectazi, develops in their lower parts. A process can pass to the wall of thorax, diaphragm with formation of migrebernih svishiv.

From the organs of abdominal region more frequent a blind gut is struck. There is the compression, that reminds apendicoulyarniy infiltrat, that is afterwards opened by svishem on a front abdominal wall.

Actinomicoz needs to be distinguished from tubercular limfadenitou, malignant and of high quality tumours. For establishment of diagnosis vnoutrishnocognыe tests and serologichni reactions are conducted with actinolizatom, and also explore a pus in the presence of drouz.

Medical treatment of actinomicozou requires complex approach. Antibiotics, preparations iodines, are applied, rentgenoprominyovannya, transfusions of components of blood, and also specific actinolizati. At uneffective of conservative therapy dense infiltrat is deleted, sometimes drenouyot hearths of accumulation of pus.

Syphilis(lues)is the chronic disease, that arises up usually as a result of contact infection(rarely – transfouziyno). Exciter of Syphilis – pale treponema (treponema pallidum), that penetrates through the shallow defects of skin or slizouvatih shells and causes the complex of local and general reactions.

Primary syphilitic affect – hard shancer (ullus durum) – is localized more frequent all on external privy parts.

Cistci and joints are usually struck by second Syphilis or in the late period of disease (quarter-litre Syphilis).

Clinic.In the second period of Syphilis there can be sickly bone stratifications – so called lyoetichniy (syphilitic) periostitis. More frequent all the periostitis develops in cistcah of skull, large bertsoviy cistci and in ribs. For him there are characteristic nightly pains. Similar changes are observed also in the case of innate Syphilis.

In a quarter-litre period the rubbers appear in cistcah (gummae). Thus a process takes not only periosteum but also bone (ostitis) and marrow (osteomyelitis). At formation of rubber simultaneously there are two processes – destruction of bone and its education. Rubbers are observed in ribs, in a breastbone, in cistcah of forearm or shin. Shallow cistci (bone of nose, soft noba) are added to complete destruction. There are the ulcers surrounded to the dense skinning valicom. At cicatrization of ulcers there are large star-shaped flyaci, are interlinked with a cyst.

Establishment of diagnosis is very laboured sometimes. Important part herein is acted by siro- and licvorologichna diagnostics(classic reactions Vasermana and Cana, their modification), and also positive results at application of specific protivosifilitichnogo medical treatment. The disease needs to be distinguished from bone tuberculosis, chronic osteomielitou and malignant tumour (sarcomas).

Medical treatment.Medical treatment of Syphilis, in t.ch. cistoc and joints, specific. Only in the case of stratification of the second infection it is necessary surgical interference.